Blog
Optimizing ACO Care Management Programs to Succeed in Downside Risk Arrangements
July 9, 2018By 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 […]
Accessing More of the Health Premium: The Transition into Population Health and Value-based Payment
June 28, 2018 Read moreOptimizing an ACO Network to Succeed in Downside Risk Arrangements
June 21, 2018Recent 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 […]
Golden State Guidepost – A Preview of Operational Financial and Regulatory Dilemmas
June 15, 2018 Read moreHeads You Win, Tails You Win – Roadmap to a Win-Win Path to Downside Risk in Medicare Alternative Payment Models
June 6, 2018ACOs 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 […]
Fee-For-Service to Value-Based Payment Transformation Part 3: Bearing Financial Risk in a Changing Landscape: Are You Ready? Part B
June 5, 2018 Read moreCalifornia Delegated IPAs and Medical Groups: Operational, Financial and Regulatory Dilemmas
April 16, 2018Delegated 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 […]