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Care Management with Case and Disease Management Through Population Health Analysis. How Population was Impacted?

Defining Population Medicine and Health Analytics is akin to the proverbial story of the elephant described by the four wise but blind men. One ‘saw’ it as a huge pillar while he felt one of its legs.

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Trends in Healthcare: An Estimate and a Summary

Healthcare in the United States has slowly but surely been moving in a new direction over the last decade in a subtle but unmistakable manner. On the surface, this does not seem to be a radical shift.…

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Utilization Management: How to Reduce Costs without Denying Care?

Utilization management (UM), care management, control of spiraling costs, care coordination: these are all the words we hear regularly these days with the advent of accountable care and increased enrollment…

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SMART Office

We hear about smart cars and smartphones, smart cities, and smart manufacturing plants a lot these days. Greater use of technology is expected to alleviate many of the problems faced by these entities…

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Smart Defense in the Legal Era of Whistleblowers

Where will a whistleblower act next? Is my company at risk? These are questions that are asked by executives, lawmakers, and compliance officers the world over, every day. There are over 40 federal whistleblower-friendly…

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How Do Organizations in Healthcare Measure the Value Proposition?

How do organizations measure the value proposition? Both the numerator (Quality) and denominator (Cost) must be measured to demonstrate value. We achieve Quality through Effectiveness, Patient-Centered…

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Risk Adjustment: A Compliant, Efficient and Medicine-Based Approach

As premiums continue to be reduced, Health Plans, IPAs, MSOs, and medical groups must have plans in place that ensure an accurate RAF score. To obtain these, healthcare organizations must not only recapture…

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The First Impression: Waiting Rooms and Reception Areas

The introduction to a medical practice begins in the waiting and reception area. A patient’s perception of the practice starts there, and it’s an impression that will be perceived as who we are. We…

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Pre-billing: A Safety Net : By Carlos Arias, MD, CPC

Imagine driving on a narrow road between two mountains. Suddenly, rocks begin tumbling down around you from both sides. That is, I believe, the feeling many providers and healthcare companies get when…

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RAPS vs EDPS: Explaining the Differences and Implications

Currently, the calculation for setting capitation rates used for Medicare Advantage is based on cost (claims) data collected from fee-for-service providers. That is about to change. CMS will soon be setting…

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The Disappearing Art of Heart

It is perhaps a symptom of our society today that respect for the doctor is falling. Google is available widely for any medical search. Pharmaceutical companies are marketing directly to the consumer.…

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The Pareto Singh Principle

Two principles have always intrigued me: The Pareto Principle and the Homeopathic System of Treatment; how they come together in splendid confusion. Pareto is brilliant in many ways. Anyone trying time…

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