Tag Archives: patient risk

Lessons learned from payers aid in shift to value-based care.

As fee-for-value payment models replace fee-for-volume models, providers are more often managing medical costs and risk. These are roles once dominated by payers. As providers find themselves needing to analyze risk, they can learn from health plans, employers and other payers — and adopt some of the same tools they use. One tactic providers can […]
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Data can help shape patient interventions.

The future success of fee-for-value payment models depends partially on the ability of provider organizations to help patients manage their own health. The idea is that proactive interventions will keep patients healthier and avoid the high costs that arise when a condition worsens to the point of requiring acute care. Analytics can help providers create […]
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Trusting predictive analytics

Most likely, the last time you purchased something online you were offered “recommendations” or saw what “others also liked.” The technology behind these common prompts uses predictive analytics. Your online merchant is leveraging data about your shopping and online searching behavior to predict their desired outcome — that you might buy something else! As we […]
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Making the most of health care claims data in value-based care

In my last blog post, I wrote about the need for using clinical data to create a comprehensive data set for analytics. The other side of that equation, however, is using claims data effectively. Providers already can more easily leverage claims data than clinical because of stronger reporting tools and standards, but there are some […]
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Clinical data a must for managing patient risk

In the new health care economy, we counsel providers seeking to strengthen their position should utilize a comprehensive data set. But too often, health care providers are limited in the data they use. Medicare claims data are their traditional source of data, and it’s often used as their main source of health care intelligence. It’s […]
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Data and analytics support one IPA’s risk-based business

In our last blog, we talked about how AppleCare Medical Group, an independent practice association in California, is helping manage patient risk by making sure its physicians are happy. Engaging physicians and keeping them on board as you move to risk-based reimbursement is a must, said AppleCare’s Surendra Jain, MD. Physicians will participate, he said, […]
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Physician relations: A key to managing patient risk

In our last blog, we introduced AppleCare Medical Group, an independent practice association in California that has successfully managed risk since its inception in 1996. The IPA has done so by following a number of guiding principles, including carefully analyzing its new contracts to make sure the opportunities and risks each one presents is clear.

AppleCare: Understanding how one IPA successfully manages risk

How do providers with no patient risk-bearing experience prepare for their transition from volume to value? The experience of one independent practice association (IPA) in Southern California, AppleCare Medical Group, offers some valuable insight.