Employers Leaning Toward High-Performance Networks, ACOS to Improve Care Access
As we head into the future, more and more employers are going to be more proactive about the health of their employees, according to a new survey. This means that by 2020, almost 40% of employers are looking at opening a health center at their offices, hoping to increase employee productivity, health, and on-the-job satisfaction. Here at Welter Healthcare Partners, we understand that employee health is essential to your company’s productivity, and we applaud this progress. nn
Employers are increasingly focused on improving access and quality of care for their workers, according to a new survey.nnWithin the next three years, nearly half of employers plan on implementing high-performance networks (HPN), centers of excellence (COE), onsite or nearby health centers and accountable care organizations (ACO) as ways to provide quality and affordable healthcare options, according to a Willis Towers Watson (WTW) survey released Wednesday morning.nnEighty percent of respondents intend on having COEs within a health plan, a 29% jump year-over-year, and the number of employers who plan on including HPNs more than doubled to 65%.nnBy 2020, almost 40% of employers are looking at opening a health center at their offices, while more than 25% plan to offer one near their facilities.nnThese trends have gained momentum in recent years, as more than 80% of employers with an onsite or near-site health center reported that the move has “succeeded in improving employee access to convenient health care services,” “enhancing employee productivity and bringing absenteeism under control,” while also “delivering and promoting preventive health screening and services, getting ahead of medical issues through early detection and by instilling healthy habits.”nnThe survey also shows that employers are increasingly more concerned with quality of care provided than cost savings as the “most important feature” when considering an HPN.nnSandy Ageloff, managing director, west region health and benefits consulting leader, told HealthLeaders that the survey results indicate that the shifting thought process among employers is being driven by four major paint points.nnThese include the need for better care access, especially around mental health services for employees, providing high quality care, making care cost effective, and concerns about system complexity.nn”I think employers have done a lot to try to improve cost and quality, but what we’re realizing is that employees and their family members are challenged to understand all of the various pieces of the puzzle,” Ageloff said. “Employers are now embracing the need to say, ‘You need to help people navigate through what we’ve done to create beneficial, high-quality programs that provide affordable costs.'”nnComplete and original article published on healthleadersmedia.com.
Now that we are all familiar with ICD-10 it’s time that we start focusing more on specificity when it comes to diagnosis. It’s not just import for patient charts, with HCC becoming the new standard and payers tracking things like readmissions it’s becoming more important than ever for Coders to capture as much in their code selection as possible.nnICD-10 includes a classification system implemented to capture data, which previously was not tracked. Classifications such as “underdosing of drugs” can prove to be vital when readmission rates are not only tracked but also could affect a practice’s reimbursements. As coders, it’s not only important that we extrapolate this information from the documentation but also code why the drug was not taken correctly or, in some cases, not at all. Classification codes T36-T50 (utilizing a fifth or sixth character of “6”), deals with specific drug underutilization while Z codes Z91.12- Z91.19 classifies the patient’s non-compliance with medical treatment and regimen. Z codes should, when known, be accompanied by the correct underdosing code to help account for intent.nnThe Journal of AHIMA wrote about this back in 2016, however this topic will continue to become more relevant as Risk Adjustment Models are adapted by more practices and payers.nn
Colorado Gov. Jared Polis stood outside of Denver Health Medical Center almost a month ago laying out his “roadmap” to save people money on health care.nnAs the Boulder Democrat ticked off his list of plans, both short term and long term, it quickly became apparent that most of the governor’s ideas to lower health care costs in Colorado weren’t possible unless state lawmakers passed a series of bills.nnDemocrats and Republicans have come together to create the beginnings of a 
nnThis bill would require “health insurance carriers, health care providers, and health care facilities to provide patients covered by health benefit plans with information concerning the provision of services by out-of-network providers and in-network and out-of-network facilities; outlines the disclosure requirements and the claims and payment process for the provision of out-of-network services; requires the commissioner of insurance, the state board of health, and the director of the division of professions and occupations in the department of regulatory agencies to promulgate rules that specify the requirements for disclosures to customers, including the timing, the format, and the content and language in the disclosures; establishes the reimbursement amount for out-of-network providers that provider health care services to covered person at an in-network facility and for out-of-network providers or facilities that provider emergency services to covered persons; and creates a penalty for failure to comply with the payment requirements for out-of-network health care services.nnRead the rest of the