Blog

Value-Based Payments Require a Value-Based Business Model: Many providers today find themselves amid shifting tides. Though local markets are at different stages in this process, the trajectory away from fee-for-service and toward value-based payment (VBP) is well under way, with strong policy tailwinds and buy-in from commercial payers. Prudent health care enterprises are embracing […]

In summer 2015, four of the five biggest insurance companies shook the health care industry when they announced two mega-mergers: Aetna to buy Humana for $37 billion, and Anthem to acquire Cigna in a $54 billion deal. Since the announcements, many have wondered about the potential ramifications of leaving a trillion-dollar industry in the hands […]

  Current state of health care: The traditional approach to health care delivery is quickly becoming obsolete as health care shifts from a focus on treatment to prevention. Treating an illness is often far more expensive than providing the preventative care that would deter its onset, and is imperative to developing long-term solutions for […]

Friends, family, colleagues and our valued clients: To say that we live in interesting times is an understatement. Having just completed a very challenging election season, many in our nation feel vindicated and excited while others are saddened and maybe even frightened. As a firm, I feel the need to share that we’re proud of […]

More than half of the adult U.S. population has one or more chronic conditions1. In order to combat this alarming statistic, there are various ACA provisions that incentivize patient management, including provider reimbursement opportunities or federal support for disease management programs.  Programs and incentives are important enablers, but the key to active chronic disease management […]

Role of CBOs in VBP As the healthcare industry shifts towards population health management, integrated delivery systems (IDSs) working with health plans are quickly realizing the need to reimagine traditional partnerships. As incentives drive care out of acute care settings, a focus on preventive care has alerted providers of the need for support outside of […]

New York State’s (NYS) Delivery System Reform Incentive Payment (DSRIP) program, a component of the NYS Department of Health’s (DOH) 1115 Medicaid Waiver, provides a unique opportunity for providers to invest in the delivery system and financial incentive transformation required for long term financial sustainability in a population health management business model. The DSRIP program […]

Providers in California, Texas and New York are currently implementing transformation projects under various 1115 Waivers to achieve the Quadruple Aim: better health, better care, less cost, higher satisfaction.  Work under delivery system reform incentive payment programs (DSRIP) — the component of 1115 waivers that pays for outcomes if providers change practices from volume to […]

As mass media totes an impending national nursing shortage, many young students and career transitioners are flocking to nursing school. In Fall 2015, total nursing baccalaureate enrollment totaled 331,703, up from 180,127 ten years ago1. As a result of this increased enrollment, the Health Resources and Services Administration (HRSA) estimates the number of licensed registered […]

How quickly can a health care market shift from traditional fee-for-service to payments based on value? New York state has a worthy but ambitious goal of moving 80-90% of managed care organization Medicaid expenditures to value-based payment (VBP) by 2020. In order to accomplish this, the state is using a carrot and stick approach with […]