Tag Archives: RISKMATTERS

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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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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Use data to prepare for payer/provider risk contract negotiations

In my experience negotiating risk contracts with providers on behalf of payers, I saw some significant differences in the way provider organizations approached these negotiations. Some providers came to the negotiating table with data, analytics and a clear strategy to support their position. Others would accept proposed terms without fully evaluating and analyzing the cost […]
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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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How to strategize when the strategic goal is unknown

One of the contradictions of value-based care is that we know we need to plan, yet we’re not always sure what we’re planning for. The old adage that “when you fail to plan, you plan to fail” applies here, but planning without seeing the entire picture means you may be taking your organization into dangerous […]
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Population analytics bolsters preventive services

My previous post outlined how increasing preventive services outreach can keep people healthier and result in better financial outcomes. But this can only happen if payers and providers know who need those services. This is where population analytic tools come into play. The two components of successful population analytics are comprehensive data and technology systems […]
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Perspectives from provider organizations transitioning to value-based care models

Organizations across the country are transitioning to value-based systems of care delivery and reimbursement at different speeds and with varying objectives. With the first half of 2015 bringing many major announcements from both commercial payers and the Centers for Medicare and Medicaid Services (CMS), the push toward value-based models seemed to have become the preferred […]
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Is your organization data rich but insight poor?

The good news: more than 80 percent of doctors have electronic health records (EHRs) and more than 90 percent of hospitals have EHRs. The not-so-good news: 30 percent of hospitals use a data mining or a warehousing tool, while 80 percent of EHR data is unstructured. There’s lots of data available, but what insights are […]
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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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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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