Friday May 06, 2016

Exploring the Implementation of Prospective Bundling in Health Insurance

Prospective Bundling has gained much attention lately among health plans, mainly due to the Centers for Medicare & Medicaid Services (CMS) Comprehensive Care for Joint Replacement initiative. In an effort to reduce costs for joint replacement and improve care, CMS is paying for a majority of these now as bundled cases. This means all providers who treat a patient have to share one bundled payment for that procedure. This includes any foreseeable complications and readmissions.

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Wednesday Jan 20, 2016

Continue the Transformation and Modernization Conversation during Oracle Industry Connect 2016

The impact of digital disruption is being felt across the insurance industry. For many insurers the answer lies in a progressive transformation for both the customer engagement process and the underlying systems with customer-centric processes and industrial-strength core components.

At last year’s Oracle Industry Connect, Kimberly Harris-Ferrante, Vice President and Distinguished Analyst at Gartner Research, led a panel discussion on the trends, challenges and opportunities facing insurers today. She was joined by Francine Hampleman from La Capitale and Deborah Norton from Harvard Pilgrim Health Care, who shared their recent transformation experiences.

At Oracle Industry Connect 2016, we will continue the conversation on process modernization as it affects life, annuity, P&C, and health insurers. You will not want to miss an opportunity to network with your industry peers and participate in discussions about the impact that digital disruption is having in the Insurance industry. The program will include sessions and panel discussions where industry experts and Oracle customers will review technology requirements to support product innovation and discuss how newer technologies such as Data as a Service (DaaS) can drive significant value for insurers in the future.

We look forward to seeing you in Orlando, FL.

Don’t forget to keep up with Oracle Insurance year-round:

Wednesday Jan 06, 2016

Webcast: Navigating the Continuum of Health Care Reform: The Role of Bundled Payments

The emergence of value-based contracting models represents an evolution in clinical and payment methodologies aimed at creating better quality and cost outcomes, greater provider accountability, and improving cost efficiency. As the Centers for Medicare & Medicaid Services (CMS) rolls out Bundled Payment pilots – for the reimbursement of healthcare providers on the basis of expected costs for clinically-defined episodes of care – health insurers are wrestling with the reality of making these arrangements work in their current environments.

In this webinar, we will examine the advantages and disadvantages of the Bundled Payments reimbursement model as well as the consideration for entering into these contracts with your providers. The discussion will also touch on how current systems have limitations on whether these programs are administered prospectively or retrospectively.

Attendees will also learn how modern component-based technology solutions, specifically designed for emerging value based payment models, can help healthcare payers make this process easier and more efficient. We’ll explore how you can move from spreadsheets to automation in this informative seminar.

For more information on Oracle Health Insurance Components, please visit oracle.com/insurance.

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Tuesday Jun 23, 2015

Watch Now: The Changing World of Value Based Payments

The emergence of value-based contracting models represents an evolution in clinical and payment methodologies aimed at creating better quality outcomes, greater provider accountability, and improving cost efficiency.

As a quick introduction to the topic, we’ve created a short video that examines the background and emerging payment models.

In a recent Webcast with FierceHealthPayer, Richard Lieberman, Chief Data Scientist at Mile High Healthcare Analytics and Oracle’s Kathy McCarthy, Director of Sales Consulting, discuss the shift from fee-for-service to value-based payments. Some of the topics discussed are:

  • How the transitions to value-based payments are being accomplished
  • Where are the success stories
  • How the new models of capitation are different from capitation of old
  • Integrating accountability into value-based payment models

Richard and Kathy examine the technology needed to accomplish these payments, what types of systems/models are suited to this new paradigm and how this technology can be delivered to your organization. They also discuss where and how cloud technology can fit into your transition.

For more information on Oracle’s solutions for healthcare payers, visit oracle.com/insurance.

Don’t forget to keep up with us year-round:

Tuesday Jul 29, 2014

What Providers Should Consider Before Jumping into the Payer Market

The evolution of ACOs in the market has led to an increase in provider based payer organizations, the addition of some 400 this year require a new level of data sharing and analytics. The ability to analyze impacts of changing payment models and care guidelines on healthcare delivery and payment will define the stability and growth of the integrated organization.

Kathy McCarthy, Director of Sales Consulting for Oracle Health Insurance, discusses the topic in today’s post:

With the ACO model, healthcare organizations will continue to acquire groups and services within a specific demography.  Using integrated analytics to predict the impacts when entering new markets where different services and payment models overlap will be a key for accelerated expansion.

Providers need to consider several criteria before entering the payer market. The provider organizations needs to:

  • Understand the complexity of the market
  • Have clear goals
  • Conduct the necessary research
  • Evaluate delivery systems

Research has shown that there is no correlation between success and market share, location or deep pockets.

Providers need to:

  • Have positive relationships with other health systems in your area.
  • Have existing risk-based contracts with your providers.
  • Look at your market.
  • Have a relationship with a  payer organization

Providers will require systems that can:

  • Respond to rapid changes in policy
  • Merge clinical and financial data
  • Provide quality cost-efficient care
  • Support HIPAA PHI requirements
  • Create new sustainable payment and delivery models

Operational efficiency will be a key to success. Payers will need to have IT and analytics that will play an important role .Being able to merge clinical and financial data will be crucial to success. They need to improve the overall IT efficiency and gain more predictable costs and outcomes.

IT needs providers should consider:

  • Be prepared to implement changes required to improve performance.
  • Need for analytic capabilities.
  • Need for alternate payment arrangements.
  • Need to quickly introduce new plans, support efforts to reduce operating costs and take advantage of the emerging opportunities.
  • Many legacy systems are decades old and require costly and time-consuming hard coding to make even simple changes.
  • Seek and require rules-based systems.
  • Seek new payment models.
  • Provide quality care for a reasonable cost.

Oracle Health Insurance components help address these issues by providing:

  • Rules-based componentized products allow plans the agility and flexibility needed for success.
  • SOA-based components allow plans to purchase solutions that do not require an entire new system.
  • Scalability and reliability are built into all Oracle products.
  • Solutions can be delivered in multiple ways.

Learn more by watching the recent webcast, How to Navigate the Emerging Trend of Providers Shifting Focus to Healthcare Financing.

Don’t forget to keep up with us year-round:

About

Oracle’s solutions provide the modern, rules-driven flexibility insurers need to support Digital Insurance transformation, simplify their IT environments, and innovate to keep pace with changing demands.

For more information, visit oracle.com/insurance.

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