Anthem’s vice president of provider alignment solutions wants providers to know that the spigot of upside-only risk arrangements will not stay open forever.
ACOs need to provide comprehensive care management across a spectrum of provider specialties. To do this, they need a framework for evaluating potential partners that will help risk-bearing providers establish the partnerships that will enable them to achieve their goals.
Providers and payers are being asked to tackle the ‘upstream’ causes of poor health. Medicaid managed care organizations are being asked to screen enrollees for social needs. Some targeted efforts have translated into cost savings and make sense in value-based arrangements. But are we asking the health sector to take on too much?
A look at three different approaches that seek to address social needs in a strategic and somewhat comprehensive way. At this point, all of them are experiments, and no one knows which will prove to be sustainable, replicable, or even beneficial to the patients and communities they seek to serve.
Medicare’s new bundled payments program is expected to be popular, despite unanswered questions about the target prices for the episodes, risk adjustment, and use of quality data. Here’s what we know—and don’t know.
Research has pointed to ways that falls can be prevented, but logistical and financial barriers get in the way.
Building on a similar effort in California, Catalyst for Payment Reform is proposing a standardized set of 50 ACO measures. Some of the country’s largest purchasers are taking it to their health plans.
The 40-year-old has to guide one of the health insurer’s regional markets as the ACA continues to evolve. His course? Keep strengthening ties with providers.
Once they have the right platforms in place, insurers can layer on predictive analytics, digital medical records, and other innovations that promise to make health care costs more manageable—and in the process make health insurers more competitive with the likes of CVS and maybe, eventually, Amazon.
In theory, this approach could help untangle some knotty cost and quality concerns about medications as they move from clinical trials and into clinical use. But there’s that credibility issue.
Consultants predicted it would be a major business. Large employers and insurers were experimenting with it. But medical tourism has not lived up to the heady expectations. The ACA and moderation of increases in health care costs cooled off interest. Besides, who really wants to go to an unfamiliar place for health care?
The CNN story once again puts controversy about prior authorization into the spotlight. But is it necessary to review the entire medical record?
Sometimes patients are angry. Sometimes it is a symptom of their illness. Either way, nurses are on the front lines of health care and bear the brunt of the physical and verbal abuse from patients; gender may be a factor. In California, hospitals and other health care providers are now required to keep a log of violent incidents and develop violence prevention plans. Federal legislation has been introduced.
Mistreated is a comprehensive and brilliant analysis of American health care by Robert Pearl, the CEO of the Kaiser Permanente Medical Group. The book’s subtitle aptly summarizes the author’s point of view: “Why We think We’re Getting Good Treatment–and Why We’re Usually Wrong.”