Tag Archives: Accountable Care Organization

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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Providers and advocates express concerns about narrow networks, but what do patients say?

As the use of narrow provider networks expands, political attacks and provider push-back has also started to grow. While the current emergence of narrow networks has not incited widespread consumer backlash, these network models have started to become a political hot button. Some providers have expressed concerns about narrow networks hurting physicians who won’t accept […]
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CMS is incentivizing providers to participate in its value-based care programs

The organizations who will likely thrive as health care shifts to fee-for-value payments are those who aggressively embrace the changes. Both the Centers for Medicare and Medicaid Services (CMS) and Congress have sent strong indications recently that the primary engine for future health care reforms will be quality rather than quantity. And based on the […]
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What does the latest data from CMS mean for Medicare accountable care organizations?

The numbers coming out of the Centers for Medicare and Medicaid Services (CMS) tell an encouraging story about the prospects for Medicare Accountable Care Organizations and the Medicare Shared Savings Program. According to a CMS report, 243 ACOs saved Medicare $877 million in an 18-month span that ended in 2013. While that is only less […]
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Using technology to drive business transformation

The challenges of today’s evolving health care climate will not be resolved with yesterday’s technology. For a payer organization to effectively compete and thrive in the current environment, it must replace outdated legacy platforms, aging ancillary systems and expensive, error-prone manual processes. Payers need next-generation, business-transforming technology that radically innovates and efficiently addresses business imperatives. […]
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Five common areas where provider-based risk can falter

There is no single path to success for provider organizations who want to learn how to take on patient risk. Hospital/physician gainsharing, patient-centered medical homes, bundled payments, shared savings models and global payments all vary in the level of risk managed by the provider, as well as in their ability to bend the cost curve. […]
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Released but not forgotten: Improving the patient discharge process

It used to be that hospitals behaved like restaurants. Once a patron eats a meal and pays their bill, they walk out the door and the restaurant’s responsibility to provide a great product and service ends. In today’s regulatory environment, however, patient care doesn’t end when a patient checks out of the hospital.

Understanding the root causes of patient rebounding

No health care provider ever wants to see a patient return to the ER or their office due to complications from a prior illness. But emergency room rebounding and hospital readmissions happen, and it’s up to healthcare leaders to understand how and why to fix the problem.