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 (…)
As providers assume greater risk from payers, they are requesting accountability from consumers. But, how do providers engage and empower consumers to make educated health choices and become partners in their own health care? In this point of view, Lumeris offers five, interrelated strategies, based on 10 years of value-based care experience, to help guide accountable providers to successfully engage patients for better clinical and financial outcomes.
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. The strategic survey reports include: Consolidation: Determine how market consolidation is impacting surveyed health systems; Physician Alignment and Evolving Payment (…)
Effective provider engagement in value-based care is an ongoing operation that requires a comprehensive approach and proven methodologies. In the first post we illustrated the different activities to implement for a provider group early in their risk journey. In the second installment, we focused on how creating the right infrastructure enables growth and expansion in (…)
We continue to examine the success factors for supporting providers during their transition to value-based care. In the first segment we looked at providers just starting on their journey and the phased approach of activities that helped them achieve improved clinical and financial outcomes. In this next entry, we focus on how providers, with the (…)
Client: Essence Healthcare – Lumeris used the Collaborative Payer Model between payers and providers. A mentorship program to align physician behaviors around accountability to achieve the Triple Aim Plus One was also incorporated to achieve the desired outcomes. The Accountable Delivery System Platform (ADSP)® was deployed to enable the financial and clinical management of the defined population, resulting in nearly 65% MCR (2013 before physician compensation distribution), a 30% reduction in costs and 40% reduction in readmission rate compared to an unmanaged population.
One of the biggest challenges for health systems transitioning to value-based care contracts is figuring out how to engage physicians in the process. Physician buy-in is critical for value-based care success, especially since physicians drive the bulk of utilization decisions that influence health outcomes. The move from traditional fee-for-service payment models to a value-based world (…)
To successfully transition to value-based care, health systems must engage their physicians in the process. It’s simply not optional. But figuring out the most effective way to engage physicians has remained one of the toughest challenges for organizations. Why? Because physicians drive the bulk of utilization decisions that influence health outcomes, their buy-in is critical (…)