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  July 2, 2014 Follow us on FacebookFollow us on TwitterJoin us on LinkedInRSS feed

Payer-Provider Data Integration Not Without Pitfalls

Christopher Cheney, Editor for HealthLeaders Media

Combining payers' claims data with providers' clinical data is an essential element of revolutionizing the delivery of healthcare. But there will be unintended and unfavorable consequences, says one data expert. >>>


Editor's Picks

Providers Blast CMS on Two-Midnight Rule

One of the hottest healthcare controversies—the two-midnight rule—boils over in comments submitted to federal officials regarding the 2015 Inpatient Prospective Payment System rules. >>>

Infuriated by MOC Rules, Physicians Unleash on Certification Boards

Revised maintenance of certification rules are drawing howls of protest from doctors who are angry about "extortive" costs and other burdens. >>>

Medicaid Expansion Hits Resistance from States

Two dozen holdout states are still balking at expanding a federal program that would extend access to healthcare to more poor adults and ease the cost burden on providers who treat them. >>>

9 in 10 New Physician Jobs Follow Employment Model

The growing importance of population health management and value-based care as well as market share and leverage with payers is spurring much of the trend toward physician hiring. >>>

ND Blazes Medicaid Expansion Trail

Small-town, rural North Dakota's commercial bidding approach to expanding Medicaid could have big, national implications. >>>

Physicians Lead Most, Best ACOs

The transition to value-based healthcare requires strong physician leaders. Physician engagement is the most critical factor for ACO success. But financing and working across the care continuum are challenges for physician-led ACOs. >>>

6 Revenue Pressures Create Negative Outlook for NFP Hospitals

A ratings agency leader sounds the alarm for not-for-profit hospitals, saying they "have begun to lose the battle" and that a host of negative trends warrants a credit downgrade. >>>

Take Advantage of ICD-10 Delay

It's not too soon to start coordinating with referral partners, planning for the increased workload that will come with ICD-10, and making sure that provisions for dual coding are in place. >>>

LIVE Webcast

Webcast: Hospitals Developing Health Plans—Key Steps to Becoming a Provider-Payer

Date: July 16, 2014, 1:00–2:30 p.m. ET Health plan leaders from North Shore-LIJ and Sanford Health outline the strategic transition from provider to payer, and new opportunities for controlling costs, managing risk, and maximizing reimbursements. Register Today >>>

News Headlines

Inspector General reports find problems with Obamacare eligibility

The Hill, July 2, 2014

OR program allows mediation for medical errors instead of suing

The Oregonian, July 2, 2014

VA hospital claims turn-around on wait times

The Indianapolis Star, July 2, 2014

Washington and other states see new insurers on exchanges

Kaiser Health News / Capital Public Radio, July 1, 2014

UnitedHealth, an insurer switching roles, helps hospitals on Medicare billing

The New York Times, July 1, 2014

Big data helps insurer pinpoint at-risk patients

InformationWeek, July 1, 2014

Cheaper premiums in 'copper' health plans mean higher costs to pay if you get sick

The Washington Post, July 1, 2014

UT hospitals try the unthinkable: Get a grip on costs

USA Today, June 30, 2014

Without Medicaid expansion, financial future bleakens for safety net hospitals like UVa

The Daily Progress, June 30, 2014

Opinion: WA Health exchange transparency coming, access next

The Olympian, June 30, 2014

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HealthLeaders Media LIVE From Baylor Scott & White Health: Clinical Integration

Date: August 20, 2014 | 11:00–2:00PM ET Leaders from Baylor Scott & White Health discuss the key components to achieving a successful merger and driving clinical integration within an ACO. Register Today Download the Free Case Study >>>

From HealthLeaders Magazine

New Goals, New Alliances

The historically adversarial relationship between providers and payers is shifting toward cautious cooperation as both sides recognize that they must implement structural and strategic changes to ensure their mutual survival. >>>


Transitioning to Bundled Payments


Preparing and Caring for Patients with Dementia

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