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health plan
Oscar’s Narrow Network Strategy: Will it Work?
Writing in Vox, Sarah Kliff describes VC-backed health plan Oscar’s latest twist on strategy:
Oscar’s hope is that it can take narrow networks to the next level; rather than simply cutting costs, Oscar wants to use a narrow network to improve patient experience by deeply integrating with the hospitals and doctors it works with.
Is this the right strategic approach for Oscar? It depends.
BCBSIL Refuses to Negotiate Jointly With “Affiliated” Providers. Now What?
Tensions between health plans and care providers have taken an fascinating turn in Chicago. Blue Cross Blue Shield of Illinois (BCBSIL) is refusing to allow care providers “affiliated” through a clinical integration agreement to negotiate contracts jointly.
The ramifications for future network contracts are significant and could play out very differently in other health care markets.
Background
In February 2014 Advocate Health Care and Silver Cross Hospital announced a clinical integration affiliation agreement. Advocate is the state’s largest hospital network and Silver Cross […]
Aetna, Cigna, Wellpoint Recreating Their Business Models
Major U.S. health insurers, including Aetna Inc., Humana Inc. and WellPoint Inc., are retooling to become more than just health plans, in the wake of the federal health-care overhaul that is changing the rules for the industry’s core business.
Diversification plans, touted in meetings with investors this year, include stepped up acquisitions and partnerships that will allow the companies to employ doctors directly, deliver health-information technologies, and participate in new hospital-doctor groups known as accountable-care […]
BlogTalkRadio Interview — Is Hospital-Physician Alignment Sustainable?
Why have hospitals increasingly been buying physician practices? Are these marriages based on true love or convenience? Will these marriages survive?
To address these questions, let’s take the long view (50–100 years) and revisit 7 assumptions that have driven us to today’s healthcare non-system:
Healthcare payment systems have rewarded piecemeal work.
Despite uneasiness, hospital-physician relationships have been cooperative.
Physicians can function effectively in small/medium size practices.
The healthcare mindset: built on control, not collaboration.
Barriers to sharing patient info and coordinating care are high.
The hospital has been the economic bedrock […]
Is Hospital-Physician Integration Sustainable?
Reprinted courtesy of MCOL.
Perspectives on a Selected Key Topic |Â Â Â Â April 2011/May 2011Â Â Â Â |Â Â Volume Three Issue Two
Will a material number of hospitals and their core medical […]
List of Top 10 Health Plan Issues — Out of Whack!
Healthcare IT News just published its list of top issues for health plans in 2011:
Administrative Mandates (Compliance HIPAA 5010, ICD-10, etc.).
Care Management, Data Analytics, and Informatics.
Health Insurance Exchanges and Individual Markets.
New Provider Payment & Delivery Systems (ACOs, PCMHs, etc.).
Bend the Cost Trend.
Medicare and Medicaid.
Health Information Exchanges and EMRs.
Consumer’s Role in the Modernization of Healthcare.
Reform Uncertainties.
Payer/Provider Interoperability.
Dear health plan colleagues,
Wake up! The order of this list is totally out of whack.
#2: Care Management, Data Analytics, Informatics. Good…sounds about right.
However,
#2 can’t […]
Tire Kickers Need Not Apply: 8 First Impressions of the Medicare ACO Rule
On March 31, CMS released the long-awaited “Medicare Shared Savings Program: Accountable Care Organizations” document (ACO Rule). Read the details here (strong suggestion: unless you’re working on your PhD in ACOs, start with the fact sheets).
There are many surprises. Here are eight first impressions on this 429 page tome:
The bar has been set high…very high. Tire kickers need not apply.
Don’t expect to see many or any small ACOs.
Patients will be confused by ACOs.
Concerns over maintaining competition and avoiding antitrust are […]
Health Plan Strategy Options in Two Sentences
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“If you’re a health plan, you either become a care delivery system or an information services company,” said David Brailer, a former George W. Bush administration health official who now leads an investment firm. “The traditional business is dead.”
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Read more at Kaiser Health News.
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Is Economic Credentialing A Tool for Primary Care to Lead ACOs?
Is economic credentialing — the use of economic factors such as loyalty and utilization rates in the physician credentialing process — a potential tool for primary care physicians to lead ACOs?  and reestablish the vitality of primary care in American health care?
Keith Wright and Gregory Drutchas’ incisive article Economic Credentialing: A Prescription To Secure Shared Savings Under Accountable Care provides useful history and context about economic credentialing:
For many years, the use of economic factors by hospitals in making medical staff credentialing decisions […]
Complimentary Webinar — An Impending Marriage: Electronic Health Records (EHRs) and Care Management Software
Webinar Title: An Impending Marriage: Electronic Health Records (EHRs) and Care Management Software
The presentation will be geared at practicing clinical case managers in health plans, hospitals, disease management companies, and similar organizations:
Describe market forces driving integration of EHRs and care management software.Â
Review care management software survey data and stimulus funding for EHR adoption.Â
Describe a 3 stage framework for the evolution of EHRs and care management software.Â
Characterize benefits to patients and impacts on care manager responsibilities.
The event is sponsored by HealthSciences Institute […]