Provider insights

Articles

Navigating the uncertainty of potential ACA ‘repeal and replace’: A preliminary analysis

The findings in this Intelligence Brief provide an introductory perspective on how the next US administration and Congressional Republicans may approach altering the ACA and related legislation. The information is based on publicly reported information released through December 8, 2016. Our Reform Center team is continuing to refresh this perspective on a real-time basis and is closely analyzing potential implications and economic impacts for each policy element under a full range of scenarios.

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Beating the odds: Hiring and retaining an RN workforce to optimize patient outcomes and minimize unnecessary expense

Effective workforce management can increase RN retention, reduce absenteeism, and improve patient outcomes and experience. Here's how to get ahead of emerging challenges.

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The next imperatives for US healthcare

Two steps—increasing healthcare-sector productivity and improving healthcare-market functioning to better balance the supply of and demand for health services—would likely produce sufficient savings to lower medical cost inflation to the rate of GDP growth.

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Provider scale strategies: The evolving landscape

M&A remains an important option for health systems, but targets and strategies are shifting. While traditional economies of scale will continue to be a strong stimulus for M&A, providers will likely seek and achieve value creation much differently in the future.

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Achieving ROI from EHRs: Actionable insights that can transform care delivery

Traditional arguments for EHR implementation such as efficiency gains and meaningful-use incentives are insufficient to maximize a health system’s returns on its technology investments. However, clinically and operationally oriented sources of value can generate an additional $10,000 to $20,000 per bed in annual margin.

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How tech-enabled consumers are reordering the healthcare landscape

Consumers’ accountability for healthcare spending is increasing, and more than a thousand companies are developing new digital/mobile technologies that should allow consumers to take greater control over their healthcare choices. This combination may disrupt the industry’s migration toward larger, more integrated systems and put almost $300 billion—primarily, incumbent revenues—into play.

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Improving care delivery to individuals with special or supportive care needs

What states, private payors, providers, and technology companies are doing to control costs and improve outcomes for individuals with behavioral health conditions or in need of long-term services and support, including those with intellectual or developmental needs.

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Clinically integrated networks: Can they create value?

Although structurally simple to create, clinically integrated networks (CINs) are difficult to get right. Health systems considering establishing CINs must think through what it truly takes to create value through these entities and then make sure they have designed the CINs appropriately.

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Evolution of provider economics and identity

Changes in provider economics are requiring them to rethink their sustainable valuable propositions. Here’s how.

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The market evolution of provider-led health plans

Offering a health plan can give health systems an opportunity for growth, but it is not without financial risk. To benefit from this move, health systems should use a different lens to understand both consumers and risk, know where the best growth opportunities are, rethink their payor-provider interactions, and take advantage of integrated claims and clinical data.

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Breaking down the gender challenge

To make meaningful progress on gender diversity, companies must move beyond the averages and focus on the biggest pain points.

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Hospital networks: Perspective from three years of exchanges

We analyzed every individual exchange hospital network across the U.S., and here’s what we learned.

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Sources of value from healthcare IT

Analysis of the HIMSS Value Suite database suggests that investments in healthcare IT can produce value, especially in terms of improved treatment and clinical care. However, gaps remain that the industry must fill before value from healthcare IT can be fully understood and maximized.

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Women in healthcare: Of leaky pipes and sluggish middles

Last year, in partnership with LeanIn.Org, we conducted the first annual comprehensive study of the state of women in corporate America. The findings reveal challenges – but also optimistic notes – for women in healthcare.

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Unlocking the potential of academic and community health system partnerships

Faced with increasing challenges to their business model, many academic medical centers (AMCs) are seeking new sources of financial and competitive advantage, including partnerships with community health systems. These arrangements can be difficult to structure, but eight lessons can help AMCs avoid pitfalls and maximize the odds of success.

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How healthcare systems can become digital-health leaders

The potential of digitization is well understood, yet healthcare systems are struggling to convert ambition into reality. Here’s what we recommend.

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Debunking common myths about healthcare consumerism

As consumers take an increasingly active role in healthcare decision making, payors and providers need an accurate understanding of how healthcare consumerism is playing out. Using data from surveys of thousands of people across the U.S., we debunk eight of the most common myths circulating in the industry.

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The role of big data in medicine: Interview with Dr. Eric Schadt

Technology is revolutionizing our understanding and treatment of disease, says the founding director of the Icahn Institute for Genomics and Multiscale Biology at New York’s Mount Sinai Health System.

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2016 exchange market remains in flux: Evolution of carriers and offerings

The mix of carriers and plans is continuing to change, with nearly half of consumers seeing a new entrant, and plan types becoming more managed.

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Exchange-eligible consumers heading into OEP

As we near the 2016 OEP, outreach and retention efforts are ramping up. Understanding the different consumer segments is critical for driving uptake.

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Designing and implementing an integrated oncology care management program

The newer approaches to managing oncology care have been somewhat effective in controlling near-term costs, but are often cumbersome and create friction between stakeholders. A more integrated program, however, can deliver long-term benefits to both payors and providers.

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Measuring the patient experience: Lessons from other industries

A comprehensive approach health systems can use to better understand the patient experience and thereby improve patient satisfaction.

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Capturing returns in healthcare

New research finds that the healthcare sector has been very good to private equity, especially payor and pharmaceutical services. And specialist firms seem to have an edge over generalists.

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Hospital networks: Evolution of the configurations on the 2015 exchanges

Updated 2015 network data, including a comparison of networks offered on the 2014 and 2015 exchanges, insights into how networks’ pricing structures are evolving, and insurer and provider participation.

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The access imperative

Improving outpatient access can deliver a triple win for payors, providers, and patients.

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Lessons from a veteran diversity advocate

The former CEO of Kaiser Permanente describes the formative experiences that led him to champion gender diversity, and reflects on the ways that diversity benefits both leaders and organizations alike.

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Provider-led health plans: The next frontier—or the 1990s all over again?

By offering its own health plan, a hospital system may be able to gain a variety of advantages -- but the move is not without risks.

Infographic: On the Eve of Open Enrollment 2015

Survey findings shed light on how a variety of factors could affect the decisions consumers make about enrolling: eligibility for subsidies, penalties for not enrolling, satisfaction with 2014 plans, and increases in premium rates.

Multimedia

Reform Center video series: Exchange network

A close look at the public exchange network in 2014.

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Healthcare’s digital future

Insights from our international survey can help healthcare organizations plan their next moves in the journey toward full digitization.

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Reform Center video series: Medicare Advantage

ACA reimbursement changes are likely to bring shifts in growth and profitability across counties.

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Reform Center video series: Medicaid

From 2012 to 2019, Medicaid enrollment is projected to grow by 9-15M lives (16-26%), and by the end of the period managed Medicaid is expected to cover ~80% of enrollees.

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Hospital networks: Updated national view of configurations on the exchanges

This updated view of the network configurations being offered on public exchanges across the country suggests that consumer choice of health plan design is expanding.

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Individual market enrollment: Early assessments

Our fourth intelligence brief on exchange dynamics shares observations of the individual market through the mid-point of open enrollment.

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Hospital networks: Configurations on the exchanges and their impact on premiums

Our third intelligence brief on ACA exchange dynamics sets forth five observations based on analysis of new network configurations across 20 urban rating areas.

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Winning strategies for participating in narrow-network exchange offerings

In the post-reform era, payors will attempt to capture savings by creating limited networks with reduced reimbursement rates. To respond, health systems need a clear understanding—market by market—of their competitive advantages and of when, if, and how to trade price for volume.

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The impact of expanded coverage on hospital utilization

For most health systems, the one-time impact of expanded insurance coverage on utilization will be small but significant. Systems that can capture a substantial share of the increase in utilization may gain a competitive advantage.

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The post-reform health system: Meeting the challenges ahead

This series of articles examines transformational imperatives specific to health systems in the post-reform era, drawing on extensive work with healthcare stakeholders across the value chain.

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Engaging physicians to transform operational and clinical performance

Health systems (and health plans) that are serious about transforming themselves must harness the energy of their physicians. To do so, they must develop a true ability to engage physicians effectively.

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Academic medical centers: Transformational imperatives to succeed

Operating margins at AMCs are under severe pressure, placing their tripartite mission at risk. To survive, AMCs need significant structural and cultural changes. Five steps are imperative if they are to navigate the challenges ahead.

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Hospital revenue cycle operations: Opportunities created by the ACA

Although the ACA may make revenue cycle operations more complex, it also presents an opportunity for providers to improve, excel, and differentiate. By adapting their RCM operations and acquiring new capabilities, providers could open up opportunities to win.

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Clinical operations excellence: Unlocking a hospital’s true potential

A multiprong approach that puts physicians—and clinical care—at the heart of performance transformation efforts can help hospitals and health systems deliver more financially sustainable, patient-oriented, and physician-friendly care.

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The smarter scale equation

Given today’s realities, health systems must look beyond the traditional economies of scale if they want to reap the full benefits of M&A. They must consider other economies that M&A can offer, commit themselves fully to the effort, and execute flawlessly.

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Creating and sustaining change in nursing care delivery

By giving nurses more control over their work environment and more opportunities for professional advancement, hospitals and health systems can reduce nurse turnover, lower costs, and improve patient care.

Reports

The ‘big data’ revolution in US healthcare

Big data could transform the healthcare sector, but the industry must undergo fundamental changes before stakeholders can capture its full value.

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How to improve clinical behavior in primary care

Getting physicians to make significant changes to their day-to-day activities can be difficult. But the result can be better patient outcomes and lower healthcare costs.

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Changing patient behavior: The next frontier in healthcare value

To address the rising cost of chronic conditions, health systems must find effective ways to get people to adopt healthier behaviors. A new person-centric approach to behavior change is likely to improve the odds of success.

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Integrated care 2012

Articles in this publication are designed to help payors, providers, and health systems overcome the challenges ahead and leverage integrated care effectively to deliver better patient care at a lower cost.

Reports

Accounting for the cost of U.S. health care: Pre-reform trends and the impact of the recession (2011)

This report analyzes US healthcare spending trends overall and by category of care, and compares US healthcare expenditures with other developed countries.

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Cross currents in the health economy

This paper outlines five broad changes in the U.S. healthcare system and the likely strategic responses across the value chain.

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Using care pathways to improve health systems

Care pathways enable health systems (and other healthcare organizations) to make evidence-based decisions about where to focus improvement efforts.

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How IT can help fix hospitals

Mandated upgrades to healthcare IT will demand heavy investments by providers but will help them minimize waste and standardize best medical practice.

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The emerging market in healthcare innovation

Innovators—some from developing nations—have found ways to deliver care effectively at significantly lower cost while increasing access and quality.

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How sourcing excellence can lower hospital costs

Better procurement practices can help hospitals achieve rapid supply cost reductions of 20 percent or more and keep future cost escalations under control.

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Why Americans pay more for healthcare

The United States spends more on healthcare than comparable countries do and more than its wealth would suggest. Here’s how—and why.

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Three imperatives for improving US healthcare

Making healthcare more affordable is the key to making the US system sustainable. Bringing the three largest sources of underlying costs and their growth under control is necessary.

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Service-line strategies for US hospitals

All signs point to a more specialized future for US hospitals. But getting from here to there won’t be easy.