Recent trends are affecting providers’ revenue cycles and altering how providers should manage those cycles. Basic RCM is no longer enough.
Topic Commercial group insurance/private payors
The US health insurance industry continues to be defined by uncertainty. The 25 articles in this compendium can help health insurers navigate the changes ahead.
A new concept, organizational agility, can help healthcare companies adapt more quickly to changing customer needs, competitor responses, and regulatory guidelines—without requiring a full-scale restructuring.
Converging trends are disrupting the US healthcare industry. Health insurers are not likely to disappear, however, despite predictions to the contrary. Insurers that can take advantage of these trends are likely to find that their best years are ahead.
To select which markets to focus on—both within health insurance and in adjacent businesses—payors must have strong market insights, the fortitude to make tough decisions, and the agility to alter course rapidly.
In our healthcare system, those in the best position to control risks and costs often have inadequate incentive to do so. Refining healthcare financing and reimbursement requires a deep understanding of the nature of medical risk.
Four fundamental questions can help payors and providers improve productivity and better control utilization—the prerequisites for making value-based care sustainable.
In private health insurance, a focus on technical excellence in product development, pricing, underwriting, and claims handling can improve insurers’ bottom line—while easing their dependence on investment returns.
What insights from a large employer survey tell us about the current and future state of employer health benefits.
Will private exchanges reach a tipping point by 2018?
Private exchange enrollment is projected to nearly double in 2014 and could comprise 20% of the employer market by 2019.
While recent attention has focused on public exchanges, the commercial group market will be a hotbed of change over the next five years. Unmanaged, the segment faces profitability pressure, but payors who take proactive measures to redesign their health benefits product portfolio and optimize their pricing approaches will find revenue and earnings growth.