The past decade has brought some big shifts in service reimbursement. There is more managed care – 73% of the insured population is enrolled in managed care plans (see U.S. Population Enrolled In Managed Care, 2011-2018: An OPEN MINDS Reference Guide). This means that almost all consumers with employer and commercial coverage are in some…

Less talk, more data should be a mantra for health and human provider organization executives. Being selected for highly valuable value-based and preferred health plan contracts requires a different approach than in years past. The key? Design and manage services that have better “value” than your competitors – lower costs, better health outcomes, and great…

The relationship between specialty provider organizations and health plans has changed dramatically during the last 10 years as a result of the many shifts in the health and human services market that are adding competitive pressure across the spectrum. In response, provider organization executive teams are forging new, and in some cases “preferred” relationships with…

Is partnership possible? That’s a reasonable question when a management team is moving from being a “vendor” to a more preferred health plan relationship. We have put together articles and presentations on provider organizations that are “success stories” with reimbursement that is preferred and moves beyond traditional fee for service.
How To Make A…

“Faced with the choice between changing one’s mind and proving that there is no need to do so, almost everyone gets busy on the proof.” — John Kenneth Galbraith
Most executive teams have started down the path of determining what infrastructure they need to work in a contracting environment focused on value and performance…