High-performing health systems have succeeded in “breaking even” in Medicare, but many continue to struggle to achieve similar results in Medicaid. A concerted effort to improve revenue can strengthen a system’s financial sustainability.
Economic ebbs and flows are called “cycles” for a reason. The challenge for healthcare leaders is not whether the next downturn will occur—it’s whether you’re ready for it.
Survey findings shed light on how social determinants of health affect healthcare utilization rates and consumers interest in social program offerings.
Value networks and value-based payment are usually implemented independently, limiting their effectiveness. Greater alignment of these strategies can allow payers to unlock their transformative potential.
Since Star Ratings were introduced a decade ago, average MA plan performance has improved, quality standards have risen, and more people are enrolled in higher-quality plans.
Extending the use of episode analytics beyond alternative payment models: A scalable architecture for improving payer performance
Payers (and providers) that have dismissed bundled payments or treated it as a narrow part of their strategies may under-appreciate the value of episode analytics in improving core business functions.
Healthcare is a dynamic industry with significant opportunity, but cost concerns, uncertainty, and complexity can also make it an unnerving one. Substantial upside exists for players that can deliver value-creating solutions and thrive under uncertainty.
Performance measurement for the Quality Payment Program (QPP) has begun. Although 2017 is a transition year, providers and payors need to start planning for the future, given the QPP’s implications for them.
Ken Burdick, CEO, WellCare shares his perspective on major trends and opportunities in US healthcare with David Nuzum, Senior Partner, McKinsey and Company.
As more data about individuals with special care needs becomes available, the latest innovations in data analytics can be used to transform care delivery for them in a financially sustainable way.
Recent trends are affecting providers’ revenue cycles and altering how providers should manage those cycles. Basic RCM is no longer enough.
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.
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.
In October, CMS released the Medicare Advantage Star ratings for 2017. By analyzing CMS’s data, we uncovered trends indicating it will be critical for payors to continue to invest in their capabilities if they want to deliver quality programs that receive a Star bonus.
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.
New McKinsey research shows that changes in health insurance type are a common event for most Americans.
When people get to the age of 75, chances are they’ll stay put—with their health plans at least. According to our Annual Enrollment Period (AEP) survey of 2,208 senior consumers, the Medicare population is a loyal bunch, and loyalty increases with age.
We analyzed CMS’s data covering 642 MA plans and prescription drug plans across the 50 states to develop a perspective on the payor industry’s Stars performance.
On October 10, 2014, CMS released the Medicare Advantage (MA) Star ratings for 2015.
Following the decision to become a value-based provider, how did the Emory Healthcare Network look to make transformation real?
ACA reimbursement changes are likely to bring shifts in growth and profitability across counties.
This intelligence brief discusses the likely impact (on both reimbursement rates and MA margins) of the provisions contained in the the final 2015 Rate Announcement and Call Letter for Medicare Advantage and Part D programs.
Five misconceptions are limiting payors’ ability to take advantage of the opportunities in the MA market—but those opportunities are considerable. To succeed in this market, payors must balance tailored investments in local-market planning and care-delivery effectiveness with greater administrative efficiency.