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How Claims Reimbursement affects Healthcare Innovation

Welcome to the latest #DataRX Report, a weekly digest of interesting news and trending topics in the healthcare industry. Every Friday we're pulling together the best articles and insights to keep payors and providers informed, engaged and up to date on the headlines that are impacting the industry.  

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When Claims Reimbursement Doesn’t Cover Healthcare Innovation
Providers often face a familiar Catch 22 around the service and payment. Many routine services don’t carry reimbursable codes, and as such, are commonly performed for free. Holding back care until they can bill, however, is not only unethical but will likely backfire as patients seek services elsewhere. There’s a similar scenario brewing between payors and providers  around reimbursement for innovations not yet covered. Find out how Nemours Children’s Health System is successfully dealing with the challenge.


Prescription for Payors

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Commercial Payers See Promise in Diabetes Prevention Program
The CDC estimates that 29.9 million people in the US have diabetes, and about 90 million adults have diagnosed or undiagnosed prediabetes. AHIP recruited seven large payers to participate in a pilot program administering the CDC’s Diabetes Prevention Program. Here’s more info on what the AHIP learned.

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Payers See Cost, Quality Gains with Value-Based Payment Models
Highmark Health Plan saved $260 million in 2017 by customizing performance payments for participating providers. Value-based payment programs can help reduce costs, while improving outcomes. See why value-based payments are expected to account for 59% of all healthcare payments by 2020.



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Value-Based Care Slashes Per Member Per Month Costs in Kansas
BlueCross BlueShield of Kansas is working hard to effectively achieve the triple aim of healthcare. Find out how their value-based care models have contributed to lower hospital admissions, reduction in emergency room visits and a decrease in hospital readmissions.


Prescription for Providers

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How Patient Loyalty Supports Value-Based Care, Patient Wellness
In the past, patients looked at their healthcare as a transactional or episodic type of thing, but now the mindset is shifting. Patients want a longer lasting, richer experience. As healthcare prices rise, patients are looking to spend their money at an organization that will partner with them in their wellness journey. Learn what hospitals are doing to build those partnerships.

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Getting Warmer on Wellness Tech
Google is working on a health and wellness coach for its next-gen smartwatches. Find out how they could be the key to taking AI in healthcare mainstream.


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10 Examples of Customer Experience Innovation In Healthcare
One example of customer experience innovation happening in healthcare is the use of virtual reality. Virtual reality allows patients to get the care they need from the comfort of their own home. Read more about the other nine here.

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