"Many benefit designs cannot be administered without a known unit cost for the service provided. Electronic health records, the billing systems, the accounting systems—the whole system is built around this." — Brian Wheeler, CareFirst BlueCross Blue Shield.

The fee-for-service claims submission process is still the primary means for capturing the broader encounter data needed for value-based analysis and payment. This is creating problems for the transition. Laura Beerman reports.

Also this week, with the pandemic raging, Sutter Health capitalized on functioning as an integrated network and effectively increased critical care capacity by more than 200%. Chris Cheney details how they did it.

Why the Fee-For-Service Chassis Continues to Dominate Value-Based Purchasing and What to Do About It

How can payers and other stakeholders make more rapid and substantial VBP progress and move away from the FFS chassis while it’s still in place? Two solution categories are IT and integration.

Integrated Network Health System Gains Advantages During Pandemic

To meet the potential need for more critical care beds, Sutter Health focused on supply chain and staffing. To address critical care staffing, the health system reassigned nurses, credentialled ICU-capable doctors at all of its hospitals, and boosted the number of electronic-ICU beds.

How Unemployment Insurance Fraud Exploded During the Pandemic

Bots filing bogus applications in bulk, teams of fraudsters in foreign countries making phony claims, online forums peddling how-to advice on identity theft: Inside the infrastructure of perhaps the largest fraud wave in history.

Healthcare Leaders Identify Top Digital Transformation Priorities for Healthcare

A new Lumeon survey lists improving patient access, team coordination, and improving care quality as top wishes, but inadequate budgets, data silos, and inflexible EHRs remain as barriers.

How Predictive Analytics in Nurse Staffing Saves One Hospital $1M Each Year

Tower Health's Reading Hospital also netted lower turnover rates and higher job satisfaction.

2021 Tech Business Revenue Will Top Record $487 Billion in 2021, CTA Says

Consumer demand and new tech supply are driving growth, says trade group.

Fitch: 'Relentless' Cyber Attacks Pressuring Nonprofit Hospital Operations

The move towards remote work provided hackers with more opportunities to infiltrate healthcare organizations, according to Fitch.

After 18 Months, Sutter Antitrust Settlement Finally Poised for Formal Approval

Numerous twists and turns have slowed the court's approval of the settlement in late 2019.

Facing Headwinds on New Alzheimer's Drug, Biogen Launches Controversial Campaign

The drugmaker is running an educational campaign directed at the consumer, one who is already worried about whether those lost keys or a hard-to-recall name is a sign of something grave.

2022 OPPS Proposed Rule: CMS Backing Off From Eliminating Inpatient-Only List, Increasing Price Transparency Penalties

In addition, CMS says it intends to increase hospital compliance with its price transparency policies by increasing financial penalties for certain facilities.

HHS Extends COVID-19 PHE Another 90 Days

HHS has promised to give states at least 60-days notice before lifting the PHE, which allows among other things waivers or flexibility on certain CMS requirements for participating in Medicare.

Must Reads

Amid massive hospital sell-off, corporate giant continues suing patients — NPR
A healthcare worker who was hospitalized for a month with COVID-19 says she now has nearly $1 million in medical bills — Business Insider
Anthem Blue Cross drops Dignity Health hospitals, medical groups over contract spat — The San Luis Obispo Tribune
Dozens march in support for Medicare for All in DC — WJLA
Missouri Supreme Court: August's Medicaid expansion measure was constitutional — Missourinet
Opinion: Like millions of Americans, I can never leave my spouse. I'll lose my healthcare — The Guardian

That's all for this week's Payers enewsletter.

We'll be back in your mailbox next Monday with more news and reporting on health insurance and the business of healthcare.

Check our website frequently throughout the week for updates. And, remember to sign up for our E-newsletters to keep you informed on the top industry trends, challenges, and opportunities.

If you've got news tips, thoughts, or suggestions, I'd love to hear from you at jcommins@healthleadersmedia.com.

Stay safe!

John Commins
Senior Editor

@ComminsCom

"Many benefit designs cannot be administered without a known unit cost for the service provided. Electronic health records, the billing systems, the accounting systems—the whole system is built around this." — Brian Wheeler, CareFirst BlueCross Blue Shield.

Must Reads

"Many benefit designs cannot be administered without a known unit cost for the service provided. Electronic health records, the billing systems, the accounting systems—the whole system is built around this." — Brian Wheeler, CareFirst BlueCross Blue Shield.