Designing an Accountable and Integrated Value-Based Health Plan

Designing an Accountable and Integrated Value-Based Health Plan

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

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5 Key Requirement Considerations for Value Based Health Plans

5 Key Requirement Considerations for Value Based Health Plans

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

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4 Key Strategies for Payers and TPAs to Win in a Disrupted Industry

4 Key Strategies for Payers and TPAs to Win in a Disrupted Industry

In our last post we looked at four key threats to payers from industry devolution with value based reimbursement. These included: Administrative Service Disintermediation Network Management Disintermediation Health Management Disintermediation Loss of Negotiating Leverage Each threat is largely a result of the consolidation of provider organizations of all types into multi-modal comprehensive integrated delivery systems.

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4 Key Threats to Payers and TPAs in the New Healthcare Industry

4 Key Threats to Payers and TPAs in the New Healthcare Industry

In previous posts we’ve discussed the impact on providers of the industry’s transition to value based reimbursement concurrent with the devolution of healthcare providers, settings, and technology. But our payer and third party administrator (TPA) clients are also facing significant risks and challenges from these changes in industry structure and dynamics. Just as with providers

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Value Based Reimbursement + Integrated Healthcare = Your Future

Value Based Reimbursement + Integrated Healthcare = Your Future

For some time now we’ve been briefing our clients on the impacts of the healthcare industry’s transition to value based reimbursement. The conversation quickly moves into the added complexity of this transition occurring concurrently with devolution of the healthcare ecosystem. Payers and providers of all types, and those supplying the industry with products and services

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