Tag Archives: ACO

Documenting diagnoses makes a difference in care quality.

An often-repeated statistic warns that 8 million Americans have diabetes and don’t know it. There are similar claims about other chronic illnesses, like hypertension and chronic heart failure. If a patient doesn’t know they are missing a diagnosis, their health care provider may not either. The white paper Accurate coding: The foundation of accountable care explains that […]
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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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The journey to value: Navigating the journey from providing care to managing health

There’s little doubt that health care is transitioning from fee-for-service to fee-for-value. Everyone seems to be getting on board: commercial payers are spending billions on risk-based contracts while the Centers for Medicare and Medicaid Services (CMS) is putting its clout behind its accountable care organization (ACO) and other value-based purchasing initiatives. What’s not clear is […]
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Florida Medical Clinic scores new contracts after using analytics

In the move from fee-for-service to value-based health care a number of organizations are missing the target. I have seen several very good health care groups miss out on substantial value-based contracts because they could not take on the risks. The solution is to manage the risks through the utilization of analytics. Florida Medical Clinic, […]
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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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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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