The Burden of Prior Authorizations
Prior authorizations are one of the myriad of examples of inefficiency, bureaucracy and red-tape that bogs down our healthcare system. Unfortunately, prior authorizations are not going away. This...
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What is a referral?
In healthcare, a referral is commonly defined as the act of directing a patient to a medical specialist. However, that definition is too simplistic. A better and more comprehensive definition is the...
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The Data Show Providers Lack The Necessary Information When Making Referrals
Our recent blog post discussed how the vast majority of consumers rely on their doctor for advice and guidance on care decisions. We concluded the post by saying, “the bottom line is that to save...
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Healthcare Decision Making Continues To Sit With The Provider, Not The Consumer
Austin Frakt recently published a fantastic article in the New York Times titled, “Shopping for Health Care Simply Doesn’t Work. So What Might?” In short, the article notes that consumers rely almost...
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The Success of the NY State DSRIP Program
In April 2014, New York Governor Andrew Cuomo announced that New York would be implementing a series of Medicaid reforms through a Delivery System Reform Incentive Payment (DSRIP) program. The DSRIP...
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The Implications of the Stark Law As We Shift to Value-Based Care
The Stark Law was enacted in 1989 to prevent physician self-referral. Self-referral is when a physician refers a patient to a hospital, lab or other entity to which he/she has a financial benefit....
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Referral Management in a Nutshell
Q: What is referral management? A: Referral management is the process of a primary care provider (PCP) referring a patient to a specialty care provider (specialist). There are two routes that a...
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Ride Sharing Has Just Entered Healthcare
Uber recently launched its newest service line called Uber Health. Uber Health is designed to arrange and facilitate rides for patients that do not have access to reliable transportation. The service...
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Surviving CMS “Crackdowns” on Medicare Advantage Plans
A Modern Healthcare article today highlights the importance for MA plans to do a better job of managing their provider networks in terms of maintaining accurate directory information and ensuring...
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Can We Talk?
The last decade has seen the rapid adoption of the electronic medical record (EMR). While a few major EMR software companies have become familiar names, the overall market is very fragmented, with a...
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