FEATURED INSIGHTS

It’s Not So Simple: Why Provider Organizations Need a Strategy For the Middle

Transitioning to value means accounting for nine critical market realities and their implications for executive decision making. Transitioning to value given current market uncertainties makes it essential for all health systems to have a market-specific private payer strategy addressing all key payer segments including traditional fee-for service commercial, Medicare advantage, and managed Medicaid.

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Provider Venture Capital Funds: Investing in Innovation

As an increasing number of health systems move into the realm of venture capital investing, they can benefit from the lessons learned from corporations and provider VC funds that have pioneered the market.

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Next Generation Health Care:
Employer-led innovations for healthcare delivery and payment reform

After two decades to applying the usual levers of benefit design to improve employee health and rein in costs large employers are taking things into their own hands and are collaborating directly with providers.

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Integrating Physical and Behavioral Health

The integration of physical and behavioral health has an enormous—and frequently overlooked—potential for producing cost savings. The potential for savings nationally and per person may surprise you.

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Highlights from the Tenth CEO/Innovators Roundtable

The 2016 CEO/Innovators organized around a central theme—Consumerism and Retail Healthcare— reflecting the large and growing role consumers are playing in healthcare today.

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Finding the ‘Sweet Spot’ in Value-Based Contracts

Featured on the August 2015 cover of hfm Magazine, Bill Eggbeer’s “Finding the ‘Sweet Spot’ in Value-Based Contracts” focuses on the transition to fee for value that is accelerating in healthcare markets across the nation; the time is at hand for providers to develop and implement value-based contracts.

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Partnering with Payers? Key Lessons to Keep in Mind

Recipient of hfm Magazine’s 2013-14 Helen Yerger/L. Vann Seawell Best Article Award. As providers enter into risk-sharing arrangements with payers, they will benefit from keeping in mind several optimal practices employed by others.

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Health Care’s New Game Changer: Thinking Like a Health Plan

The shift towards value-based care is blurring the lines between providers and payers. To meet new market expectations, hospitals and health systems are taking a page from the playbook of insurers as they design an approach for population health management.

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A Race Against Time

CO-OPs and provider start-ups are in a race against time to survive in the health insurance marketplaces. The health insurance exchanges are proving unforgiving markets for idealistic start-ups as well as national health plans who misread the market.

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Characteristics of Successful ‘Super ACOs’

The development of new regional partnerships, collaborations, and joint ventures that can accomplish some of the same goals as mergers is accelerating.

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7 Challenges for Providers in the Emerging Consumer Market

Healthcare is being transformed from a wholesale hospital business to a retail consumer business where consumer choice and engagement are basic business challenges for providers.

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Launching a Provider Led Health Plan?

Provider systems seeking to move up the risk curve must acquire substantial new care management capabilities and will need to assess a variety of build vs buy or partnering options to bring a plan to market.

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Launching 1,000 Ships? Time to Refocus Your Strategy on Creating Value

A successful transformation strategy means focusing on the growth and alignment of programs to create value — bringing new business initiatives to scale, harvesting near-term benefits quickly, and disengaging when life cycles start trending down.

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Organizing for the Second Curve: Combining Health Plans and Healthcare Provider Systems

Integrating new health plan ventures with a provider systems presents a unique set of organizational challenges and requires significant preparation.

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2015 Market Outlook

Steve Weylandt, firm Managing Director, highlights how the 2015 market will accelerate its transition to value-based payment business model.

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Competing on Professionalism

Local health systems have the opportunity to revitalize medical professionalism and increase system performance.

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The Thing That Ate Healthcare

Neal Hogan, firm Senior Advisor, writes “the well-informed retail customer whose own money is on the line in every transaction is a ‘frightening monster’ for an industry that has not really had to contend with it before.”

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Is Your Physician Compensation Plan Aligned with Value-based Reimbursement?

Physician compensation models must quickly migrate to performance-based plans with care model transformation leads to improved health and outstanding organizational performance.

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Roadmap for Physician Compensation in a Value-Based World

Aligning physician compensation changes with changes in care delivery models provides the opportunity to improve health outcomes, patient experience, and cost efficiency.

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Taking a Fresh Look at Medicaid

The expansion of Medicaid under the ACA requires provider to take a fresh look at the Medicaid program. Medicaid expansion opportunities are uneven but some provide sponsored Medicaid plans can do well.

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Medicare Profitability in a Reform Market

As leading healthcare strategists, BDC offers thoughtful insights on Medicare Advantage as a key strategy for achieving Medicare profitability in the new world of healthcare reform.

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Preparing for Population Health Management

Boards can use these seven questions to stay ahead of the market.

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Should MA Plans Try to Attract the Sick?

Orry Jacobs, Senior Advisor, lays out the case for Medicare Advantage plans to focus on bringing in more high risk enrollees as a means of improving the quality of care and life for those patients — as well for increasing the profitability for the MA plan.

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Transitioning Patient-Centered Medical Homes to Clinically Integrated Medical Neighborhoods

PCMHs and Medical Neighborhoods provide a pathway to Clinically Integrated Physician Networks and Accountable Care Organizations.

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Crossing the Crevasse: A Message to Hospitals and Health System Boards

“Crossing the Crevasse” to tomorrow’s value-based markets requires a plan of how to compete and be profitable in a market where organizations will see fewer commercial patients and more Medicare and Medicaid patients.

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Emerging ‘Super ACOs’ Fill Unique Needs

Super ACOs aim to maintain the local character of independent hospitals while meeting increasing cost and quality requirements. Alliances provide an alternative ot formal mergers providing opportunities for regional ACO contracting with commercial plans nad direct employer contracting.

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Strategic Cost Repositioning

A top-down, bottom-up methodology for strategic cost repositioning for hospitals, health systems and academic medical centers.

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Dual-Eligible Reform

A critical element of population health management bringing billions in savings, while improving health care quality.

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Medicare Advantage Remains a Good Strategic Option

Medicare Advantage continues to offer providers more control over financial performance, including revenue enhancement and cost reduction.

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Narrow, Tailored, Tiered and High Performance Networks: An Emerging Trend

New health plan network products are being designed to maximize value and provide sustainable affordability.

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Health Insurance Exchanges Bring Potential Opportunities

Exchanges will alter the healthcare landscape and it’s critical to turn the change into a competitive advantage.

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Six Steps for Success in the Reform Market

Healthcare providers must be prepared to thrive under Medicaid expansion, health insurance exchanges and more.

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The New Key Role in Hospital Leadership—VPPS

Collaboration with physicians is critical to the changing models of care and healthcare reform.

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Building The High Performance Health System

Health systems need to go beyond typical “performance improvement” efforts to be competitive in the new health paradigm.

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Total Cost of Care Contracts: Early Lessons

TCOC payment reform shifts fee-for-service to fee-for-value, linking payments to the rate of growth.

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Reform is a Market Issue

Collaboration with physicians is critical to the changing models of care and healthcare reform.

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