Provider

Key MACRA timeframes

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• Process improvements lead to increased value-based care program revenue for physician practice

  By Laurie Lingefelt | 05 April 2018

  A family physician practice, recently acquired by a private equity firm, looked to improve its financial performance.

• Is your provider organization maximizing its performance in value-based care programs?

  By Rod Martin, 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.

• Risk adjustment in CMS episode-based payment models: A resource guide

  By Samuel Bennett, Thomas D. Snook | 20 December 2017

  This paper provides a high-level guide on risk adjustment within the broader scope of four Centers for Medicare and Medicaid Services episode-based payment models.

• Impacts of hurricanes on health outcomes and health insurance company operations

  By Lynn F. Dong, Scott O. Jones, Michael J. Polakowski | 23 October 2017

  From an operational and financial perspective, natural disasters can have significant effects on healthcare providers, insurers, and payers.

• Provider coding accuracy in commercial value-based contracts

  By Jared Hirsch, Howard Kahn, Rong Yi | 02 October 2017

  This paper explores various aspects of risk sharing as it pertains to value-based contracting for commercial lines of business.

• Regulatory capital strategies in an evolving health insurance landscape

  By David M. Liner | 30 August 2017

  As the relationship between health plans and healthcare providers continues to evolve, this landscape creates new financial opportunities for health plans managing regulatory capital.

• Health plan considerations for growing direct-to-consumer genetic testing

  By Barbara Culley | 17 August 2017

  This white paper looks at the progression of direct-to-consumer genetic testing and the current demand and growth, discusses industry concerns, and suggests activities for health plans to consider.

• How capitation arrangements can be applied to deliver the NHS Sustainability and Transformation Plans

  By Tanya Hayward, Joanne Buckle | 16 May 2017

  This paper explores how the principles of a traditional capitation arrangement may apply in a regional National Health Service system where the stakeholder roles differ and the implementation of various key capitation principles is not possible.

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