Provider

By Shyam Kolli  |  21 March 2017

This paper explores what price transparency means in the healthcare market, the forces driving the need for price transparency, challenges and uses of price transparency, and potential ways in which transparency can be improved for the benefit of consumers and also to be more effective in reducing overall healthcare costs.

By David V. Williams, David M. Liner, Colleen Norris  |  21 February 2017

This paper introduces three pillars to optimize a provider’s performance with value-based contracts: transparency, stability, and control.

By Lynn F. Dong  |  13 February 2017

A discussion of recent trends, potential benefits, and considerations for providers and payers considering joint venture health plans.

By Elizabeth Anne Jackson, Jessica Naber  |  26 January 2017

Treating patients with gene therapies could avoid years of medical and drug expenses for both patients and payers.

By David C. Lewis, Charlie Mills  |  30 November 2016

This paper explores different claims-based approaches for evaluating provider reimbursement.

By Kenneth L. Clark  |  28 September 2016

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will affect the Medicare Supplement industry in calendar year 2020.

By Adam Laurin, Cory Gusland  |  31 August 2016

For shared risk agreements to be transformational, providers and payers must work together to construct agreements that adequately reward providers, are economically viable over a multiyear period, and strive to transfer care management risk.

By Mary Margaret Huizinga, Pamela M. Pelizzari  |  18 August 2016

This paper covers the transition from current payment programs to the Merit-Based Incentive Payment System (MIPS), reviews the MIPS inclusion criteria, discusses the Composite Performance Score (CPS), demonstrates how the CPS leads to the determination of the MIPS adjustment factor, and explores the effect of changing practices on both the CPS and MIPS adjustment factor.

By Charlie Mills, Christopher Kunkel, Pamela M. Pelizzari  |  18 August 2016

This paper explores both the challenges and the opportunities associated with participating in an Advanced Alternative Payment Model (APM) and obtaining Qualifying APM Participants status, helping providers understand not only why this status may be desirable, but also what risks they might encounter along the way.

By Lynn F. Dong, Pamela M. Pelizzari  |  16 August 2016

This paper explores the definition of an Advanced Alternative Payment Model (Advanced APM) , how providers can qualify to be paid under the provisions of the Advanced APM track instead of under the Merit-Based Incentive Payment System, and why that might be desirable.

By Christopher Kunkel, Colleen Norris, Lynn F. Dong  |  09 August 2016

A list of five important considerations regarding the Medicare Access and CHIP Reauthorization Act of 2015 and how these may affect providers.

By Mary Margaret Huizinga, Pamela M. Pelizzari, Susan E. Pantely  |  03 August 2016

This paper covers the timeframes associated with the Medicare Access and CHIP Reauthorization Act of 2015 with a focus on the Merit-Based Incentive Payment System and the Advanced Alternative Payment Model.

By Marla Pantano  |  11 July 2016

Value-based reimbursement contracting and payment can lead to long-term success if the appropriate resources are engaged.

By Colleen Norris, Mary Creten (van der Heijde)  |  11 July 2016

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) may seem like it has little to do with health plans in the commercial, Medicare Advantage, or Medicaid space, but in reality, MACRA has broad and wide-ranging implications for other payers.

By Colleen Norris, Mary Creten (van der Heijde)  |  11 July 2016

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a major piece of legislation that will reshape the way in which healthcare is paid for.

By Charlie Mills, Cory Gusland, Noah Champagne  |  31 March 2016

This article identifies five key considerations that all accountable care organizations (ACOs) should closely review before deciding whether or not to use the Next Generation ACO Model.

By Michael J. Polakowski, Nicholas Johnson  |  25 January 2016

This article summarizes the proposals, released December 18, 2015, by the Senate Finance Committee that, if adopted, would have a wide-ranging impact on traditional Medicare, Medicare Advantage, and Medicare accountable organizations.

By Kimberley K. Hiemenz  |  15 October 2015

This article discusses common elements critical to analyzing and understanding shared risk and population-based arrangements.

By Kenton J. Roepke, Leigh M. Wachenheim  |  13 February 2014

Bonus calculation methods in the Medicare Shared Savings Program should improve medical cost trends but may put pressure on ACOs.

Articles and news relevant to healthcare providers, including hospitals, doctors, and others.