Category Archives: Risk Management

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 […]
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Managing bundled payments: A key component of your value-based strategy

Compared to other value-based reimbursement methods, bundled payments for episodic health care are old news. Many payers have been slow to embrace them. However, one major payer that’s looking at bundling to drive down costs is the Centers for Medicare and Medicaid Services (CMS). In April, CMS launched its Comprehensive Care for Joint Replacement (CJR) […]
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Trust: The secret sauce for the next generation of health care

Survival in today’s value-based health care industry takes trust — in people, technologies and business processes. Trust is the “secret sauce” that brings everything together, said health care futurist Joe Flower in the Spring/Summer edition of Optum RISKMATTERS. Volume to value, the shift from doing fee-for-service medicine to taking a financial risk in one way […]
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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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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 […]
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Eliminate silos, strengthen teamwork for better patient care

More than 40 years ago, the Institute of Medicine released its Educating for the Health Team report that advocated cross-functional provider teamwork over siloed service areas. But fee-for-service payment models kept such forward thinking from taking hold. Under value-based reimbursement, which incentivizes providers to take on risk, inter-professional collaboration is now the rule rather than […]
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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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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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Health care alliances require balance, clear goals

In our previous post, we discussed how health care alliances are becoming more prevalent as the industry evolves. There are tremendous benefits to forming alliances, but health care leaders need some solid skills and strategies to make them work. There are a number of challenges in making a health care alliance work. First, each alliance […]
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Four areas where providers can dramatically improve care management

Value-based care is fundamentally altering the nature of health care in the United States. Care delivery is transitioning from an episodic, somewhat reactive model into a more proactive health management approach. More and more often, provider organizations are accepting a per-member-per-month budget to manage the health of a population, and their incentives revolve around maximizing […]
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