Tag Archives: risk management

Linking quality data to risk-based contracting success

What you don’t know might hurt you. That seems to be the fear plaguing health care executives eyeing a transition to contracts that put providers on the hook for financial risk. Healthcare Informatics (HCI) reported on a survey from trade association American Medical Group Association (AMGA). It asked health care executives about the biggest barriers […]
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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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Timing a transition to value-based care

Once providers decide they will transition to value-based care, the next question is when should they make their move. Providers can do more than pick an arbitrary date. There are tools to help organizations make informed decisions on transition timing. Providers can conduct a financial impact assessment. Doing so allows groups to model several factors […]
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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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Combining high-tech and high-touch with care guides

The previous blog post focused on how Minneapolis-based HealthEast applied data and analytics from Optum One to get great care management results. This final blog in the three-part series will show how care management is making a difference in patient lives. One relatively new element to care coordination that HealthEast put into practice was certified […]
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Designing an effective integrated clinical model

As the shift to risk-sharing and value-based models of care continues, physicians, hospitals and hospital based physician group must put greater focus on better coordination of care and outcomes. They must also be capable of taking on some level of clinical and financial risk. But how do we integrate these different aspects into a single […]
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IT strengthens payer–provider partnerships as Value-Based Reimbursement arrangements take hold

With new reimbursement models, changing regulatory dynamics and broad quality initiatives, providers and health plans are feeling the pressure to increase their focus on the value of health care services delivered for premium dollars. Risk is now being transferred from payers to providers, blurring the distinction between the two entities. Increasingly, both groups face the […]
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Five common areas where provider-based risk can falter

There is no single path to success for provider organizations who want to learn how to take on patient risk. Hospital/physician gainsharing, patient-centered medical homes, bundled payments, shared savings models and global payments all vary in the level of risk managed by the provider, as well as in their ability to bend the cost curve. […]
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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.