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
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