American Hospital Association’s Post

What benefits does a full-risk capitation model provide for physician practices?    ✅ More control over patient care  ✅ Reduction of unnecessary spending  ✅ Reduction of unnecessary care  ✅ Increased administration efficiency   Learn more about how fee-for-service and full-risk capitation models differ and why full-risk capitation is growing in use: 

CMS has released a final rule making important reforms to Prior Authorization in order to cut patient care delays and electronically streamline the process of PA for physicians, according to @KevinBO'Reilly. According to HHS, these changes will save physician practices an estimated $15B over ten years, and at the same time likely reduce unnecessary hospitalizations, life threatening events, and disability or permanent bodily damage as has been reported by over 1K physicians resulting from prior authorization delays in a survey by #ourAMA #FightingforDocs and making important progress in the #RecoveryplanforAmericasphysicians.

The most recent survey. On Feb. 10, 2022, the AMA released updated survey results on the impact of prior authorization on patients and physicians. Per the findings: 93% of physicians report care delays 82% percent of physicians report that prior authorization can sometimes lead to a patient abandoning treatment 34% of respondents report that prior authorization has led to a serious adverse event for their patient, including hospitalization, life-threatening event, or disability Practices complete 41 prior authorizations per physician per week Physicians and key staff spend almost two business days each week completing prior authorization 40% of physicians have staff who work exclusively on prior authorization

Life After Change Cyber-attack: Without Payment for Claims, Physicians Struggle to Keep Practices Afloat According to the survey, which was conducted from March 26 to April 3, restricted functionality since the cyber-attack has resulted in: 36 percent of respondents reporting suspension in claim payment; 32 percent being unable to submit claims; and 22 percent being unable to verify eligibility for benefits. https://lnkd.in/eX-tYQSv

Payers are making rules that make it more costly and difficult for therapy providers to remain in a fee-for-service model. Our new article shows private practice clinics can start to prepare for a change to value-based care. https://bit.ly/3Q1twW4

Attn: WA physicians and practices: New federal rules improving prior authorization, supported by the WSMA, are here. Learn how you and your practice can benefit at a free webinar being held by CMS this Friday, 1/19 at 10 a.m. PST on the rule: https://bit.ly/3SlN74B #priorauthorization

Interesting news on the #MedicareAdvantage #MA front today. Higher than expected utilization of hospital visits, outpatient clinics, and pharmacies is eroding profit margins and leading the company to leave some counties, reassess product mix offerings, and increase #MA plan premiums. This news comes at a time when policy changes including the #inflationreductionact #Medicare #partD redesign is introducing additional volatility, leading to predicted premium hikes and fewer plan choices for Part D plans in 2025, and to calls for the Centers for Medicare & Medicaid Services to step in and help derisk and stabilize the market. Today's news certainly leads some credence to claims that predictions and plan designs are difficult across Part D and Medicare Advantage right now in the post-COVID world, and will likely not get easier in the foreseeable future. This may be bad news for #raredisease patients who are often disproportionately impacted by #steptherapy, other #utilizationmanagenent #um and high out-of-pocket cost in form of copays and coinsurance given most #orphan therapies are placed on the specialty tier of the formulary.

Insurer Micromanagement and prior authorization rationing of #medicareadvantage access, diagnostics and treatments increased patients morbidity and mortality (sickness and death) https://lnkd.in/dDhzmTNA #tripleaim #medicare #publicprivatepartnership

The A4H biweekly newsletter recaps the latest health care news on Capitol Hill. Ahead of Congress’ holiday recess beginning December 18, the House E&C Committee advanced the Physician Fee Schedule Update and Improvements Act which included a one-year extension of the advanced APM bonus at 2.5%.   The proposed extension also includes a step down of the bonus determined by the number of years a clinician has participated in advanced APMs. Maintaining the current 3.5% APM bonus or reinstating the original 5% incentive for all advanced APM participants in 2024 is critical to maintain momentum for #accountablecare.   We expect that lawmakers may consider the APM bonus extension along with other health care policies in mid-January 2024, linked to government funding legislation. For more information, and to receive updates directly, subscribe here: https://conta.cc/41dbDrs

With JUDI®, our cloud-native enterprise health platform, pharmacy claims processing has been modernized and streamlined. Whether it's a commercial, #Medicare, or #Medicaid plan, centralizing pharmacy benefit workflows in one platform saves time, allowing for greater focus on member care. Step into the future today. https://okt.to/UjfDPl #MedicareProcessing #JUDI #StreamlinedProcess #Innovation #HealthcareTechnology #Efficiency #FutureOfHealthcare #HealthcareInnovation