I recently met with leaders of provider organizations representing a range of specialties and geographies. One of the themes that came through loud and clear was their ongoing struggle to obtain claims data from their payers. As providers continue their efforts to navigate alternative payment models (APM), their need for global claims data becomes a more pressing issue.
Why claims data is important to providers
Many providers are still in a position …
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In the wake of medical home certification, meaningful use, the Cures Act, and the pandemic, it’s clear that virtually all health care is now built on a digital foundation. EHRs are pervasive in the delivery system and are increasingly connected to practice management software, virtual visit, mobile capabilities, health information exchanges, and population health platforms. As we consider the criticality of interoperability throughout this evolving digital ecosystem, I’m moved to …
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In health information technology circles, interoperability has become quite the buzzword. A Google search for “Interoperability in Healthcare” yielded 28 million results. Given its pervasiveness, it’s not surprising that the precise meaning of the term is often obscured. The 21st Century Cures Act defined three key components of interoperability: “(A)… the secure exchange of electronic health information with, and use of electronic health information from, other health …
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Value-based care (VBC) continues to be a popular expression across the health care landscape, but the challenges and opportunities it offers are quite different across specialties. Behavioral health (BH) providers are an important case in point. The opioid epidemic combined with increased recognition and prevalence of mental illness secondary to the pandemic has brought behavioral health to the forefront, but for BH providers, the transition to VBC continues to present …
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Value-based care has become a buzzword over the past decade with early experiments in Massachusetts, followed by creating Medicare accountable care organizations (ACOs) as part of the Affordable Care Act. As commercial insurers jumped onto this bandwagon, most providers became familiar with the concepts of gainsharing, upside and downside risk, and bundled payments.
Much of the activity in this space has focused on primary care, particularly for ACOs and ACO lookalikes. …
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In the face of genetically engineered therapies for many cancers and the incredibly rapid development of effective vaccines for COVID-19, it’s easy to lose sight of the breadth and depth of unsolved puzzles in medical science. Many of these remaining mysteries may be at least partially resolved as we overcome the mind/body dichotomy. A fascinating example of this issue has emerged with recent evidence of the excessive prevalence of Type …
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For the past year, we have been inundated with statistics about the impact of COVID-19 on our lives. Reports of daily case rates, hospitalizations, and deaths are so pervasive that they have become routine fodder for “water cooler” and dinner table conversations. Several early studies, looking at the pandemic’s secondary health implications, give us an inkling of just how broad and deep its impact has been.
Mental health
Perhaps the most visible …
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As early as April 6, 2020, the New York Times (NYT) published an article revealing early pandemic statistics that showed the death rate for people with intellectual or developmental disabilities (IDD) who received residential services in New York State (NYS) was double that for the general population. As difficult as the pandemic has been for all of us, it was clear from the beginning that some were more vulnerable than …
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Just as providers have reimagined their clinical and business models in light of the pandemic, there is an opportunity to reimagine their relationship with health plans. Particularly in the context of evolving value-based contracts, there are a variety of “asks” that are likely to find receptive health plans. Three issues that are particularly important to health plans are administrative efficiency, quality measures, and overall cost of care. Each one creates …
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Those of us in health care understand that the pandemic represents just one more example of the disproportionately negative impact of health issues on people of color. As stated in a 2017 National Institutes of Health report, “For racial and ethnic minorities in the United States, health disparities take on many forms, including higher rates of chronic disease and premature death compared to the rates among …
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In the midst of the COVID-19 pandemic, it is difficult to assimilate the global transformation that has taken place in just a few short months. As we each struggle to make sense of this life-altering event, it might help to reflect on pandemics’ history in general.
In his book, Epidemics and Society, published last year, Frank Snowden does just that. Exhibiting diligence and deep knowledge, Snowden demonstrates how pandemics have shaped history …
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As we’ve listened to providers describe their reactions to this pandemic, telehealth continues to be a pervasive theme at the foundation of their response. They refer to this as a “watershed” event that will permanently change healthcare delivery. In that context, many expressed concern that the current relaxation of regulations, and as importantly, the parity payments for telehealth services will be retracted as the crisis eases. While most agree that …
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Given that October is National Dental Hygiene Month, today we’re going to take a look back at the history of dentistry, its separation from medicine, and the importance of bringing them together.
A 2006 article in Nature magazine describes the discovery of nine people in a 7,500 to 9,000-year-old graveyard in Pakistan with eleven drilled molar crowns. It’s somewhat surprising that dentistry has …
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