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The transition from fee-for-service to value-based contracts is a challenge faced by the health care industry. The ability to succeed in value-based payment contracts is critical for public hospitals that are often the primary safety net for a given community. Without the right operational foundation and data-driven strategy, organizations can easily jump into a risk […]

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By now, it is well documented that a small percentage of “super users” account for over half of the health care costs in the country. A concept first brought to mainstream attention by Atul Gawande’s oft-cited 2011 article Hotspotters, identifying these super users and establishing targeted interventions has the potential to both vastly improve these […]

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Recent announcements from the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) indicate that the current administration sees cost savings opportunities when providers, including hospitals, take downside financial risk. HHS Secretary Alex Azar commented, “There is no turning back to an unsustainable system that pays for procedures […]

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ACOs that started in the Medicare Shared Savings Program’s Track 1 in either 2012 or 2013 must determine whether to move to a risk-based model by their third contract periods, which begin in 20191. A number of the MSSP ACOs are making strides in improving quality, reducing hospitalization and waste in Medicare. The Centers for […]

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2018 has been a year of uncertainty in federal and state health policy, particularly with respect to population health. Despite increasing complexity and ambiguity, most markets continue to move toward various forms of value-based payment (VBP). However, most health systems and physicians continue to operate in pluralistic payment environments, defined by having a portion of […]

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Delegated IPAs and medical groups in California provide valuable health care services to millions of Medi-Cal Managed Care, Medicare Advantage and Commercial Health Maintenance Organization (HMO) members. These “pioneer” providers practiced population health management before it gained industry currency and have utilized outcomes-based payment to incentivize provider innovation for decades. Risk-bearing medical groups and IPAs […]

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Health care is in a tumultuous time and what’s for certain is that nothing is for certain. The passing of the recent Tax Cuts and Jobs Act of 2017 (TCJA) has broad but still not completely understood implications for the business community and economy, including non-profit health hospitals and health care systems, generally adding more […]

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  Health care providers in Texas continue to work diligently to improve care delivery systems to all patients through Medicaid 1115 waiver transformation initiatives, specifically focusing on the Medicaid and low-income uninsured populations. The work of the Anchors and Delivery System Reform Incentive Payment (DSRIP) program providers in 2017 and previous years is evident in […]

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It is no trade secret that physicians drive quality and medical spend in the health care industry. Across the nation, health systems, Independent Physician Associations (IPAs) and Accountable Care Organizations (ACOs) are challenged with effectively partnering with their physicians to achieve high quality outcomes and reducing the total cost of care. Those organizations most successful […]

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California public hospitals have a unique opportunity to leverage the PRIME program to help build the competencies needed to thrive in a risk-based environment. Public health systems and hospitals that make strategic investments in data analytics, network optimization, care management and quality improvement will be set up for success and long-term sustainability. Overview: The […]

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