News and Insights

Network Strategy and Provider Alignment

Accelerating the Shift of Care to Lower Cost Settings


The migration of care from inpatient (IP) to outpatient (OP) and ambulatory surgery center (ASC) settings is revolutionizing healthcare delivery. The trend began with cataract and cosmetic surgery moving from IP to OP and ASC settings more than a decade ago, and now the list of ASC procedures has grown…

How to Pick the Right Provider Partner for a Value-Based Care Arrangement


As the healthcare industry continues to move toward value-based delivery and payment models, payers must rethink the way they engage with provider partners. Building new payer-provider collaborations will be critical to success in a value-based healthcare world where both parties share financial risk for achieving health outcomes. Under such models,…

Rising to the Challenge of Transparency: Key Next Steps for Healthcare Leaders

Numerof Brief

The healthcare delivery world is rapidly becoming more transparent. Efforts by consumers, the government, and private institutions to make price and quality data available are growing – and they will transform how healthcare executives think and operate. Neither a hard-earned reputation nor brand equity purchased with expensive advertising are enough…

Payer-Provider Collaboration: Time to Bury the Hatchet


In the healthcare industry, the relationship between payers and providers has long been adversarial–and it’s become counterproductively so. Financially unsustainable Affordable Care Act exchanges and CO-OPs are collapsing all over the country (seven since Oct. 1 alone). Major player UnitedHealth Group is threatening to withdraw from the marketplaces entirely in…

3 Strategies for Changing the Health Insurance Business Model


In the face of a market-wide demand for lower costs, many of the players in the healthcare space have defined their strategic response as doing what they’ve always done–but for less. After decades of financial success, it’s difficult to think about meaningfully changing the business model. For their part, insurers…

Payment Reform: A Primer for Taking on Risk

hfm Magazine

Our healthcare system today is broken in large part because of how we pay for it. Our fee-for-service legacy gives providers an incentive to deliver as many exams, tests, and treatments and fill as many beds as possible. But as we know, piling on services does not equate to high-quality…