Not too long ago, the relationship between health plans and provider organizations was straightforward. Health plans purchased services on behalf of consumers—if they were preauthorized—and provider organizations provided those services in commodity-like network arrangements. Over the past decade, that relationship has changed due to shifts in the market and new competitive pressures on health plans.…

Adopting a value-based reimbursement strategy is important, and many provider organizations have gotten that message—about 58% of specialty provider organizations are getting some revenue from value-based reimbursement agreements, and 9.3% have 20% or more of their revenue coming from VBR—a big change (see  2019 OPEN MINDS Performance Management Executive Survey). But as many health and human service…

Over the years it has become clear that developing a value-based model of care isn’t a one size fits all task. Any provider organization that intends to work with a payer in a value-based contract needs to put in the time to identify either a market gap or a payer “pain point” (see From Pain…

One of the most frequent requests our team receives is to help provider organization management teams get new (and preferred) contracts with health plans and accountable care organizations (ACO). The reasons are obvious-more Americans receive their health care through health plan and ACOs than ever before (see Navigating The Changing Relationships Between Health Plans &…

The health and human service field is well down the path from talking about value-based reimbursement (VBR) and forming meaningful partnerships between health plans and provider organizations to deliver the requisite value in VBR contracts—including moving to more advanced VBR arrangements, such as bundled payments, case rates, and capitation fees. If provider organizations expect to…

How does an organization go about creating innovative, value-based partnerships with health plans? It starts with an understanding the broader market—including consumer needs and preferences and payer “pain points”. From there, you can design services that address the needs of health plans more efficiently, measure your results, and then build a contracting relationship leveraged on…

Not too long ago, the relationship between health plans and provider organizations was straightforward. Health plans purchased services on behalf of consumers—if they were preauthorized—and provider organizations provided those services in commodity-like network arrangements. Over the past decade, that relationship has changed due to shifts in the market and new competitive pressures on health plans.…

Over the past couple of months articles surrounding coding and the social determinants of health have been popping up in the news—see AMA & UnitedHealthcare Partner To Propose New ICD-10 Codes To Identify & Address Social Determinants Of Health, UnitedHealthcare Expands Initiative To Use Diagnostic Codes To Capture Social Determinants Of Health, and Standardizing Social Determinants…