Healthcare

Qualified Health Plan
QHP Certification Guidelines for Payers

The Patient Protection and Affordable Care Act (PPACA) and applicable regulations assert that health plans, including SADPs, must meet a number of standards in order to be certified as a…

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Qualified-Health-Plan-tender
An Introduction to Qualified Health Plan

The Affordable Care Act (ACA), defines QHP as an insurance plan certified by the Health Insurance Marketplace which provides Essential Health Benefits (EHBs), follows established limits on cost-sharing, and meets other requirements…

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PHM Technology
How Technology can enable PHM?

Healthcare organizations need to have technological capabilities within their care delivery processes to effectively use data to manage the cost and quality of care. To pursue more aggressive risk-based reimbursement…

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Benefits of PHM / Value-Based Healthcare Delivery

Population Health Management is the systematic process of patient data gathering, analyzing and managing patient’s data in the health care system. The changes in the healthcare industry are impacting traditional…

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BlueButton Download Data
BlueButton 2.0 Use Cases in Healthcare Ecosystem

Blue Button 2.0 is creating a data-centric ecosystem for Medicare beneficiaries. By facilitating access to patient health history, it has the potential to drive down Medicare spending and improve health outcomes.

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Home Health
Impacts of HHGM on Home Health Software

With the finalization of the Home Health Grouping Model, the CMS intends to shift from paying for volume to paying for value by eliminating therapy visits as a factor in payment determinations. The HHGM is expected to meet or exceed industry quality standards in healthcare by incentivizing home health providers. It also has the capability to remarkably influence the operations of home health agencies and healthcare industry as a whole.

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Home Health Grouping Model
Home Health Grouping Model

The current case-mix adjusted payments under the Home Health Prospective Payment System (HH PPS) are therapy driven, and beneficiaries with low-income, living in under-served areas have a high severity of…

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