Sandiola, LLC’s Post

As the movement towards value-based reimbursement models progresses, it continues to be unclear whether there will be methodological consistency between providers and payers across the myriad patient outcome improvement programs being advanced. @AaronWells shares some insights from his vast experience in this arena. https://bit.ly/3Lio2nS Catch the follow-up to this article in Monday's post. #valuebasedcare

More frequent pushback from commercial and Medicare Advantage payers is complicating patient self-pay collections and, ultimately, undermining the revenues and cash reserves of hospitals, health systems and physician groups, according to a pair of recent reports. #revenuecycle

Navigating value-based care (VBC) requires #healthcare organizations to address reimbursement models, clinical workflows, and #data analytics. From bundling payments to adapting to managed #Medicaid, the journey towards VBC is complex but promising. Key practices include: -Developing programmatic #ClinicalModels -Highlighting unique service offerings -Adapting #workflows and measuring outcomes -Prioritizing robust analytic strategies Innovative reimbursement initiatives are emerging, catering to specialized providers like healthcare at home and #BehavioralHealth services. Simplifying management and reporting efforts can encourage widespread adoption of VBC, driving improved patient care and financial sustainability. "The Road to the Value-Based Care Promised Land" By Paul Barnes Janie Tremlett Kim Williams CWH Advisors 📰 Read the article: https://lnkd.in/eyJ3xex8

A new survey found that payers and payviders have found their value-based care programs to be somewhat successful in controlling costs. Learn more from the survey: https://hubs.ly/Q023R7f80

Patients and Providers Beware- CEO UHC:"...we are committed to the kind of earnings growth rate over the next 12 months that you would expect from us even if there hadn't been a [MA] rate notice cut," Per Beckers Payer Issues - "Medicare Advantage changes 'incredibly positive,' UnitedHealth CEO says": At UnitedHealth Group's investor day conference, CEO Andrew Witty said the risk adjustment rates are "essentially a price cut for Medicare Advantage." The effects of the cut ripple through UnitedHealth Group's metrics, Mr. Witty said.   "You see that pattern flow through the business, and yet here we are today, standing up and saying despite that change, despite that impact, we are committed to the kind of earnings growth rate over the next 12 months that you would expect from us even if there hadn't been a rate notice cut," Mr. Witty told investors. The rate changes were a catalyst for UnitedHealth to redouble its energy around value-based care and efficiency, the CEO said.  [N8 wonders what this means for patients and providers] So it goes n8 #healthinsurance #medicareadvantage #hosptials

Check out our recently published article in Behavioral Health News. Authors Paul Barnes, Janie Tremlett, and Kim Williams highlight critical practices needed for implementing a #valuebasedcare program. #VBC #DataAnalytics #Technology #Reimbursement #ClinicalModel #Medicaid

New in today's Radar on Medicare Advantage: Large payers hint at MA benefit cuts in 2025, why risk-bearing providers should pay close attention to payers' margins, San Francisco Health Plan prepares to launch a new D-SNP, and more top stories. https://hubs.ly/Q02vX7GV0

Don't miss this Q&A with John Fryer, Chief Revenue Officer of Lumeris and President of Tribus, as he shares insights on value-based care in Healthcare IT News. John shares his thoughts on the strategies needed for a healthcare delivery system that benefits patients, providers, and payers. Read the full interview here: https://lnkd.in/gEfDdNGx. #patientcare #valuebasedcare #healthcareinnovation #healthcaredata #healthcarestrategy

Pretty crazy end to the week with UnitedHealth Group reporting earnings before the market opened yesterday🔝. Not only did they crush the Medicare STAR ratings but they absolutely crushed earnings coming in with 11 billion more in top line revenue to 92.4 billion in the quarter (14% growth). They ended up raising guidance on EPS for the full year 2023 net earnings outlook to $23.60 to $23.75 per share and adjusted net earnings to $24.85 to $25.00 per share. Really good call from UNH and I love that they point to this really strong growth being attributed to the investments they have made maturing. Both UHC and Optum experienced large growth for businesses this size but the key takeaways from the call and financials. Optum Optum Health, which is their provider network, was the star of the show with revenues growing by 29%, approaching $24 billion, driven by an increase in the number of care services. Operating margins compression.......... continuesttps://https://lnkd.in/g3ayjM2J #marketaccess #healthcare #digitalhealth

The future of Medicare Advantage is here! 💡 Dive deep into the latest insights and strategies for navigating the shifting landscape. From demographic shifts to regulatory changes, learn how payers can stay ahead. Check out the article now: https://lnkd.in/d4sWZqhP #Healthcare #Medicare #HealthcareTrends #Automation #Droidal