Tag Archives: payment reform

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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Today’s narrow networks: Repeat of history, or new and improved?

Health Maintenance Organizations (HMOs) and the narrow provider networks they used spurred plenty of controversy in the 1980s and 1990s. But in a time of continuously rising health care costs, narrow provider networks are making a comeback. Will they last? Recent numbers suggest they might, due to their popularity with both employers and those who […]
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If Patients Determined Health Care Payments

Left to their own, health care consumers might well design very different delivery and payment arrangements for health care – and we can learn from this perspective. While providers often think of health care on a continuum, individuals generally think of themselves in just one segment of the system: healthy, acutely ill, managing a chronic […]
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