Health Care System

The United States health care system encompasses a mixture of private and public entities that are either non-profit or for-profit. Health care coverage may be financed through federal and state government programs or can be purchased through the health insurance marketplace. In contrast, a smaller proportion of the U.S. population is uninsured. The resulting effects of a decentralized system has led to considerable challenges for provider organizations—including cost pressures, a push towards alternative payment models, and market consolidation. Despite these challenges, there are opportunities for provider organizations in reducing excess costs and utilization, particularly as payers look for innovative approaches that can demonstrate a return-on-investment in terms of cost and consumer outcomes.

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How To Meet The Challenge Of Multiple Payers & Multiple Performance Measures

Diversification of revenue streams and increasing revenues in value-based reimbursement are an integral part of the strategic plans of many specialty provider organizations. But most organizations have not designed their service delivery workflows—or their consumer data collection—for this reality. An example of the complexity? The average provider organization already tracks 151 performance measures at any given point in time.  And there are… Read

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