The URAC Report

As the Department of Veterans Affairs (VA) prepares to award contracts for managing its Community Care Network in four regions nationwide, organizations should keep in mind the importance of delivering sustainable, local healthcare solutions.

The convenience of being able to speak to a physician via live videoconference is changing healthcare, but how do we maintain quality control and keep our personal data safe?

Announcement provides proprietary information to accelerate healthcare transformation

Washington, DC -- Independent accreditor URAC today made public its proprietary standards for the organization’s Patient Centered Medical Home (PCMH) program. The announcement, which provides a complimentary download of the PCMH Certification standards, is part of an effort to help primary care practices nationwide implement best practices for providing value-based, quality medical services.

There’s a changing philosophy in health utilization management today, away from simply thinking of it as a cost-containment approach and more toward using it as a proactive tool to achieve the oft-repeated mantra of the right care for the right patient at the right time. Data and automation are increasingly being used to make that shift possible, while also putting greater power in providers’ hands to make medical decisions.

While the new administration has brought uncertainty to what the Affordable Care Act will look like in the coming year, industry experts believe that the healthcare transformation will continue.

Four experts shared their insights into trends, opportunities and challenges for the coming year for physicians and provider networks. 

Health plans are increasingly seeking ways to cement partnerships with the providers in their networks, helping to provide tools that will allow them to survive and thrive in the move toward value-based care. At the top of that list is leveraging the enormous amount of data that payers have available and putting it to use to make it easier for providers to do business with them.

It will be just as much a year of change for the pharmacy market as it will be for physicians and provider networks. Many of the same market pressures on providers are bearing down on pharmacies as well, including the challenges of more collaborative care, squeezed margins and the transformation toward value-based care.

The arrival of a new year and new administration inevitably brings a measure of uncertainty. Within that uncertainty may lie some of the healthcare industry’s greatest challenges for 2017, but it also can yield some of its greatest opportunities. That’s the mindset of case management experts as they reflect on the coming year.