With profit margins shrinking and the cost of health care going nowhere but up, operational leaders and consultants throughout the healthcare industry are looking in every nook and cranny to either find ways to cut costs or generate more revenue. With the ongoing need for costly equipment, an expert workforce and the state-of-the-art facilities needed …
It’s Working – CMS Report Concludes the Effectiveness of Risk Adjustment
Posted in Gebbs HealthcareIn late June, the Centers for Medicare & Medicaid Services released data demonstrating that its Risk Adjustment Program – developed as part of the Affordable Care Act just five years ago – is working just as planned. What was the plan? To prevent payers from developing plans intended to attract healthier patients and to incentivize …
The #1 Most Critical Driver in the Successful Adoption of Shared Risk Programs
Posted in Gebbs HealthcareThe unavoidable shift toward value-based and two-sided risk payment models is here to stay – and while the benefits are countless, the journey thus far has been slow and somewhat painful for payers, providers and healthcare organizations alike. Healthcare is one of the slowest industries to effectively adopt technology and the reasons for this are …
Strategies for Mastering Two-Sided Risk
Posted in Gebbs HealthcarePopulation health and the transition to two-sided risk is no easy feat – it’s a monumental shift in the way providers, payers and hospitals think about the delivery of health care. And, while, we all know it’s coming – knowing how to get there and doing it successfully is the real challenge. While most accountable …
Accurate RAF Scores Could Mean Billions in Savings for Medicare
Posted in GeBBS Healthcare Solutions, Medicaid, MedicareA recent study published by the Kaiser Family Foundation sheds light on a complex issue – how to determine the real or predicted cost of care for Medicare Advantage plan members when establishing RAF scores is based on the inexact science of provider documentation. The study released this spring indicated that those who were enrolled …