- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Documenting When a Patient Falls Outside a Recommended Pathway
Documenting when a patient falls outside of a recommended pathway has the dual benefits of improving the algorithm and helping a provider get reimbursed faster, explained Torrie K. Fields, MPH, senior program manager of Palliative Care Program Design & Implementation for Blue Shield of California.
Documenting when a patient falls outside of a recommended pathway has the dual benefits of improving the algorithm and helping a provider get reimbursed faster, explained Torrie K. Fields, MPH, senior program manager of Palliative Care Program Design & Implementation for Blue Shield of California.
Transcript
How does digital data help when a patient falls outside of a recommended pathway?
When a patient falls outside of that pathway, the first thing is making sure it's actually documented, why you made a difference choice. That, actually, can feed back into the algorithm that helps people better understand what types of patients respond to what types of treatment, and it could essentially create a new pathway, and a more nuanced focus on personalized medicine. So we're able to feed data back in when we are able to document somebody falling outside that.
It helps a provider in terms of audit, or in explaining to a payer, a financer, about why they went outside of that pathway, and that creates a dialogue that really focuses on change or quality improvement, rather than on incentives and mandates. So, when a payer, especially when we're moving to value-based payment, knows why somebody went outside of a pathway, they're able to look at it differently and assess and respond and pay/reimburse faster.
IgE Mediation in Pediatric Atopic Dermatitis, Concurrent Immune Disorders: Amy Paller, MD
August 4th 2025Amy Paller, MD, pediatric dermatologist and clinical researcher at Northwestern Medicine's Feinberg School of Medicine, discussed the potential impact of reducing immunoglobulin E (IgE) levels in pediatric patients with atopic dermatitis.
Read More
The Importance of Examining and Preventing Atrial Fibrillation
August 29th 2023At this year’s American Society for Preventive Cardiology Congress on CVD Prevention, Emelia J. Benjamin, MD, ScM, delivered the Honorary Fellow Award Lecture, “The Imperative to Focus on the Prevention of Atrial Fibrillation,” as the recipient of this year’s Honorary Fellow of the American Society for Preventive Cardiology award.
Listen
Promoting Equity in Public Health: Policy, Investment, and Community Engagement Solutions
June 28th 2022On this episode of Managed Care Cast, we speak with Georges C. Benjamin, MD, executive director of the American Public Health Association, on the core takeaways of his keynote session at AHIP 2022 on public health policy and other solutions to promote equitable health and well-being.
Listen
GLP-1 Receptor Agonists Reduce Adverse Cardiovascular Outcomes, Improve Survival
August 2nd 2025Studies found that glucagon-like peptide-1 (GLP-1) receptor agonists were valuable tools in improving outcomes and survival in those with coronary plaque and after ST-elevation myocardial infarction.
Read More
