Tag Archives: PHM

Managing bundled payments: A key component of your value-based strategy

Compared to other value-based reimbursement methods, bundled payments for episodic health care are old news. Many payers have been slow to embrace them. However, one major payer that’s looking at bundling to drive down costs is the Centers for Medicare and Medicaid Services (CMS). In April, CMS launched its Comprehensive Care for Joint Replacement (CJR) […]
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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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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 journey to value: Taking the first value-based steps with population health management-Part 2

In the previous Journey to Value post, we discussed the usefulness of population health management (PHM) as a bridge between the volume and value worlds. This final post in the Journey to Value series discusses another program necessity as organizations journey to value: comprehensive data and sophisticated analytics. The fuel for the value-based care is […]
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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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The journey to value: Taking the first value-based steps with population health management-Part 1

In our previous Journey to Value post, we suggested four elements that organizations should consider as they as they determine their roadmap for value-based care. With a roadmap that accounts for market needs, financial impacts, provider network strategies and aligned incentives, organizations are ready to program the milestones around which they will convert to value-based […]
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Health care alliances require balance, clear goals

In our previous post, we discussed how health care alliances are becoming more prevalent as the industry evolves. There are tremendous benefits to forming alliances, but health care leaders need some solid skills and strategies to make them work. There are a number of challenges in making a health care alliance work. First, each alliance […]
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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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Realizing the value of health care alliances

Mergers and acquisitions (M&As) have ebbed and flowed with the health care industry for decades. The economic downturn of the late 2000s brought with it an increase in M&A activity. But, while it’s still an important trend, another trend is emerging that may contribute to a slowing of M&A: provider alliances. In the latest Optum […]
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