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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, […]
Six Characteristics of Successful Post-Acute Care (PAC) Value Networks Between 2001 and 2015 Medicare payments to post-acute care (PAC) providers more than doubled. 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 […]
Interoperability within health care has long been a goal within the health care IT ecosystem. Historically, interoperability has been focused on providers exchanging data with other providers under HIPAA. Although advances have been made, true data liquidity between providers, consumers, and caregivers has yet to be achieved. It is essential to find better ways to […]
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.”
On Monday, January 23, U.S. District Judge John Bates issued his highly-anticipated decision regarding the Department of Justice’s anti-trust challenge that blocked the proposed $37 billion- merger between Aetna and Humana. The ruling in favor of the Department of Justice (DOJ) is significant because of the merger’s potential to cause Medicare Advantage disruptions and other […]
Emergency medical services (EMS) evoke images of EMTs and paramedics responding to medical crises and transporting patients to the hospital rather than thoughts about value-based care and changes in health care delivery and payment models. EMS leaders are trying to change that paradigm through a movement dubbed “EMS 3.0.” EMS 3.0 aims to make emergency […]
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 […]
PAC represents the next frontier of opportunity for the success of ACOs, BPCI Model 2 participants, and CJR hospitals. In fact, of the ACOs which achieved shared savings, most attribute their success to closer PAC care coordination. Hospitals are narrowing networks, wanting to find the best PAC partners possible, and stronger care pathways and coordination are taking place at unprecedented levels.
One potential ACA replacement strategy could include punting health care reform to the states. The incoming administration could accomplish this is by significantly relaxing the 1332 innovation waiver requirements.
From a security perspective the last 24 months have proven to be quite detrimental to the health care industry with dozens of successful and very public and costly cyber / malware attacks. These attacks are relentless and increasing. As the health care industry explores solutions to mitigate and defend against attacks, one technology that is […]