Tag Archives: fee-for-value

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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Reimbursement: The narrowest curve on the value-based journey

Health care reimbursement isn’t as easy as a provider sending an invoice and the payer cutting a check. Since DRGs were introduced by Medicare in the early 80s, getting reimbursed for services performed has become increasingly complicated. Regulatory and industry changes related to the Affordable Care Act and the ICD-10 mandate have made it even […]
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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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Coding and documentation are linchpins in optimizing performance

The degree to which health care organizations have access to accurate and complete data will make or break a health care organization’s ability to respond to change. In the evolving world of value-based care, this rings true in how well leaders manage coding and documentation to improve performance. Of the five steps along the “optimizing […]
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Medical necessity is a must for any value-based organization

In our previous post, we outlined how optimizing the technologies and processes behind clinical care is critical to optimizing performance in a value-based environment. The next step on the journey “Beyond the Curve of Health Care” involves medical necessity. Medical necessity can be burdensome, but its various rules must be followed to avoid significant penalties […]
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Optimizing the technologies and processes behind clinical care

Our last blog discussed some of the new rules for optimizing patient access in the world of consumerism and value-based reimbursement. Today, we’ll take a look at optimizing the technologies and the processes behind clinical care. For a deeper look at ways you can optimize financial performance under value-based care, download the Optum eBook “Beyond […]
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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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Make wise investments along your journey from volume to value

Executives in provider organizations are often mission-driven, focusing on maintaining and strengthening their institution so that it can continue to provide critical services to its community. It’s important that you’re careful with the resources that are entrusted to you. So you’ve been deliberate as you’ve looked for ways to optimize clinical and financial performance. You’ve […]
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Your journey to a new health care world needs a new mindset

In addition to making value-based care more widespread, health reform legislation in the late 2000s set the stage for a massive influx of newly insured patients. These developments are some of the major reasons that provider leaders like you are looking at ways to adjust your care delivery model. It is in this stage of […]
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