Tag Archives: risk-based contracts

Prepare for bundled payments by focusing on these six areas

As one year ends and another begins, we sometimes take stock of what’s changed or developed in the last 12 months. The online news site HealthPayerIntelligence.com did just that for the health insurance market by defining the top trends of 2016. Bundled payment models made the list.  Take 5 minutes to explore bundled payments in […]
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MACRA is big for doctors. What about hospitals?

With the Medicare Access and CHIP Reauthorization Act replacing the sustainable growth rate, changes are coming for physicians. But will MACRA impact facility providers? Consultants at Optum say yes. Specifically they say hospitals and health systems should prepare for changes to referral patterns and readmission rates. Jay Hazelrigs, vice president and lead actuary at Optum, […]
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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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Code offers chance to test care management skills

So far doctors are underutilizing a reimbursement option designed to help bridge the gap between fee-for-service and value-based care. More than a year ago the government created the chronic care management code (CCM). It provided a way to pay doctors for time spent coordinating care for Medicare beneficiaries – specifically those diagnosed with two or more chronic […]
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Learn about business pros who can make risk less risky

When the Centers for Medicare and Medicaid Services (CMS) called on health plans to apply for a value-based insurance test project, it stipulated that interested organizations must include financial projections and that those projections must be “actuarially certified.” While that term wouldn’t stump health plans and traditional payers – for whom the use of actuaries […]
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Comfortable managing chronic illness? Ready for what’s next?

When just beginning the shift to data-driven value-based care, health care providers can start by focusing on one clearly defined population. But true population health management is about successfully administering care for all patients attributed to an organization. So how do providers travel the path from novice to intermediate levels of care management? Once a […]
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In provider networks bigger not necessarily better … or worse

As the health care industry adapts to the Affordable Care Act and value-based care, provider networks and their size are making news. Insurers are ditching large preferred provider organizations in favor of narrower networks. The appeal is easy to see. In a Huffington Post blog, President and CEO of the New York State Health Foundation James […]
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Interest in predictive models tied to value-based care

There is a link between the transition to value-based care and an increased interest in analytics-based models that can successfully predict patient outcomes. As providers move to payment models that reward results over total number of procedures performed, they are accepting more financial liability. To meet that responsibility, providers must understand more about how their […]
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Providers can prepare to negotiate risk-based contracts.

Launch a web search for physicians and contracts. Much of the information you’ll find relates to employment contracts — agreements of hire, salaries, on call hours. But, with the changing health care industry doctors, hospitals and other providers are finding themselves negotiating new kinds of contracts. They are sitting down across the table from payers […]
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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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