HighPoint Blog

In our first blog on data governance, we described what data governance is and the important role it plays in health care.

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One of the most stressful situations a patient can encounter is navigating through a hospital stay.  Throughout the process, the patient and family are trying to wrap their heads around the entire experience but forget the financial impact.

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Who doesn’t love Faith?

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Co-authored by Suzanne Kunze, RN, CCM, MBA and Norita Wilson, RN BSN

Population health is advancing as the health care industry shifts from fee-for-service to value-based care. As population health evolves, we are seeing the merging of care management (CM), disease management (DM) and utilization management (UM).

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Co-authored by Ann Mendlowitz, Director, Provider Solutions

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Medecision’s acquisition of AxisPoint Health brings 58 VITALS and CCMS solution clients under the Medecision umbrella. These organizations have been aware of plans to sunset CCMS and VITALS since before Medecision’s acquisition, but they now have the opportunity to make a streamlined transition to Medecision Aerial platform, in addition to the option of selecting a new vendor.

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Co-authors: Norita Wilson and Becky Jones

In our previous blog A Closer Look at Population Health/Care Management Solution Vendors , we looked at Gartner’s March 2018 “Market Guide for Healthcare Payer Care Management Workflow Applications,” and its recommendations for health plans who are evaluating care management workflow application vendors.

We will now explore how health plans should...

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Co-authors: Norita Wilson and Becky Jones

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At the simplest, Relative Value Units (RVUs) measure the value used in Medicare reimbursements for physician services.

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Co-authored by: Suzanne Kunze, Norita Wilson, and Lori Harris

In our previous blog, you learned about the strengths of both NCQA and URAC accreditation. Now we’ll look at how you can prepare for accreditation.

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Co-authored by: Suzanne Kunze, Norita Wilson, and Lori Harris

Health plans will look to two prominent and nationally recognized organizations, NCQA or URAC, when they are seeking accreditation. Accreditation provides an impartial opinion on a health plan’s quality. URAC or NCQA accredit a health plan when it has been determined its practices meet national standards.

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Quick facts:

  • Health Records section added to Apple’s Health App for iOS mobile devices
  • Several major health systems on board at launch (Penn Medicine, Cerner, and more)
  • Uses FHIR-based integration (Fast Healthcare Interoperability Resources)

Apple’s recent announcement to enter the electronic health record (EHR) marketplace is intriguing. Health IT pundits largely agree – it was a long shot...

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Co-authored by Chris McShanag, VP Healthcare Provider Solutions

Last week in Las Vegas, Nevada, senior representatives from the Trump Administration and the Centers for Medicare and Medicaid Services (CMS) spoke at the Healthcare Information and Management Systems Society (HIMSS) conference, restating the administration’s commitment to overhaul “meaningful use”, place patients in the driver...

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While almost any business would leap at the chance to increase revenue by 4 percent or avoid an equivalent revenue loss, in the healthcare provider payments landscape, such outcomes can be held in the balance by confusing new legislation. Despite increasing cost pressures and tighter private payer margins, many providers are not taking the steps necessary to prepare for a current high-impact...

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Projected trends in population growth and size published by the U.S. Census Bureau indicate the U.S population is projected to increase by 98.1 million between 2014 and 2060. Over that same time span, the population aged 65 and over is expected to grow from 15 percent to 24 percent of the total population — an increase of 9 percent.  One can surmise from the statistics alone that a huge...

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Now that the first performance period for MACRA — the U.S. Medicare Access and CHIP Reauthorization Act of 2015 — is underway, it is vital that healthcare providers identify and implement strategies to ensure value-based reimbursement (VBR) success. MACRA, which expands and reforms quality-based Medicare clinician payments, has the potential based on program incentives to either increase or...

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Special thanks to co-writer Neelabh Saxena, Associate Director Pricing, Contracting, and Market Access. 

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The dawn of a new healthcare landscape is upon us. But what exactly it may look like when the dust of the new Trump Administration settles is anyone’s guess.

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While components of the Affordable Care Act (ACA) are expected to come under significant scrutiny from the Trump Administration and Congress, the ongoing “retailization” of healthcare will accelerate regardless of the dustups over Obamacare.

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It’s been nearly a month since Donald Trump won the election to become the next President of the United States. In those four weeks, industry experts and healthcare executives have been projecting and planning on what the win means given President-Elect Trump ran on a platform to repeal PPACA and transform Medicare. The overall tenor of the election was a demand for change and eliminating the...

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For any Managed Care rebating organization, formulary confirmation can mark a massive drain on resources, or simply an overlooked area of financial leakage. There is a wide range of solutions that companies use to work through the logistics and process necessary to adjudicate formulary-based rebates. The process of formulary adjudication is without a doubt the most varied area of managed care...

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When open enrollment 2016 closed for the Health Insurance Marketplace, U.S. consumers made nearly 13 million plan selections in which they were either first-time enrollees or they adjusted their plans. Add Medicare and commercial plans to the mix and open enrollment 2017 will mean another expansion of healthcare coverage nationally, as well as a deluge of claims to process.

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The game has changed

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Organizations across industries have made significant investments in their CRM strategy, implementation and on-going maintenance.  While each industry brings its own uniqueness with how they chose to interact and engage their customers, we have seen a common theme among nearly every large-scale CRM initiative.  It is a common pitfall most organizations do not plan for; or chose to...

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The Centers for Medicare and Medicaid Services (“CMS”) and the Centers for Disease Control and Prevention (“CDC”) announced the 2017 ICD-10 coding update to be implemented October 1, 2016 and it’s a doozy. The first annual update since the partial code freeze was enacted in 2011 includes the addition of 3,651 ICD-10 hospital inpatient procedure codes and 1,900 ICD-10 diagnosis codes (a...

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Written by Jim Goldfinger, VP Client Value Networks & Strategic Alliances 

As the world of healthcare has evolved over the past few years, we are seeing a dramatic shift in focus to the patient. Patients don’t necessarily need more medication, they need more support. We need to heighten our focus on healing, not just treating. Life Sciences and Healthcare companies need a technological platform...

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