Our Latest Thinking

We are constantly scanning the health care market for new and interesting developments; then we write about them here. Check out our latest thinking.

Value-Based Payment

The “Exit Polls”: Initial Thoughts on PTAC’s First Meeting

May 11th, 2017

Background The Centers for Medicare and Medicaid Services (CMS) has initiated a process whereby physicians and other stakeholder entities can design physician-focused payment models (PFPMs) that fit with their clinical practices, while also providing better outcomes for patients, and recommend such models to the Health and Human Services Secretary (the Secretary) for consideration and/or further […]

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The MACRA All-Payer Advanced APM Pathway: System-Wide Implications

May 3rd, 2017

Background The Quality Payment Program (QPP) under MACRA is now more than three months underway into the first payment year. However, there are still many nuances of the program, specifically under the multi-payer Advanced APM option, that payers —including commercial, Medicare Advantage, and Medicaid — and clinicians need to understand before they can begin collaborating, […]

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The Future of Medicaid

May 1st, 2017

The Affordable Care Act turned Medicaid into America’s largest public health care coverage program. While the volume associated with this growing program created increasing opportunities for providers, health systems, health plans, and vendors, these same stakeholders shouldn’t write off opportunities in Medicaid now simply because of the change in direction at the federal level. Instead, […]

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Bundles: Not Just for Your Cable and Internet

April 27th, 2017

Bundle payment models, including the Bundled Payments for Care Improvement Initiative (BPCI), are an important part of the episode-based health care value transformation.  However, they are also under increased scrutiny, in part due to strong concerns among some Republicans regarding mandatory models as well as the idea that they do little to curb the volume […]

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Torch Insight: A Revolutionary Way to Look at Health Care Markets

April 25th, 2017

Today, businesses striving to understand health care markets purchase siloed data. While data exists on individual industries (provider, payer, pharmaceutical, etc.), the data lacks the key connections needed to provide visibility into the relationships between those industries and how markets actually operate. Imagine buying individual strands of dried spaghetti from many sellers, binding them together, […]

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Six Characteristics of Successful Post-Acute Care (PAC) Value Networks

April 18th, 2017

Between 2001 and 2015 Medicare payments to post-acute care (PAC) providers more than doubled.[1] As such, PAC represents a growing opportunity for value-based entities such as accountable care organizations (ACOs), bundled-payment model participants, and medical groups to create savings in overall spend. Consider that five percent of Medicare beneficiaries account for almost 50 percent of […]

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Charlie Brown, Lucy, and Risk Corridor Payments

February 17th, 2017

On October 13, 2015, your humble blogger received the AIS Inside Health Insurance Exchange quote of the day related to non-payment of the Risk Corridor payments, “…. there was a contract going into this that there would be certain protections… and plans would price as best as they could, knowing that there was no actuarial precedent for the risk. The news that CMS could pay carriers 12 cents for every dollar requested for the first year of the risk corridor program felt like Lucy moving the football at the last second.”

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Challenges for Small Rural Practices in Value-based Care

December 14th, 2016

The Government Accountability Office (GAO) recently issued a report outlining five key areas in which smaller, rural physician practices tend to struggle as they shift from fee-for-service reimbursement to value-based care. Given the unique nature of rural medicine, and the fact that value-based payment will continue to grow, it is important to understand these challenges […]

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