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Value-based Payment (VBP) seeks to tie healthcare payment compensation to measurable improvements in the quality of care in an effort to achieve the Triple Aim: an improved care experience, and better health, at an affordable price. Here, DST Health Solutions’ Adele Allison discusses VBP, explaining what it is, what it means for health plans, why i…
 
CMS added the MTM CMR completion rate measure to Star Ratings for Medicare plans in 2016. Since then, plans have struggled to reach the cut point to achieve 5 stars. Further changes to the measure create new challenges, but they may also open new doors. By transitioning the MTM CMR measure from process-based to outcomes-based, CMS is setting the st…
 
A Readmission or re-hospitilization is when a patient returns to inpatient hospital care shortly after discharge, typically within 30 days of discharge. There are many reasons why readmissions are important; one of which is that they are exspensive. Preventing avoidable hospital readmissions is considered by many to be the most important opportunit…
 
Achieving value in the management of chronic HCV infection is one of the most complex challenges facing health plans today. Listen as AJ Ally, R.Ph, MBA, Vice President of Clinical Programs at DST’s Argus Health, talks about the balancing act between treating to cure and cost-effective management with a strategic focus on identifying and eliminatin…
 
MCOL, an industry leading publisher of healthcare news, interviewed DST’s risk adjustment expert Michael Nemeth about the challenges health plans face managing risk adjustment and quality performance and how integrating these two complex processes using an analytics platform can provide opportunities to impact health outcomes and optimize revenue. …
 
As value-based care gains prominence, payers are developing new models that better align cost effective, consumer-focused, and value-based strategies for paying for medical services. Listen as DST’s Argus Health President Marc Palmer shares insights for integrating value into pharmacy benefit management, ways of balancing care with costs and his vi…
 
Preventing prescription drug abuse remains a top health priority for state and federal policy makers, and one that requires a comprehensive approach. In early 2016, the Centers for Disease Control and Prevention (CDC) announced several new opioid abuse prevention and treatment initiatives and as recently as July 22, 2016 President Obama signed into…
 
Earlier this year HHS released guidance on new regulations related to the Health Insurance Marketplace. Listen as Stephanie Leftwich, Director of Health Insurance Marketplace Strategy at DST Health Solutions helps you understand these regulations in order to gain a strategic business advantage. Let us help you master these complexities of the Healt…
 
In an increasingly fragmented health care system, there is a need to understand the coordination of physicians involved in patients’ care to optimize quality of care and patient safety. Listen as Dr. Karen Kinder, Executive Director, Johns Hopkins ACG® System, explains the importance of care coordination and information sharing among physicians and…
 
What are the challenges facing healthcare in the UK? Are these similar or different to the challenges faced by the healthcare organizations in the US? Listen as Alan Thompson, (MSc), Senior Consultant and UK Team Leader at John Hopkins University, explains the tools and techniques they are using to address these healthcare challenges.…
 
We spend more than 10% of our healthcare expenditures on medications. The need for medications has gone up as life expectancy has gone up over the years. In many cases, a patient is seeing several physicians who are prescribing medications without being aware of all the medicines the patient may be taking. Listen to Marilyn explain why this makes m…
 
The Accountable Care Organization (ACO) model is about orchestrating care delivery in kinship with fellow providers for success as an organization – a community – instead of care delivery in a vacuum, only focused on an individual component piece of the delivery system. Today, there are an estimated 20.5 million lives covered by ACOs in the U.S. To…
 
Network Optimization seems to be a challenge faced by many health plans right now. For health plans to successfully compete in today’s market, they must quickly move to faster and more powerful tools fully capable of executing complex multivariate analysis based on actual operating models and that yield actionable recommendations and real-time impr…
 
The Affordable Care Act establishes quality-related requirements for Qualified Health Plan (QHP) issuers and Marketplaces including a system to rate QHP's on the basis of quality and price and an enrollee satisfaction survey system to assess enrollee experience with each QHP. To provide our listeners with the answers to their most pressing question…
 
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