Tag Archives: value-based reimbursement

The risks and rewards of value-based contracting

In the new Optum white paper, “The speed of transformation: Preparing for the payment models of tomorrow,” we discuss the drivers that are pushing the move to value-based reimbursement. One area that will see some of the greatest — and fastest — changes is contracting with payers. Moving to fee-for-value creates significant financial risk for […]
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Keeping up with the fast-moving changes of value-based health care

Any business leader will tell you that keeping up with market shifts is crucial for financial success. That is especially true in health care today. As the market moves from fee-for-service to fee-for-value reimbursement, organizations face huge challenges in transforming their operations, finances, physician relationships, culture and patient engagement — all while the industry moves […]
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Coding can have a profound impact on quality of care

Coding and reimbursement have become almost synonymous in the health care industry. Diagnostic Related Groups (DRGs) have been the standard for inpatient reimbursement for more than 30 years, with the Inpatient Classification of Diseases (ICD) a global system used for public health and policy purposes. In the new era of pay-for-value, however, the type of […]
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Navigating existing strategies in the new year

There’s something refreshing and exciting about ushering in a new year. Perhaps it’s the feeling that a new year means a new beginning. After giving pause to reflect on our progress the past 12 months, we feel inspired and optimistic as we envision what lies ahead. But what is often overlooked in the infancy of […]
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Innovative payment approach for successful value-based reimbursement models

As you see health care transitioning away from traditional fee-for-service payments and toward performance-based payments, value-based reimbursement (VBR) approaches are becoming popular options for health plans. Pay-for-performance contracts, patient-centered medical homes, bundled payments and accountable care organizations offer unique value creation while allowing payer organizations to work collaboratively with their provider partners. Payers are looking […]
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Predict the future: stratify patients by risk to more effectively coordinate care

As organizations take on more risk, both clinical and financial, they are looking for ways to improve the quality of the care they provide and reduce costs. Population health management (PHM) with a strong emphasis on advanced analytics is one strategy for getting there.

Risky business for providers: Planning for financial realities and capacity downturns

Ultimately, the financial side and the clinical side of the ACO equation need to be in balance. Adjusting to the financial realities of value-based contracting is essential. Therefore, our fourth risk-bearing action for provider organizations is financial and capacity planning.

Risky business for providers: Population-based planning in provider risk-bearing arrangements

Provider organizations that want to bear patient risk need to be informed by their local markets and the attending health care concerns that come with that market. That’s why our third action that leads to bearing risk is population-based planning.

Risky business for providers: Strong leaders, appropriate structure needed

Taking on patient risk requires careful planning and the right leadership to carry it out. That’s why developing the correct structure is the second of five actions that allow your organization to take on medical risk.

Risky business for providers: Building value-based and market-based models

In a previous post, we outlined the five key actions needed to begin and successfully take on patient medical risk in a value-based reimbursement environment: Market Assessment; Strategic Structure; Population-Based Planning; Financial and Capacity Planning; and Value-Transformation Road map.