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Benchmarking adds an important dimension to measuring and propelling performance and market competitiveness. It enables providers and payers to understand how they stack up against industry leaders and local players on key performance indicators as well as national standards of excellence. The first step in a successful benchmarking process is to establish a baseline of […]

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Challenge: Frequent regulatory and plan requirement changes, coupled with the need to adapt to pandemic challenges, prompted Uniformed Services Family Health Plan to find a partner to undertake a thorough review and restructuring of its medical management program. US Family Health Plan, a TRICARE Prime® military health care option serving military families in New […]

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There can be significant conflict when it comes to designing and implementing a utilization management (UM) program. UM is designed to ensure care is aligned with nationally recognized clinical standards and to minimize cost related to unnecessary care. It’s a primary cost-control strategy for commercial and government payers as well as some independent physician associations […]

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Fragmented, uncoordinated care remains a bane of the U.S. health care system. Certainly, health systems, hospitals, and medical organizations have made strides in offering ancillary care support, such as social workers to help patients, primarily after treatment. However, the current model depends on care management infrastructure and services that work around providers, rather than integrating […]

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If you’ve invested in population health staffing, resources and services but are still struggling to lower costs and improve care, you should look at your physician compensation models. The failure to appropriately compensate primary care physicians for managing populations and total cost of care remains a major obstacle to transforming care delivery, costs, and revenues. […]

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When health leaders are scrambling to ensure adequate staffing every single day, bringing a more strategic focus to their healthcare workforce may not make it to the top of the to-do list. But a long-term holistic approach that begins quickly paying off is exactly what’s needed to move away from the constant staffing fire drills […]

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Health equity is at the top of the agenda for growing numbers of providers as well as the Biden Administration: 58% of health systems now say health equity is a top priority, up from 25% in 2019, according to the Institute for Healthcare Improvement. A key to erasing racial and ethnic healthcare disparities including access […]

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By 2030, one in every five Americans will be 65 or older, according to the U.S. Census Bureau. That year, Medicare spending will hit $1.7 trillion, up from $835 billion in 2020, estimates the Congressional Budget Office. But don’t expect business as usual. While The Centers for Medicare & Medicaid Services (CMS) have experimented with […]

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It’s time to prepare for the inevitable: The Centers for Medicare and Medicaid Services is moving more strongly to downside risk, increasingly the likelihood of new, mandatory alternative payment programs. Fortunately, health care organizations can leverage current Medicare programs to accelerate their move to full risk and population health. How do you evaluate which programs […]

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The Centers for Medicare & Medicaid Innovation has laid out a new framework for driving health system transformation over the next 10 years. While CMMI did not announce specific changes or new programs as of yet, the focus on value-based care, aligning financial incentives through value-based payments and health equity — and making more progress […]

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