The URAC Report

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.

Washington, DC -- Independent accreditor URAC today published its latest industry insight report addressing the present and future of the telehealth industry. The report, Disrupting Healthcare: Risks and Rewards of Telehealth, examines the major factors driving the growth of telehealth in the U.S. healthcare sector, including financial incentives, changing medical philosophies and a growing need to serve patient populations who lack access to care.

It is no secret that the Department of Veterans Affairs (VA) has faced tremendous challenges providing our nation’s veterans with access to the timely, quality care they deserve.

Washington, DC, – URAC’s Vice President for Quality, Research, and Measurement, Marybeth Farquhar, PhD, MSN, RN, has been selected to represent URAC on the National Quality Partners (NQP) Leadership Consortium in 2017.

Just like the critical handoff of the baton in a relay race, a smooth transition of care from one healthcare provider or setting to the next is key to reaching the finish line of positive health outcomes, lower hospital readmissions and fewer medication errors. In the move toward value-based reimbursement, best practices in transitions of care have never been more important. 

“It’s not just looking at the medical aspects of what the patient is dealing with, but those non-clinical issues that so many times impact a transition and can cause avoidable hospital readmissions,” said Cheri Lattimer, executive director of the National Transitions of Care Coalition. “In good care coordination, the team understands their role is not done when the patient walks out their door. The team must put forth the effort to communicate, share and transfer information and make sure the patient and family caregiver are included.”

Patient experience plays a big and increasing role in measures of quality, accounting for eight of CMS’s 34 quality care measures for ACOs, for instance. That’s why many providers and health plans are taking steps to make sure their call centers enhance patients’ satisfaction rather than leave them hanging up in frustration. 

“It’s just like with any customer service line, if we have to wait on hold forever, it leaves a bad taste in your mouth,” said Bonnie Zickgraf, integrated services manager for URAC. “Plus, with social media, the bad experiences are 10 times more magnified than the positive ones.”