Tag Archives: risk management

Three steps: Get ready for risk-based, fee-for-value health care

Ready or not, here it comes — risk-based, fee-for-value health care is here or coming to a market near you! Health care providers are no longer asking whether they should get ready. They are asking: How fast should we make the transition? They know it may not be pretty. “Organizations need to set a goal […]
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Is a provider-led health plan a good fit? Evaluate 6 areas to find out

To drive down costs and improve care through value-based models, one must have a deep understanding of the population they serve. Health care providers have this knowledge. Their familiarity with the demographics, economics and general needs of their communities means some are well-positioned to launch their own provider-sponsored health plans (PSHP) and have a sense […]
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Medicare Advantage risk adjustment: How deep is the well?

Health plans realize the value of comprehensive risk and quality programs to meet the needs of providers and members. These programs are also critical to addressing increasing regulations and the focus on quality. For Medicare Advantage in particular, it’s important to address quality as defined by the Star Rating system and the bonuses that are […]
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Health systems find direct contracting with employers beneficial, yet difficult

Contracting directly with large employers to provide care for their employees is an increasing trend among health systems. Successful direct contracting programs address employers’ frustrations with skyrocketing costs by proving value, according to a Hospitals & Health Networks article reprinted in the Spring/Summer edition of Optum RISKMATTERS. One health system that is proving value, Aurora […]
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Health systems starting to re-embrace provider-sponsored health plans

The failure of provider-sponsored health plans (PSHPs) in the 1990s isn’t hindering health systems from reconsidering their worth, as inpatient volumes — and the revenues they generate — continue to drop. Confidence is higher now than it was 20 years ago due to the wide availability of technology to manage risk under value-based reimbursement. In […]
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Not perfect, but practice makes progress for ACOs

Recently released results of the Medicare Shared Savings Program (MSSP) highlight the fact that Accountable Care Organizations need to be in it for the long haul. In August, the Centers for Medicare & Medicaid Services issued an update announcing that participating ACOs continue to show improvements in their ability to contain costs. Three hundred and […]
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Trust: The secret sauce for the next generation of health care

Survival in today’s value-based health care industry takes trust — in people, technologies and business processes. Trust is the “secret sauce” that brings everything together, said health care futurist Joe Flower in the Spring/Summer edition of Optum RISKMATTERS. Volume to value, the shift from doing fee-for-service medicine to taking a financial risk in one way […]
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Relationships the secret to value-based health care success

Lehigh Valley Health Network (LVHN) executives believe no doctor, hospital or insurance company can stand alone and succeed in value-based care. That’s why the Pennsylvania-based system’s leadership emphasizes building relationships with internal staff and external partners — each of whom influences how the others perform. In the Spring/Summer edition of Optum RISKMATTERS, LVHN CEO Brian […]
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Eliminate silos, strengthen teamwork for better patient care

More than 40 years ago, the Institute of Medicine released its Educating for the Health Team report that advocated cross-functional provider teamwork over siloed service areas. But fee-for-service payment models kept such forward thinking from taking hold. Under value-based reimbursement, which incentivizes providers to take on risk, inter-professional collaboration is now the rule rather than […]
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Match provider networks with value-based care models, payer contracts

High-performing provider networks aren’t built on luck. They take careful strategy and an accurate vision of how an organization will best perform under value-based reimbursement models. Providers chosen for a network will vary in performance and quality. Organizations should build networks with current contracts in mind, with long-term vision of its position on the risk […]
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