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Collaborative Care Management Networks
Value-Based Care Needs an Operating Layer, Not Another Point Solution
Guest post by Lalit Kundu, Co-Founder & CTO, Pelica Health
Value-based care runs on a simple bet: an organization takes financial responsibility for a population’s health and keeps the savings if it can hold costs down. The organizations making that bet, physician-led IPAs, ACOs, Medicare Advantage groups, and the health plans they contract with, all run the same kind of back office to deliver on it. A small operations team, often eight to ten people, owns the daily work for the whole population: closing care gaps, capturing diagnoses, reaching the members who need attention.
On a typical day, that team can be accountable for more than 100,000 patients. When it falls behind, the instinct is to add headcount. But two more coordinators don’t move a panel that size. The constraint isn’t people, and it isn’t insight. These teams already know which members need attention; the gap list is the one thing they’re never short of.
The constraint is everything that happens after the list is generated. Someone still has to make the calls, work the callbacks, key the data into payer portals, and chase the follow-up. A coordinator can spend 30 to 40 minutes per member on that coordination alone before a single unit of care moves. That is where value-based care quietly bleeds.
In this essay, I will:
- Show why point-solution fatigue bites hardest in value-based care operations, where small teams own enormous panels against a hard regulatory clock
- Argue that the fix is a shared operating record the whole team acts on, not one more screen to read
- Explain why bolting a copilot onto every dashboard keeps the fragmentation and only adds AI to it
- Offer a test you can run on any “VBC platform” to tell a real operating layer from a well-integrated pipe, and be honest about which network effects this category actually has
MCOL Thought Leaders: Implications of Narrow Networks
ow far will the trend towards narrower health plan networks go – and what are the implications?”
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Alexander Domaszewicz
Principal,
Mercer
ACA legislation put many guardrails on health program design – premium cost sharing must be affordable based on percent of pay and cost sharing through design requires at least a 60% value plan. Narrow networks are one of the few areas that insurers and program sponsors still have left to positively impact cost […]
Universal American: A “Healthy Collaboration”
By Gregg A. Masters, MPH; originally posted at ACO Watch
I intended to post updates from Aetna and Cigna next in this series, yet today I received a tweet by Vince Kuraitis, aka @VinceKuraitis, calling attention to Universal American a managed care player I’ve not spent much time on. Yet they present a rather interesting profile and operating footprint some of which I will highlight below. According to their website Universal American (UAM):
…provides health benefits to people with Medicare. We are […]
Good or perfect: Cutting the fastest path forward
Guest post by Patrick Gordon, Director, Colorado Beacon Consortium
Early pioneers to Colorado did not have the luxury of waiting for railway or infrastructure to be in place before taming a new frontier. Their vision and determination laid the foundation for the settlers who followed. They used the tools and talents they had to develop an infrastructure and ultimately build viable, productive communities. Had they waited for the perfect conditions, they’d still be back east.
It’s a lesson we’ve […]
Employers Perceive that Health Plans Add Value to ACOs
A just released study from Aon Hewitt and Polakoff Boland — 2011 Employer Driven Accountable Care Organizations Survey Report — examines employer attitudes toward ACOs. The report provides useful insights into an area that hasn’t yet received much attention.
A couple tables in particular caught my attention.
(click on the graphic to view a larger version)
Key findings in this table include:
The Practice of Medicine: from Marcus Welby to ???
by Jaan Sidorov MD, MHSA, FACP and Vince Kuraitis JD, MBA
Physicians face great uncertainty. According to a survey conducted by The Physicians Foundation, the great majority of physicians (89%) believe the traditional model of independent private practice is either “on shaky ground” or “is a dinosaur soon to go extinct.”
In the face of this uncertainty, many physicians are jumping to a conclusion that “I have to sell my practice to the hospital.” In this post of our series on The […]
Physician-Hospital Relationships: The Hospital Morphs from Revenue Center to Cost Center
by Vince Kuraitis JD, MBA and Jaan Sidorov MD, MHSA, FACP
In our introductory posting of this series, we noted that economic incentives previously aligning doctor-hospital interests were changing. This creates the potential for The 100 Year Shift – physicians awakening to possibilities for stronger partnerships with payers than with hospitals.
In this post, we will zero in on the changing economic position of hospitals and the effect this is having on physician-hospital relationships. We will examine the […]
Payment Transformation: From Volume to Value
by Jaan Sidorov MD, MHSA, FACP and Vince Kuraitis JD, MBA
In our introductory posting, we suggested that a huge shift is underway in the health care industry. Decades of hospital-physician cooperation are not only eroding, we suggest this trend could accelerate. Instead of a natural clinical and economic affinity with hospitals, we foresee the potential for physicians forming a new dyad with insurer-buyers.
In this post, we will examine what we and many other commentators view as inevitable: the demise of […]
The 100 Year Shift? Introduction and Overview
by Vince Kuraitis JD, MBA and Jaan Sidorov MD, MHSA, FACP
Gazing at the horizon, we foresee the potential for a tectonic realignment among physicians, hospitals and payers. Here’s a quick visual representation:
This essay is the first of a seven part series. In this first post we will capsulize our vision of this potential 100 Year Shift, answer initial FAQs, and lay out the structure for the rest of the series.
The Lynchpin — Changing Economic Incentives
In the past, physicians and hospitals […]
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 […]