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The procedure of developing, maintaining, and monitoring the chargemaster and its pricing scheme often necessitates multiple hospital employees working under the supervision of a "chargemaster coordinator", [10] [11] a "charge master manager", or others in the health care system's operations or administrative support areas frequently called a ...
Change Healthcare was established in 2007 and based in Brentwood, Tennessee. [5] The company provided healthcare consumer engagement [clarification needed] and health plan cost transparency tools to health plans and large, self-insured employers [6] across the United States.
Value-based purchasing (VBP) links provider payments to improved performance by health care providers. This form of payment holds health care providers accountable for both the cost and quality of care they provide. It attempts to reduce inappropriate care and to identify and reward the best-performing providers. [29]
CVS Health group president and executive vice president Prem Shah told Yahoo Finance that PBMs, used by a majority of Fortune 500 companies, endeavor to lower costs of branded drugs — yet just ...
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
As of 2017, the largest commercial plans were Aetna, Anthem, Cigna, Health Care Service Corp, UnitedHealthcare, and Centene Corporation. [27] As of 2017, there were 907 health insurance companies in the United States, [28] although the top 10 account for about 53% of revenue and the top 100 account for 95% of revenue. [29]: 70
This total charge data can be converted into cost estimates using the CCR Files, which include hospital-wide values of the all-payer inpatient cost-to-charge ratio for nearly every hospital in the participating NIS, KID, NRD, and SID. The CCR Files are updated annually and available for the HCUP inpatient databases beginning with 2001 data.
In the United States, an independent practice association (IPA) is an association of independent physicians, or other organizations that contracts with independent care delivery organizations, and provides services to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis.