Tag Archives: risk

5 -priorities for groups pursuing a risk-based strategy

When you’re used to being paid based on a tally of procedures, it can be daunting to consider taking on the financial responsibility for outcomes. Where do you start? Or if you are already bearing some risk, how do you prepare to accept more? Organizations pursuing a risk-based strategy need to address five key areas […]
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Part 3: Thriving in a regulated era — achieving go-to-market strategies

The final entry in our “Thriving in a regulated era” blog series concludes with the technology road map, sourcing strategies and go-to-market guidance. Our first two blogs in this series touched on developing the business vision, business plan and capabilities model. Follow the technology road map. While the business plan drives your entry into new […]
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Part 2: Thriving in a regulated era — the business capabilities model

With several provisions of the Affordable Care Act already implemented, health plans are poised for new growth opportunities. Last week, we kicked off our blog series on considerations for thriving in a regulated era with a review of the business vision and business plan. Here in part two, we take a closer look at the […]
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Thriving in a regulated era: Guiding new value creation

With several of the Affordable Care Act (ACA) provisions already implemented, the marketplace presents several opportunities for growth. Your organization may be considering expansion into new geographies, establishing new offerings in government health plans or competing in the individual marketplace. In this first post of our blog series on thriving in a regulated era, we’ll […]
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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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Lessons learned from payers aid in shift to value-based care.

As fee-for-value payment models replace fee-for-volume models, providers are more often managing medical costs and risk. These are roles once dominated by payers. As providers find themselves needing to analyze risk, they can learn from health plans, employers and other payers — and adopt some of the same tools they use. One tactic providers can […]
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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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The journey to value: Handling risk means understanding your patient population

In our last Journey to Value post, we discussed how having all key players in alignment allows a provider organization to better manage risk. There’s one element still to consider: the patient. To get a true handle on risk, health care providers must first understand the needs of the populations they’re serving. Here are four […]
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The journey to value: Preparing for change starts with improved revenue

Cash is king, whether health care organizations like it or not. Moving from volume- to value-based care puts revenue at risk when cash flow is critical. There are three specific areas where organizations can improve revenue: Denials management — Denied claims limit cash flow and negate work already completed. Plus, they add more work for […]
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Consumer awareness, prioritized resources make or break preventive service use

Increased emphasis on prevention in health care is good policy, but it can’t become good practice unless the services get to the people who need them. In an earlier post, I shared statistics about how older adults are less likely to seek out prevention programs, programs which could have prevented 2 million premature deaths. That […]
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