Category Archives: by Optum Risk & Quality Solutions Team

Blazing the path of progress in value-based care

There is no one path to provider risk. Market dynamics, culture and history are among the elements that make each organization’s path unique. Providers that are transforming on the volume-to-value continuum all find themselves at various points in the process. Paths to risk can be cautious. For example, hundreds of organizations, whether they are hospital-centric […]
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Health care providers respond to market push toward value-based care

Announcements from several commercial payers along with the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. In addition to this increasing market pressure, the reality of hospitals and health systems nationally continuing to see […]
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Perspectives from provider organizations transitioning to value-based care models

Organizations across the country are transitioning to value-based systems of care delivery and reimbursement at different speeds and with varying objectives. With the first half of 2015 bringing many major announcements from both commercial payers and the Centers for Medicare and Medicaid Services (CMS), the push toward value-based models seemed to have become the preferred […]
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Is your organization data rich but insight poor?

The good news: more than 80 percent of doctors have electronic health records (EHRs) and more than 90 percent of hospitals have EHRs. The not-so-good news: 30 percent of hospitals use a data mining or a warehousing tool, while 80 percent of EHR data is unstructured. There’s lots of data available, but what insights are […]
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Engaging in risk-based contracts? Get an actuary’s opinion

Health care providers across the country are looking at ways they can increase their clinical and financial risk exposure under value-based contracts. But if they’re not experienced with risk, they may enter into contracts that put them in difficult situations. The consequences of bad risk contracts could include poor cash flows, non-competitive rates resulting in […]
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Use big data and analytics to slow health care costs and compete on outcomes

By: The Optum Risk & Quality Solutions Team Health care is awash in data, so one might think that providers and payers would be on the forefront of the big data movement. While it’s true that claims data has been used for various purposes, including epidemiological research and predictive modeling, it doesn’t have the richness […]
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Vantage Cancer Care Network makes risk work in specialty care

The pay for value revolution is here, and it means significant changes to the way primary care is provided to patients. But what does it mean for specialists? In risk-based contracts, primary care providers such as family physicians, pediatricians, OB/GYNs and internists are relied on to keep patients healthy and well. Meanwhile, the industry is […]
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Using data to move toward transparency: Six things health care providers can do

In our previous blog, “RISK now matters to health care providers”, we introduced the RISKMATTERS publication from Optum and touched on the latest conversation in the spring edition—health care providers managing financial risk becoming data-rich and insight-strong. And a new trend report in the spring edition, Transparency becoming health care’s new normal, kicks off the […]
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RISK now matters to health care providers

For the past several years, the U.S. health care industry has undergone a significant transformation in its payment structure, with many organizations evolving from supporting the current fee-for-service to a value-based payment model. A 2015 U.S. Department of Health & Human Services news release articulated its support for a new model when it set a […]
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