- Taking on Medicare Part D risk: Provider perspective
By Matthew J. Kramer, Simon Moody, Michael T. Hunter | 12 April 2019
This article summarizes the key issues providers need to consider before taking on Part D risk, an increasingly common ask from Medicare Advantage organizations, and highlights some of the complexities and common barriers observed when advising provider clients on their strategies for Part D risk.
- Providers, are you ready for employer-led accountable care?
By Simon Moody, Kimberley K. Hiemenz | 29 March 2019
Employers are becoming increasingly involved in the movement toward value-based reimbursement, particularly employers that self-fund the healthcare needs of their employees.
- Hospital professional liability database: Key findings
By Tony F. Bloemer, Rachel Soich, Tim Vosicky | 11 December 2018
An updated analysis of key findings from our hospital professional liability database.
- Are you ready for New York State Medicaid value-based payment models?
By Brett Friedman, Rebecca L. Johnson, Howard Kahn | 08 November 2018
This paper provides a high-level overview of the New York State value-based payment models, discusses the opportunities and challenges for providers considering participation in them, and highlights the needs for sophisticated actuarial, financial, and legal expertise to address the inherent business, legal, and operational risks.
- The changing landscape of out-of-network reimbursement
By David C. Lewis | 19 September 2018
To avoid unfavorable outcomes, it is important to evaluate the methodology used for setting out-of-network reimbursement levels and to identify savings opportunities.
- Fiscal year 2019 HRRP impact to hospitals
By James Lucas | 11 September 2018
This paper describes the changes that are coming with the Hospital Readmission Reduction Program and explores what the likely effects will be.
- Critical Point podcast, Episode 2: Alternative Payment Models 101
By Pamela M. Pelizzari | 24 July 2018
A discussion about alternative payment methods, bundled payment, ACOs, and more.
- Is your provider organization maximizing its performance in value-based care programs?
By Laurie Lingefelt | 06 March 2018
As the use of value-based reimbursement programs and the associated financial impact increases, it is important for providers to be educated on the mechanics of the program and to understand the analytical, operational, and clinical requirements to ensure success.
- Insurance risk and its impact on provider shared risk payment models
By Juliet M. Spector, Cory Gusland, Carol Kim | 12 January 2018
A challenge facing providers and payers is to design shared risk payment models that incentivize providers to deliver efficient, high-quality care without assuming too much insurance risk from payers.
- ACA risk adjustment management: Going all-out
By Brandy N. Millen, Jason Petroske | 22 December 2017
This paper introduces the broader concept of risk management adjustment and highlights actions you can take to maintain its long-term success.