Category Archives: Risk Management

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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Realizing the value of health care alliances

Mergers and acquisitions (M&As) have ebbed and flowed with the health care industry for decades. The economic downturn of the late 2000s brought with it an increase in M&A activity. But, while it’s still an important trend, another trend is emerging that may contribute to a slowing of M&A: provider alliances. In the latest Optum […]
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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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How to strategize when the strategic goal is unknown

One of the contradictions of value-based care is that we know we need to plan, yet we’re not always sure what we’re planning for. The old adage that “when you fail to plan, you plan to fail” applies here, but planning without seeing the entire picture means you may be taking your organization into dangerous […]
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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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Provider executives share insights on the evolution of population health

How can you adapt to population health? If you’re a health care provider, such a question can’t be answered in a sentence or a paragraph—or even an entire article. But providers who are undergoing a fee-for-service to fee-for-value transformation have offered some insight into how and why they’re evolving to become excellent at managing the […]
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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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