Tag Archives: health insurance

What health care execs can learn from Billy Beane

“We are in the midst of a generational business model transformation. It takes a strong man or woman to stand up in front of an organization and say we are going in a different direction.” Health care consultant Ted Schwab, formerly of Oliver Wyman, is quoted in the Optum eBook Moneyball, emphasizing the importance of […]
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Who should make up the team that directs your move to accountable care?

As the U.S. health care system moves away from reimbursement models that reward volume and toward those that reward care coordination – traditional industry roles are blurring. • New #5in5 video: Fee for value requires revised relationships As this integration accelerates, organizations must build new governance structures that can provide strategic direction and accountability. That […]
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Health systems: Do you see payers as partners or adversaries?

“It’s not the fact that we did that, it’s how we did it.” That’s what Jeff James, chief executive officer for Wilmington Health says is the headline from his group’s decision to team with Blue Cross/Blue Shield of North Carolina to create that state’s first commercial accountable care organization (ACO).  Watch Jeff James answer 5 […]
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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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A look back at AHIP Institute 2015

Participants from across Optum™ and more than 100 health plan organizations gathered in Nashville June 3–5 for the 2015 America’s Health Insurance Plans (AHIP) Institute. Recognized as the premier trade event for payer organizations, more than 4,000 attendees representing health plans and affiliated businesses attend AHIP annually. The event traditionally attracts mid-to-senior level executives, providing […]
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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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The health savings and spending consumer journey

Health care is one of life’s basic necessities, but it’s not the easiest to budget or understand. Ongoing changes in the industry however, have led a growing number of consumers to take greater control of their health care dollars, often through options such as health savings accounts (HSAs), health reimbursement accounts (HRAs) or flexible spending […]
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