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Category: Payment Reform

MBGH Among National Leaders Participating in CMS/AHIP Core Quality Measures Collaborative

The Centers for Medicare & Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP), as part of a broad Core Quality Measures Collaborative of health care system participants, released seven sets of clinical quality measures on Tuesday, February 16, 2016 ( https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Core-Measures.html ). This first set of core measures, used as basis for quality-based payments, were developed by a new... Read More
Posted by Cristie Travis at Wednesday, February 17, 2016 | 0 comments

Out-of-Network Charges Can Break the Bank

A recent report from America's Health Insurance Plans (AHIP) shows that across the US, some physicians are charging patients fees that are 10 times, and in some cases as much as 100 times, the amount Medicare pays when patients go outside their health plan's network. In Tennessee, for the selected procedures, out-of-network charges range from 7 times what Medicare pays to 33 times what Medicare pays. Hospitals have adopted a similar strategy. A study reported in the June edition of ... Read More
Posted by Cristie Travis at Friday, June 19, 2015 | 0 comments

Radical Approach to Hospital Bills: Set Your Own Price

According to Kaiser Health News, May 13, 2105:  "A small benefits consulting firm called ELAP Services is causing commotion by suggesting an alternative: Refuse to pay. When hospitals send invoices with charges that seem to bear no relationship to their costs, the Pennsylvania firm tells its clients (generally medium-sized employers) to just say no." "Instead, employers pay hospitals a much lower amount for their services — based on ELAP’s analysis of what is reasonable after analyzing... Read More
Posted by Cristie Travis at Thursday, May 14, 2015 | 0 comments

Beginning to See the Change We Want

An insightful article by Mark Hepler, CFO of Munson Healthcare, an 8-hospital system based in Traverse City, MI, on HealthLeadersMedia.com, reveals that health care providers, well, at least his, are beginning to make the changes that we want to see and that have, to a large extent, been spurred by the Affordable Health Care Act (see recent blog post on whether the ACA is working). What changes are happening in how health care is delivered? Investing in becoming clinically... Read More
Posted by Cristie Travis at Tuesday, October 28, 2014 | 0 comments

Creating a Burning Platform for Payment Change

In their December 2013 Issue Brief "A Burning Platform and Trust: Key Ingredients for Payment Reform" prepared by Bailit Health Purchsing, the Robert Wood Johnson Foundation encourages the following to advance payment reform and delivery system change: Create a momentum for change by continuing the discussion and paying attention to payment change. Once everyone believes that the old rules have changed, behavior will change. No one wants to be left behind. Emphasize that it is better to... Read More
Posted by Cristie Travis at Saturday, January 18, 2014 | 0 comments

Employers Urged To Reform Healthcare Payments at MBGH 2013 Annual Conference

Memphis Business Group on Health's 2013 Annual Conference, "Follow the Money: You Get What You Pay For" issued a call to action for Memphis-area employers to change how they pay hospitals, physicians, and other health care providers in order to improve the cost and quality of health care services and benefits in the greater Memphis area. In the morning, over 150 attendees heard from national experts why employers must be the ones to push for this change, how employers are piloting new... Read More
Posted by Cristie Travis at Tuesday, September 3, 2013 | 0 comments

National Scorecard Shows Only 11% of Payments Are Tied to Performance

Catalyst for Payment Reform (CPR),  released its first annual National Scorecard on Payment Reform.  The Scorecard shows that only about 11 percent of the health care dollars we pay to doctors and hospitals today are value-oriented -- tied to how well they deliver care or create incentives for both improving quality and reducing waste. Almost 90 percent of payments reported remain in traditional fee-for-service, paying providers for every test and procedure they... Read More
Posted by Cristie Travis at Tuesday, March 26, 2013 | 0 comments

TN Receives an "F" in Price Transparency

Tennessee is one of 29 states that received an "F" in a report released today by Health Care Incentives Improvement and Catalyst for Payment Reform. Tennessee is among the majority of states that provides information on hospital and some outpatient "charges". But we know that "charges" are only relevant to those that have no insurance since both public and private insurance plans negotiate prices and therefore do not pay charges. In fact, the negotiated price has little, if any, relationship... Read More
Posted by Cristie Travis at Monday, March 18, 2013 | 0 comments

National Commission Calls for Changes in Physician Payment Methods

On March 4, 2013, the National Commission on Physician Payment Reform  issued a report detailing a series of recommendations aimed at reining in health spending and improving quality of care by fundamentally changing the way doctors are paid. The Commission’s 12 recommendations provide a five-year blueprint for transitioning to a blended payment system that will yield better results for both public and private payers, as well as patients.Highlights from the recommendations include: 1.... Read More
Posted by Cristie Travis at Monday, March 11, 2013 | 0 comments

Most ACOs are Accountable in Name Only

In his KevinMD blog post , Brian Klepper, Ph.D. voices what many employers fear: that most Accountable Care Organizations are "accountable in name only". Klepper notes that although there is some movement toward change, few organizations are turning their operations "in a different direction". The culprit? Fee-for-service payment, which results in "business as usual" and provides no real threat to existing health care excesses. As several health system CFOs have said to Klepper "Why... Read More
Posted by Cristie Travis at Thursday, January 3, 2013 | 0 comments

South Carolina's Interesting Approach to Health Reform

Leah Binder, CEO of The Leapfrog Group, puts a spotlight on Governor Nikki Haley's (R-South Carolina) approach to health care delivery system reform and how it complements the health insurance reforms put forth through the ACA. Haley's approach hinges on developing new payment systems which are tied to health care quality and cost. Transparency will be a critical factor in making this payment change possible. Purchasers and patients need to know how physicians and hospitals compare on quality... Read More
Posted by Cristie Travis at Sunday, November 11, 2012 | 0 comments

New MBGH Member Benefit: Resolve Health Challenges with Other Employers Who Understand

Join us January 30, 2013 8:30-10:30 for our first meeting! Open to MBGH members and affiliates only. Register by email to ctravis@memphisbusinessgroup.org . You know other businesses face the same employee health and health benefit challenges as you. Instead of reinventing the wheel by yourself the next time one of these challenges arise, imagine being able to work collaboratively with these other businesses to arrive at creative solutions much more quickly. MBGH makes that... Read More
Posted by Cristie Travis at Wednesday, October 10, 2012 | 0 comments

Higher Prices Drive Cost Increases in Employer-Sponsored Insurance Plans

"Despite some increases in utilization,HCCI found spending growth was driven primary by increases in prices paid." That's the bottom line of a report just released by the Health Care Cost Institute (HCCI) which found that per capita healthcare spending for employer-sponsored health insurance plans rose by 4.6%, breaking the trend of decreasing "increases" seen over the past three years. (NOTE: this report focuses on spending as measured through claims, not on premiums) Major findings... Read More
Posted by Cristie Travis at Thursday, September 27, 2012 | 0 comments

Working to Get the CDC's Diabetes Prevention Program to Memphis!

As those of you that attended our September 6, 2012 Annual Conference know, MBGH is working through the National Business Coalition on Health and the CDC to get the CDC's National Diabetes Prevention Program to Memphis! This evidence-based, small-group setting, lifestyle coaching program is geared toward pre-diabetics, to help them not develop full-blown Type 2 diabetes. We know that generally, there are about 2.5 times as many pre-diabetics in the US as diabetics and the only way to slow... Read More
Posted by Cristie Travis at Friday, September 21, 2012 | 0 comments

Providers Offering Price Guarantees to Insurers to Stabilize Employer Health Costs

From the National Business Coalition on Health: According to  Forbes , one of the Midwest’s largest providers of medical care is bringing a price guarantee to a new concept being pushed by the Obama administration that rewards doctors and hospitals for working together to improve quality and cost. Milwaukee-based Aurora HealthCare has formed an Accountable Care Organization (ACO) that is working with Aetna Inc. and Wellpoint subsidiary Anthem Blue Cross and Blue Shield in Wisconsin... Read More
Posted by Cristie Travis at Tuesday, August 28, 2012 | 0 comments

Consumer Directed Health Plans Becoming Mainstream

MBGH attended the recent Memphis meeting presenting the results of the Annual Mercer National Survey of Employer-Sponsored Health Plans 2011. Although I had read the results when they were released in November 2011, at this meeting, I was particularly struck by the news about how employers are using Consumer Directed Health Plans (CDHPs) as shown by these survey results: 2011 saw the biggest year-over-year increase in CDHP offerings AND enrollment since 2007 for large... Read More
Posted by Cristie Travis at Thursday, March 15, 2012 | 0 comments

Organizations Team Up to Help Physicians, Patients "Choose Wisely"

In the field of medicine, the customer is not always right, but that doesn't necessarily stop physicians from ordering tests and procedures that may not be strictly medically indicated when their patients request such tests or procedures. Recognizing this problem, the American Academy of Family Practice (AAFP) has joined with 10 other organizations in the Choosing Wisely campaign, which is designed to develop a series of evidence-based lists of medical tests, procedures and... Read More
Posted by Cristie Travis at Monday, January 30, 2012 | 0 comments

Catalyst for Payment Reform Releases Model Contract for Employers

From the National Business Coalition on Health : The Catalyst for Payment Reform released a tool ( see model health plan contract language ) to unite employers and other health care purchasers around the shared goal to make 20% of health care payments based on value by 2020. This tool will help MBGH with our efforts to reform payment in the greater Memphis area. The model contract highlights immediate opportunities to reform how health plans pay doctors and hospitals. Together... Read More
Posted by Cristie Travis at Thursday, January 19, 2012 | 0 comments

Take Steps to Reduce Your Labor & Delivery Costs

Labor and delivery account for nearly 25% of all hospitalizations for many employers, and costs associated with pregnancy and its complications are a driving factor in the rising costs of health care. The growing use of medically unnecessary interventions is increasing costs and complications among mothers and babies, with no evidence of improved outcomes. The Catalyst for Payment Reform (CPR), an independent, non-profit corporation working on behalf of large employers to catalyze... Read More
Posted by Cristie Travis at Monday, December 12, 2011 | 0 comments

Public Reporting Helps Spur Improvement in Hospital Infections

Memphis Business Group on Health is proud to be the Leapfrog Regional Roll-Out for Memphis and West Tennessee and to serve as Vice Chair of the Leapfrog Board of Directors. We are excited to see that public reporting of hospital acquired infections is resulting in improved care for patients. MBGH has been working with our Memphis hospitals to report this information since 2009. Thank you to these hospitals for being willing to report and for focusing on improvement. Memphis area results can be... Read More
Posted by Cristie Travis at Wednesday, October 19, 2011 | 0 comments

NBCH Hospital Patient Safety Action Brief Details Actions for Employers

The National Business Coalition on Health's (NBCH) Action Brief on Hospital Patient Safety, lays out the issues, details how health plans across the country are or are not working to improve safety, and details actions employers can take to have an impact on patient safety for their employees. 2011 eValue8 results were used to track how health plans are or are not working to improve safety. MBGH is an active participant in the eValue8 process and this year both BlueCross BlueShield of... Read More
Posted by Cristie Travis at Thursday, September 22, 2011 | 0 comments

Delbanco believes the healthcare payment system needs “CPR”

Who better to help you beat the health reform blues than Suzanne F. Delbanco, PhD., executive director of Catalyst for Payment Reform (CPR). Delbanco is joining Peter Hayes , Principal for Healthcare Solutions and formerly with Hannaford Supermarkets, and John Moses, PhD, thought leader for behavior change and measurement with AON Hewitt, as national keynote speakers at MBGH September 8, 2011 Annual Conference, “Got the Health Reform Blues?” .   CPR is working to... Read More
Posted by Cristie Travis at Monday, May 16, 2011 | 0 comments


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