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.

Six Characteristics of Successful Post-Acute Care (PAC) Value Networks
April 18, 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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Overview, Impact & Strategic Considerations of the Quality Payment Program
March 31, 2017

In April 2015, Congress enacted a law that alters the method by which physicians and other health care providers are paid for Medicare Part B services.

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Cancer Treatment Costs are Consistently Lower in the Community Setting Versus the Hospital Outpatient Department
March 30, 2017

Nearly 1.7 million new cancer diagnoses in the United States are projected for 2017. Controlling the cost of treating cancer is an important consideration for curbing the overall cost of health care.

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A New Approach to Help Advance Health IT Interoperability
March 24, 2017

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 […]

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Charlie Brown, Lucy, and Risk Corridor Payments
February 17, 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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State-Based Health Care Innovation: What Flexibility Exists Under Section 1115 and 1332 Waiver Opportunities?
January 31, 2017

While a significant amount of uncertainty surrounding the content and timing of a replacement still exists, some Congressional leaders have reached out to states to explore options that would encourage innovative health care solutions at the state level.

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Challenges for Small Rural Practices in Value-based Care
December 14, 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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Accountable Care Organizations and Risk-based Payment Arrangements: Strong Preference for Upside-Only Contracts
November 30, 2016

Providers that are newly pursuing value-based care can determine how to be successful by examining the experiences of current and past accountable care organizations (ACOs).

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