The centers of Medicare and Medicaid are reliant upon the hierarchical condition categories in order to determine reimbursement to the private health care plans allowed through the use of the Medicare Advantage plans. It is these categories that determine the amount of reimbursement based on the typical care for someone falling within a category. The [...]
Health IT is a part of the health care system that is not always emphasized, but plays a large role in being able to control and potentially lower costs. There are a number of goals that are involved in effective health information technology, all of which can lead to the decrease in health care costs [...]
It has been found that a large portion of funds within the health care system are designated for the care and treatment of a number of chronic illnesses. This is one of the reasons so much importance has been put on the care management of those patients who are suffering from chronic illnesses. It has [...]
Case management has played a large role in providing an integrated and complex care for patients in a way that will benefit their recovery and treatment. Case management is a smaller part of the larger aspect of managed care within our health care system. It can be found within population management and disease management programs [...]
Disease management has been in place within the health care system for a long time, developing out of what was once called managed care, or specialty capitation. The main focus of this type of care is to develop ways to better serve those suffering from chronic illnesses such as diabetes or asthma. The goals of [...]
Population management, along with disease management are a large factor for many trying to reign in the costs that are overwhelming our health care system. The methods of population management and the implementation of programs including this are growing and continue to develop as we search for ways to lower costs without lowering the quality [...]
Accountable care organizations are a large part of the health care reform, and the trials that have been in place to test their effectiveness have just been expanded. In late April, the Centers for Medicare and Medicaid have added to the number of physicians and providers that will be participating in a trial of the [...]
There are a number of issues with our current health care system that need to be addressed and one of the larger ones is what can be done to decrease the cost of health care. This is an issue that many organizations, both private and governmental, are trying to figure out and solve. In many [...]
It is clear that there is a needed shift in how the current health care system operates, and some believe that the change could happen through the use of a Pay for Performance model of reimbursement and payment. Currently, the most common method or payment is the payment for services. What this means is that [...]
There are a number of programs that are available for Medicare beneficiaries to improve the quality of life and the quality of health services and treatments that they receive. One of the main rating programs within the Medicare system is that of the Five Star Ratings program. This is used as a way to qualify [...]