Tag Archives: Affordable Care Act

Part 3: Thriving in a regulated era — achieving go-to-market strategies

The final entry in our “Thriving in a regulated era” blog series concludes with the technology road map, sourcing strategies and go-to-market guidance. Our first two blogs in this series touched on developing the business vision, business plan and capabilities model. Follow the technology road map. While the business plan drives your entry into new […]
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Part 2: Thriving in a regulated era — the business capabilities model

With several provisions of the Affordable Care Act already implemented, health plans are poised for new growth opportunities. Last week, we kicked off our blog series on considerations for thriving in a regulated era with a review of the business vision and business plan. Here in part two, we take a closer look at the […]
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Thriving in a regulated era: Guiding new value creation

With several of the Affordable Care Act (ACA) provisions already implemented, the marketplace presents several opportunities for growth. Your organization may be considering expansion into new geographies, establishing new offerings in government health plans or competing in the individual marketplace. In this first post of our blog series on thriving in a regulated era, we’ll […]
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New rules for optimizing health care financial performance

Mention “performance” in a health care context and it brings to mind different images for different people. For physicians, it may mean providing the best care possible. To a provider organization’s executive team, it may be defined by financial success due to operational excellence. Each perspective is valid. Health care organizations across the country are […]
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The journey to value-based health care begins

The health care industry is heading full speed into reform and change. The Affordable Care Act (ACA) and the shift from fee-for-service to fee-for-value reimbursement are making leaders think differently about how organizations should be run. No two health care companies are the same. Each must find unique ways to evolve that suit their revenue […]
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In provider networks bigger not necessarily better … or worse

As the health care industry adapts to the Affordable Care Act and value-based care, provider networks and their size are making news. Insurers are ditching large preferred provider organizations in favor of narrower networks. The appeal is easy to see. In a Huffington Post blog, President and CEO of the New York State Health Foundation James […]
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Sowing the seeds of change in value-based care

Any business leader will tell you that keeping up with market shifts is crucial for financial success. That is especially true in health care today. As the market moves from fee-for-service to fee-for-value reimbursement, organizations face huge challenges in transforming their operations, finances, physician relationships, culture and patient engagement — all while the industry moves […]
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The risks and rewards of value-based contracting

In the new Optum white paper, “The speed of transformation: Preparing for the payment models of tomorrow,” we discuss the drivers that are pushing the move to value-based reimbursement. One area that will see some of the greatest — and fastest — changes is contracting with payers. Moving to fee-for-value creates significant financial risk for […]
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Keeping up with the fast-moving changes of value-based health care

Any business leader will tell you that keeping up with market shifts is crucial for financial success. That is especially true in health care today. As the market moves from fee-for-service to fee-for-value reimbursement, organizations face huge challenges in transforming their operations, finances, physician relationships, culture and patient engagement — all while the industry moves […]
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Consumer awareness, prioritized resources make or break preventive service use

Increased emphasis on prevention in health care is good policy, but it can’t become good practice unless the services get to the people who need them. In an earlier post, I shared statistics about how older adults are less likely to seek out prevention programs, programs which could have prevented 2 million premature deaths. That […]
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