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 (…)
Health systems across the country are accelerating their move toward value-based care. Whether they are looking to manage value-based contracts with payers in the market or launch their own health plan, providers are realizing that much of the difficulty in transformation lies in the “how”. Operationalizing value-based models successfully can be challenging for organizations new (…)
As healthcare accelerates toward value-based models, health systems must find ways to remain relevant in the new era. New strategies, business models and care delivery innovations continue to change the healthcare landscape. To find out more about what leading health systems are saying about trends in the market, click here to read surveys from the (…)
by Josh Neal, Vice President, Strategic Partnerships and Philip Ikoku, Director, Strategic Partnerships The New Year is shaping up to be one of new beginnings for many of the nation’s accountable care organizations (ACOs). In case you missed it, CMS issued a final rule on December 21, 2018, that, once enacted, will redefine the current Medicare (…)
by Matt Nolan, Vice President, Lumeris This Perspectives series looks at why provider sponsored health plans (PSHPs) fail. This post, Part 1, discusses the market dynamics that are forcing organizations to stand up their own plans and the major strategic misstep many PSHPs make when bringing a plan to market. Last year, Lumeris published a (…)