Population Health Management or PHM is now described as the solution to many of the challenges facing the healthcare industry. Payers and providers are generally somewhere between deciding if and how it applies to them and full blown implementation. Industry vendors are designing or retrofitting their solutions and services to make it all “work”. As
Healthcare industry payers are now moving aggressively toward value based care and reimbursement models with their provider networks. Payers of all types – employers, commercial insurers, government or individuals – can’t indefinitely sustain cost trends higher than overall economic growth. Healthcare services are simply becoming too expensive for consumers, employers, and taxpayers. Further, at some
Industry transition to value-based care & reimbursement (VBC/R) is happening. In fact, it’s happening faster than many comfortably predicted just 24 months ago. But in our work helping providers and payers plan and begin implementing various VBC/R strategies over the last 18 months, we have encountered a significant amount of confusion and misunderstanding around some
Technology, globalization and continual economic pressures are taking our world by storm. Every industry is having to evolve at breakneck speeds to keep up with the new demands and expectations of consumers. The following top 10 healthcare trends will completely transform the industry – within the next few years. 1. Intelligent Rx Intelligent Rx refers
Health benefit plan and associated provider network design are foundational to meeting plan sponsor objectives. Here are two key health plan and network design considerations for employers and payers/administrators as they shift to increasingly value based and consumer directed healthcare plans for their employees and members. Let’s define “value” as the buyer’s definition of performance
Traditional health plan designs and operational approaches created to reimburse network providers at varying negotiated levels based on activity are no longer sufficient and may soon be outmoded. They are evolving to accommodate new value based concepts of what it means to perform and provide value to plan sponsors, employees, and their plan administrators. Read