Category Archives: by Elena White

Make patients the center of your provider network

All providers have one thing in common: they want their patients healthy and happy. Physicians, specialists, pharmacists, therapists and others work to deliver the highest quality care they can. But they primarily coordinate services independent of other providers. As value-based models become the norm, health care providers are quickly realizing that collaboration and cooperation between […]
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Match provider networks with value-based care models, payer contracts

High-performing provider networks aren’t built on luck. They take careful strategy and an accurate vision of how an organization will best perform under value-based reimbursement models. Providers chosen for a network will vary in performance and quality. Organizations should build networks with current contracts in mind, with long-term vision of its position on the risk […]
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5 -priorities for groups pursuing a risk-based strategy

When you’re used to being paid based on a tally of procedures, it can be daunting to consider taking on the financial responsibility for outcomes. Where do you start? Or if you are already bearing some risk, how do you prepare to accept more? Organizations pursuing a risk-based strategy need to address five key areas […]
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Learn about business pros who can make risk less risky

When the Centers for Medicare and Medicaid Services (CMS) called on health plans to apply for a value-based insurance test project, it stipulated that interested organizations must include financial projections and that those projections must be “actuarially certified.” While that term wouldn’t stump health plans and traditional payers – for whom the use of actuaries […]
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In provider networks bigger not necessarily better … or worse

As the health care industry adapts to the Affordable Care Act and value-based care, provider networks and their size are making news. Insurers are ditching large preferred provider organizations in favor of narrower networks. The appeal is easy to see. In a Huffington Post blog, President and CEO of the New York State Health Foundation James […]
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Solving the health care risk challenge

Did you know that one-third of Americans’ health plan coverage will be part of a shared-risk program by 2020? In fact, more than 90 percent of health plans already include value-based reimbursement contract terms with their network providers. The transitioning market has created the Triple Aim, where quality of care, more affordable care and patient […]
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Lessons learned from payers aid in shift to value-based care.

As fee-for-value payment models replace fee-for-volume models, providers are more often managing medical costs and risk. These are roles once dominated by payers. As providers find themselves needing to analyze risk, they can learn from health plans, employers and other payers — and adopt some of the same tools they use. One tactic providers can […]
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Focus on the future when developing your provider network

Every health system and provider organization entering into risk-based contracts needs to focus on the types of providers they want in their network. The type of providers they want will depend on the services they provide and the geographic coverage they need. However, a network should not be static as providers take on additional levels […]
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Providers can prepare to negotiate risk-based contracts.

Launch a web search for physicians and contracts. Much of the information you’ll find relates to employment contracts — agreements of hire, salaries, on call hours. But, with the changing health care industry doctors, hospitals and other providers are finding themselves negotiating new kinds of contracts. They are sitting down across the table from payers […]
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Use data to prepare for payer/provider risk contract negotiations

In my experience negotiating risk contracts with providers on behalf of payers, I saw some significant differences in the way provider organizations approached these negotiations. Some providers came to the negotiating table with data, analytics and a clear strategy to support their position. Others would accept proposed terms without fully evaluating and analyzing the cost […]
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