Category Archives: by Erik Johnson

MACRA requires knowledge of qualities of “good” data

Medicare is allowing physicians and group practices to set their own course toward compliance with the Medicare Access and CHIP Reauthorization Act, or MACRA. But regardless of the path chosen, accurate measurement is key. That’s because the most basic level of participation requires physicians to submit data on one quality measure and one improvement activity […]
Read More »

Responding to physician reactions to MACRA

Hospitals need to understand that physicians are facing a significant disruptive force and they will react. That force is the Medicare Access and CHIP Reauthorization Act, or MACRA. What’s important is how hospitals position themselves to respond to physicians’ reactions. Leaders at hospitals and health systems should ask themselves about their ability to partner with […]
Read More »

MACRA is big for doctors. What about hospitals?

With the Medicare Access and CHIP Reauthorization Act replacing the sustainable growth rate, changes are coming for physicians. But will MACRA impact facility providers? Consultants at Optum say yes. Specifically they say hospitals and health systems should prepare for changes to referral patterns and readmission rates. Jay Hazelrigs, vice president and lead actuary at Optum, […]
Read More »

Health systems find direct contracting with employers beneficial, yet difficult

Contracting directly with large employers to provide care for their employees is an increasing trend among health systems. Successful direct contracting programs address employers’ frustrations with skyrocketing costs by proving value, according to a Hospitals & Health Networks article reprinted in the Spring/Summer edition of Optum RISKMATTERS. One health system that is proving value, Aurora […]
Read More »

Health systems starting to re-embrace provider-sponsored health plans

The failure of provider-sponsored health plans (PSHPs) in the 1990s isn’t hindering health systems from reconsidering their worth, as inpatient volumes — and the revenues they generate — continue to drop. Confidence is higher now than it was 20 years ago due to the wide availability of technology to manage risk under value-based reimbursement. In […]
Read More »

Relationships the secret to value-based health care success

Lehigh Valley Health Network (LVHN) executives believe no doctor, hospital or insurance company can stand alone and succeed in value-based care. That’s why the Pennsylvania-based system’s leadership emphasizes building relationships with internal staff and external partners — each of whom influences how the others perform. In the Spring/Summer edition of Optum RISKMATTERS, LVHN CEO Brian […]
Read More »