Successful value-based contracting between healthcare insurers and care delivery organizations is critical to the transition towards a more sustainable healthcare system. As healthcare costs continue rising, there is an urgent need to realign payment models to reward providers for efficiency and optimal patient outcomes rather than fee-for-service care volume. Value-based…
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…
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,…
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…
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…
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…
