Ideas for and from Healthcare Leaders: ACO | PCMH | Payer | Hospital
Remember the book Freakonomics? Authors Steven Levitt and Stephen Dubner chronicled very interesting insights revealed by microeconomic researchers; insights that macroeconomics would not necessarily identify. The book went on to be an international best-seller and was followed up by a
The world is changing; it started with software-as-a-service, storage-as-a-service, infrastructure-as-a-service, and now it is moving to “Intelligence-as-a-Service”, otherwise called Insights-as-a-Service. The game is on for true disruption in healthcare, and I really think the market dynamics are well-aligned for this sort of change.
Dear Jeff, Warren & Jamie: I recently met my ex-boss from PepsiCo for lunch. She was the vice president of Supply Chain before she took early retirement. After our initial family updates, her first question to me was, “What does
On February 7th, 2018, the US Senate signed a bipartisan senate deal that includes a $6 billion budget for programs focused on opioid addiction and mental health. This money will be funneled into building programs that address treatment, prevention, and
Every report we have seen talks about the opioid epidemic at a national level. Articles discuss the need for more resources, what the government’s role is, and what programs health plans, providers and pharmacies should implement. At VitreosHealth, we believe
I decided to write about the challenges that come with new enrollees because most Medicaid, Medicare Advantage, and some commercial plans enroll new members at the beginning of the calendar year (if not during other times throughout the year). New
Predictive modeling is critical in being able to identify the rising-risk members for proactive and preventive care for Medicare and Medicaid plans taking on more risk in the form of capitated payments. L.E.K. Consulting projects Medicare Advantage enrollment rising from
There are many different techniques and models that can be used for predictive analytics. This topic is so expansive, that it is deserving of a text book and certainly cannot be covered in a single blog post. Let me share
In our prior blog Top 3 Challenges to Adoption of Predictive Analytics Projects in Value-based Care we debunked the myth that the best predictive models should have hundreds of input variables. Instead, a predictive model should utilize a few key
What is Dark Data? Gartner, the leading industry analysts, define dark data as the information organizations collect, process, and store during regular business activities, but generally fail to use for other purposes. According to IDC Health Insights, up to 90 percent of
Healthcare is going through a major transformation where providers and payers are focusing on value-based care with pay-for-performance and risk-based payment contracts. This transformation has yielded innovation and adoption of technologies that have proven effective in other industries. Does AI-driven
In the last few blogs, we have discussed the differences between a proactive care management and a reactive case management strategy to address cost avoidance and cost reduction opportunities (find that blog here). Additionally, we have discussed the challenges that
As a follow-up to our last blog, Cost Reduction and Cost Avoidance: A Population Health Prioritization Dilemma, there were a lot of questions sent to us with respect to the challenges in operationalizing cost avoidance and cost reduction opportunities.
In my experience, I’ve found that C-level executives often have a difficult time grasping the concept of cost avoidance in the healthcare industry. Most people view cost avoidance in the context of prioritizing investment decisions in a world of constrained
From day-to-day, I meet many C-level executives from a range of healthcare organizations – Medicare and Medicaid HMOs, ACOs, IDNs, large hospital networks, provider groups and other healthcare organizations that are taking on risk contracts. We often discuss the latest
One of the biggest frustrations for executives at health plans and providers participating in risk contracts or value-based contracts is the realization that high quality scores do not always translate to better outcomes or lower per-member-per-month costs. I have had
The healthcare industry is constantly evolving and changing. Today, there is a lot of change in the way organizations care for their populations and the care delivery models. New care models incentivize keeping populations healthy through better preventative care, proactive
The goal for any population health program should be to keep members healthy and prevent the onset and advancement of disease. Historically, population health programs have been disjointed because payers, providers, employers and communities execute isolated efforts with no collaboration
When the calendar flipped to 2017, it heralded a year that will be radically different from the one it preceded. One industry that will certainly experience some upheaval is healthcare. In fact, those changes began day one as the MACRA
January 20, 2017, the day of Donald Trump’s inauguration marked a new era for the healthcare industry, one that’s filled with uncertainty and confusion. In other words: more of the same. One of Trump’s first acts after he was sworn
On December 13, President Barack Obama signed into law a broad and sweeping healthcare provision known as the 21st Century Cures Act. In these contentious political times, the law is being heralded as a rare show of bipartisanism after it passed
The healthcare industry is successfully transitioning to value-based care, even while the fate of the Affordable Care Act (ACA) remains unclear. This is according to a recent McKesson study that shows both payers and providers making profits from value-based care.
Things were looking down for the Affordable Care Act (ACA) even before Donald Trump won the election. Premiums for several health plans are increasing by an average of 25 percent next year. Consumers in many states have significantly fewer insurance
On November 8, 2016, the American people made an historic choice and elected the ultimate outsider as president of the United States: Donald Trump. President-elect Trump will likely put forth many policies that differ from the Obama administration. This includes
Despite the recent passage of the Affordable Care Act, healthcare costs continue to skyrocket. Many factors contribute to this cost increase, including: Pharmaceuticals Medical inflation Specific diseases and conditions like heart disease and cancer However, the most expensive healthcare cost
As is widely reported in the news, the healthcare industry is in the middle of a massive transformation. Due in large part to the Affordable Care Act (ACA), the industry is shifting from traditional fee-based care (where providers are compensated
Participants are fleeing the Affordable Care Act (ACA) in droves citing high costs and difficulties achieving benchmarks. Aetna recently pulled out from 11 states. UnitedHealth narrowed its offering to only a few states. And many smaller carriers, like the struggling start-up Oscar
Healthcare professionals and the general public view healthcare analytics with optimistic skepticism. As the following examples illustrate, it’s time for healthcare analytics vendors to show results. Recently, NPR examined some highs and lows of healthcare analytics to determine the effectiveness
Speaking at the Office of the National Coordinator for Health Information Technology’s (ONC) annual meeting in Washington, Karen DeSalvo, the national coordinator for health IT, addressed what she believes to be the critical challenges for the healthcare industry: data interoperability
Star Ratings are increasing the pressure on health plans and directly affecting their bottom line.In 2012, the Centers for Medicare and Medicaid Services (CMS) began measuring Medicare Advantage and Part D prescription drug plans using the Star Ratings, a five-star system
Oscar Health Insurance burst on the payer market in July 2013 and by April 2015 the company was valued at 1.5 billion dollars. However, in March of this year, Oscar revealed it lost over 100 million dollars last year.While the news
Healthcare is continuing its, somewhat painful, evolution from volume-based to value-based care. As it does, government programs, like Medicare, and private insurance companies increasingly use “quality measures” to evaluate a physician’s performance level. However, since everyone seems to have a