Population health service organizations (PHSOs) are supplanting management service organizations that gained popularity in the ’90s. PHSOs are emerging as the organizations within health systems that can improve the clinical and financial outcomes of the populations the health systems serve.
The past decade has seen advances in payer-provider collaboration and data sharing that reflect clinical, economic, and administrative alignment. What’s needed now is a deeper level of commitment to drive sustainable improvements in quality and cost.
Despite high need and urgency, patient adherence is low. One might think that puts the onus on patients, but a major reason for this gloomy picture is the severe shortage of mental health professionals across the country—a shortage that’s only going to increase.
Having a payer collaboration leader is especially important for large health systems that have yet to fully consolidate revenue cycle operations following a merger or have far-flung operations in multiple states. They may vary in some details, but the same payer issues tend to crop up across a health system.
CMS continues to push on measuring and reporting information from the consumer perspective for Medicare Advantage and Part D contracts. Others will follow, and we can expect more emphasis on member-reported outcomes and experience measures across all lines of business.
Britain’s National Health Service is taking a good look at how Americans do ACOs. But the move toward accountable care in England has already gotten mired in disputes (and confusion) about what organizational form it should take and whether current proposals are legal.
Think of this alternative payment model as a large set of event-driven care packages that get triggered by consumer–patients. Each care package can be priced and adjusted for the individual’s medical history. Providers who want to bid for the care package can, and what they’re offering will be available and comparable to other providers.
Nathan White, Mike Pace, Adam Johns, and Eric Latch
A few years ago, if you had mentioned ICER, even pharma industry insiders wouldn’t know what you were talking about—or would have confused it with confirmation of naval orders (aye, sir!). Now ICER—the acronym for the Institute for Clinical and Economic Review—has become familiar to anyone involved…