This Perspectives series looks at the challenges provider-sponsored health plans (PSHPs) can face. Part 1, Why Provider-Sponsored Health Plans Fail, examined the market dynamics motivating provider organizations to launch health plans. Part 2 discusses the need to focus on the key factors at launch that will drive success for a PSHP. When health systems look (…)
As health systems evaluate their ability to transition from fee-for-service medicine toward value-based care, they must understand the financial impact of their strategy. In our recent analysis, The Impact of Transitioning to Value on the Financials of a Health System, we investigate different strategic scenarios that a health system could pursue, ranging from keeping the (…)
Lumeris and The Health Management Academy (The Academy) are surveying leading health systems to understand strategic factors impacting their move to value. Each quarter, we bring data and insights covering our findings across key areas. Fill in the form to read the strategic survey reports: Defining risk: Determine how health system executives define risk in their (…)
Health systems across the country are facing tremendous financial pressures—from maintaining operating margins and profitability, to facing a shifting payer mix and stagnating reimbursement rates. These trends are creating challenges for health systems steeped in fee-for-service (FFS) care delivery. As a result, many systems are taking a hard look at their existing business model to (…)
Health system executives understand the move to value-based care is here. But accepting that reality doesn’t answer their questions about when and how to transition from a business model based on fee-for-service payment to one based on payment for value—without degrading their organizations’ financials. To help answer those questions, we analyzed a large regional health (…)
Health systems considering a strategic move away from the traditional fee-for-service (FFS) payment model to value-based payment approach can benefit from modeling the risks and likely effects of such a move. Health systems across the country are struggling to maintain their overall profitability and operating margins. Organization leaders realize they must take a hard look (…)
Market and regulatory pressures continue to drive health systems toward value-based payment. In a survey of leading health systems, half of executives state that the shift to value-based care is happening either quickly or very quickly at their organization. Moreover, respondents indicate that 23% of total care delivery in the last quarter of 2018 was (…)
Provider-sponsored health plans and Medicare Advantage are gaining traction as a critical strategy for profitable, value-based care. However, many provider organizations underestimate the necessary lead time and effort required to move from consideration to activation. Planning for a 2021 launch needs to begin now starting with a detailed market and organizational feasibility study for standing (…)
Let’s have lunch! Lee Green is not your typical health insurance agent. Formerly the chief sales and marketing officer at a provider-sponsored plan, Lee took early retirement to start a new career doing the work he had overseen for years. After a two-year stint as a benefits consultant, he struck out on his own, focusing (…)
Increasingly gloomy credit rating forecasts threaten to cast a cloud over the not-for-profit health system sector[1]. Traditional business models are under serious pressure and as value-based care and payment accelerates into an unavoidable but crucial strategy, these are the questions progressive Board Members are asking themselves: 1. What resources are dedicated to managing risk today (…)