There is a growing recognition among payers and providers that social determinants of health—the social and socioeconomic factors that influence a patient’s care, such as income and access to transportation—are strongly linked to health outcomes. This recognition has been reinforced by a shift toward value-based payments, which incentivizes improved health outcomes rather than service delivery alone. Although it is evident that mitigating adverse social determinants can have a positive impact on patient outcomes and curb spending, results from a recent study reveal that Accountable Care Organizations (ACOs) face substantial challenges in integrating social services with patient care (Murray GF, et al. Health Aff (Millwood). 2020;39:199-206).
Kansas City, MO—At the 12th annual National Organization of Rheumatology Managers conference, held September 14-16, 2017, practice managers, physician managers, and other healthcare administrators gathered to network with their peers and attend educational sessions on the future of rheumatology management in the age of value-driven healthcare.
Under the new proposed framework, the Medicare Part B therapy caps would be repealed beginning January 1, 2018. The new bipartisan agreement will continue the manual medical review process and the requirement of an appropriate modifier for claims submitted above the new threshold if procedures are considered medically necessary.
In January 2017, the AMA and 16 other healthcare organizations (Table), which represent physicians, medical groups, hospitals, pharmacists, and patients, announced that they had formed a coalition to help streamline the prior authorization process for medical tests, procedures, devices, and drugs to reduce administrative waste and save time.
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