Tag Archives: ACA

Prevention takes more than an apple a day

“An ounce of prevention is worth a pound of cure.” It may be a cliché, but it is also a truism. Today, prevention in health care is more important than ever. Several key changes are pushing payers and providers more deeply into preventive services for the populations they serve. The rise of value-based care is […]
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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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King v. Burwell: How should payers move forward after the ruling?

With the U.S. Supreme Court handing down its decision today in the Affordable Care Act case King v. Burwell, health insurers can turn their full attention to preparing for their continued participation in the health insurance exchanges. Ruling to retain policies in accordance with the current PPACA law as written allows the tax subsidies to […]
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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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Transparency provides competitive edge for health care providers

As high-deductible health plans become increasingly popular, cost may become a primary deciding factor for consumers seeking medical providers. But that doesn’t necessarily mean that consumers want the cheapest price. Instead, they want to spend their dollars wisely by understanding pricing and seeing clear accountability for outcomes. In a word, they want transparency. “The future […]
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Plans should take full advantage of technology, operations to manage exchange markets

As Affordable Care Act (ACA) exchange markets evolve, health plans managing these markets face certain realities: many exchanges have not functioned as anticipated, technology has not always panned out, pricing often has been driven by poor data and inadequate risk assessment, and the market has been in a state of flux. However, during the transition […]
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Accelerating the progression toward an integrated clinical model

As we sit post-ACA, it has become apparent that we have entered one of the most dynamic times in all of health care. Risk for all stakeholders has been on an accelerated course since 2010, but managing risk looks different depending where you are in the health care space. Providers — whether hospitals or physician […]
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The King vs. Burwell case: Implications for ACA and issuers

On March 4, the U.S. Supreme Court heard oral arguments on the case of King vs. Burwell. The Supreme Court’s decision, expected to be delivered in late June or early July, could have far-reaching effects on the Affordable Care Act (ACA) and the millions of Americans who depend on it. The suit maintains that the government […]
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