The expansion and specialization of health networks has made it difficult for most consumers to navigate and advocate for themselves within today’s healthcare organizations. For the average health consumer, simply identifying in-network providers, requesting a cost estimate, or scheduling a medical test presents a major hassle. Add a chronic condition or difficult diagnosis in the mix and…
Kaiser Permanente’s plans to acquire Geisinger Health have opened the door to new value-based opportunities. Specifically, the proposed acquisition has the potential to create an accelerated path to value-based care and lead to significant shared learning, according to Linda Finkel, chief executive officer of AVIA, a two-sided healthcare innovation network. Last month, California-based Kaiser Permanente…
We are all futurists. We all have to make predictions—even if only implicitly—about the future to shape our lives: to determine what job we take, where to live, whether to buy a house, whether to get additional education or training and in what subjects, and on and on. The same is true for the 22…
A combination of comprehensive data, sophisticated analysis and rigorous modeling are essential to unlocking the potential of value-based care. Yet without a culture of information sharing and the unification of individual datasets, healthcare organizations will be limited in how they can most effectively develop an equitable framework to allocate risks and rewards among participants. Building…
The U.S. healthcare system’s shift from volume to value has been a trudging fifteen-year journey. Despite its potential to reduce costs and improve quality of care, the national movement toward value-based care has been harried by inconsistent guidance, confusion and misalignment among payers and providers, and subsequently mixed success across various payment models. Adoption among…
All ACOs, regardless of payment model, are built on a vision of primary care services to patients. Medicare attributes patients to your ACO based on the plurality of primary care services. CMS attributes a patient to a participating specialist only if the patient has not seen a primary care physician in the ACO or at…
Most agree health disparities are a moral problem. Yet there are disagreements about how to reduce them. Some believe that in health systems, equity and efficiency are incompatible, requiring stark and painful tradeoffs. Others, myself included, believe that achieving equitable health outcomes can, in fact, be accomplished by improving efficiency. The existing structure of the…
Download Slides The Centers of Medicare and Medicaid Services (CMS) announced all patients will be in a care relationship with accountability for quality and total cost of care by 2030. Become an ACO today to practice before it becomes mandatory. CMS is offering up to $5.6 million in funds to help cover start up…
As value-based care becomes the end goal for many healthcare organizations, health systems across the country are acquiring primary care practices to achieve this mission. Critical aspects of these acquisitions include ensuring that clinician-patient relationships are uninterrupted and establishing operations that generate value for consumers, according to Matthew Weiss, MD, managing director of the EY-Parthenon…
Many referral decisions for post-acute care hinge on electronic order capability and interoperability, according to a new survey of more than 130 hospital and physician entities. Referrals are a vital part of the US healthcare system, with over a third of patients receiving specialist referrals annually. As such, obtaining a referral is a relatively common…