Just recently the number of categories has been increased by the centers for Medicare and Medicaid from 70 categories to the current 87 categories. This increase means that patients and their health care plans will be more accurately reimbursed for the cost of the client over the span of a year. The risk adjustment that comes along with the hierarchical condition categories is an important aspect of the overall health care system, and its accuracy can help to reduce excess costs.

When programs are funded more accurately, and patient’s information is shared correctly from doctors to health insurance companies, it helps in decreasing errors which could lead to higher costs. In order to gain this accuracy there needs to be a large amount of importance put on the proper physician coding. Coding is a vital part of the equation as if the codes are not properly recorded, the health plans will receive less reimbursement then warranted.

In the past year the number of companies focusing on producing health IT software has grown and the revenue from the industry has made strides in the past couple of years. As more and more effective and complex software is created and implemented, the health care industry will begin to see the benefits from these developments. As the world becomes more and more reliant on electronic means of data keeping, especially within the health care industry, the focus on health IT is going to continue to increase.

Health IT strategies can create a better financial environment for our health care system, but can also help create a more comprehensive care plan for patients. When the information gathered by different health care facilities is able to be shared and easily recorded it allows the chance for health care providers to give more integrated treatment plans for individuals.

The majority of health care plans have benefit plans that are determined by the treatment of patients whenever health issues arise sporadically, rather than thinking about the management of possibly needed chronic care. It has been found that those patients are rarely educated about their conditions and how to best live with them. Chronic care management focuses on care coordination between the doctors and the patients including education about their illness. The hope of this type of care is to limit the need for hospitalizations and treatment through the improved daily management of the chronic illness.

One of the large benefits that is seen through proper chronic care management is a reduction in costs. Better care and day to day living will lead to fewer hospitalizations which are one of the most expensive aspects of chronic care. Health care plans are beginning to realize the impact high quality chronic care management can make on their cost savings.

Case management is focused more on the multi-dimensional aspects of an individual’s care and creating a system that works for the patient through open communication. Much of the stress of case management is coordinating the care from one physician to the next, and is reliant on communication to succeed. In the majority of cases, a case manager will be assigned to a client or patient and is in charge of advocating for the patient as well as organizing treatments and services.

The overall focus of this type of management is to create a personalized and unique plan for the individual’s specific health issues. The planning of the care could span from a number of different doctors or other health care providers and needs to be properly coordinated to work. Case managers will see their patients through the planning and delivery of care as well as the analysis of the care and evaluation of the results of each patient.

In the current health care system, many health plans are looking towards disease management as a way to cut down on the cost of delivering care while not cutting down on the quality of care itself. There are a number of common diseases which are focused on within disease management including coronary heart disease, COPD, obesity and sleep apnea. Through the coordination of the system of doctors and care providers as well as support systems and families, the goal is to provide a rounded health care approach for individuals with chronic illnesses.

While many health plans currently implement one or many different disease management programs, the cost savings have not been that large because of these programs. Many health care organizations are starting to implement a number of population management programs as well as their disease management programs and finding more success in the areas of asthma and diabetes. As the programs continue to develop and new methodologies are created and evolved, there are hopes that these programs will be a source of cost savings as well.

It has been found that in order to really see the results that are needed, the coordination must span not only over the disease that a population is dealing with, but other health concerns as well. It has been found recently, that in comparison to disease management, population management programs are having more success financially in cutting costs and increasing revenue. Disease and population management have a number of similarities in their goals and ways of achieving them.

Both programs focus on creating a coordinated care effort with help from doctors, patients and the patient’s families and support systems. Population management is also focused on creating a network of integrated care, with doctors sharing information with each other as well as with the patients and support systems. The goals of this type of care is to continue the education and care for patients both inside and outside the doctor’s office. By educating patients and families on the best ways to treat and live with these illnesses, the patients have a higher quality of care.

The last set of accountable care organizations that were put into place were in December 2011 with 32 different organizations. In addition there are plans for more accountable care organizations to join the new 27 over the next couple of months. Since the beginning of the trial of this model many different organizations have applied to be a part of the program, and it is receiving a number of credits.

For those organizations who my not have the upfront funding in order to set up the necessary infrastructure to coordinate care, the Centers for Medicare and Medicaid are making an advance payment model an option. These organizations will be paid a certain amount upfront in order to cover the costs of reorganizing the system and allowing smaller groups to participate. In many cases, these organizations are being run primarily by the doctors and physicians that lead the practices. While this is found especially in smaller practices, even in hospital settings, doctors are taking a large leadership role when it comes to getting this coordinated care off the ground.

There are a number of different areas that health care analytics can assist with including finding ways to increase revenues, cut costs, and help get over some challenges between payers and providers of care. Many hospitals have begun using analytics in real-time as a way to increase their revenue and cut costs as well as make sure they are in compliance with government audits.

Health care analytics is a great resource as it can be created in a way that will be able to gather the information and present it in a meaningful way that can be used by management. It is through the use of care analytics software health care facilities are able to look at data in a different way that could be translated into learning how to best handle financial cut backs as well as an increase in revenue. Care analytics could impact all areas of health care delivery from hospitals to small physician practices across the country.

While there is still a large amount of information to collect about the potential of Pay for Performance systems, currently much of the information gathered is inconclusive. When put into comparison, the hospitals who participated in a Pay for Performance trial versus hospitals who did not participate, the numbers of the mortality rate during that time to not greatly differ. Many of the people backing this idea believe that there needs to be further study done on the process as well as a better accounting for the dynamics of the program. Many believe that there needs to be more effort put into discovering how the size or amount of incentives, as well as the specifics of the targets intended makes an impact on the effectiveness of a pay for performance system.

In terms of measuring the quality of the Medicare Advantage plans alone, Medicare has created five different categories for quality measurements and spread out within these categories is 36 different and specific topics and areas of measurement. When it comes to calculating the quality of the Medicare prescription drug services, commonly referred to as the Medicare Part D plan, there are four different categories and 17 different areas or topics that are measured. By using information that is collected through member surveys, the providers of the care as well as a number of other sources, Medicare analyzes information by topic in order to create an overall rating. These ratings are accessed each year in order to have a database that is updated and accurate for members to be able to make their decisions. Five star ratings are hard to come by and the majority of plans are rated between one and four stars.