Topic Payments


Insights into the 2020 individual market—increased consumer choice and decreased premiums

This analysis reflects carrier participation, pricing, and plan type trends for the 2020 individual exchange open enrollment period. Findings are across 50 states and DC.


How should provider-led health plans evolve?

Although they are often pursued as an approach for vertical integration, their value is not always clearly demonstrated.


The exciting news in Medicare is happening at the kitchen table—not on the debate stage

With so much attention focused on the debate over the merits of Medicare for All, it is easy to lose sight of changes in Medicare Advantage.


The evolution of healthcare-provider profit pools

Why nonhospital-provider segments are primed for growth—and why that matters.


Digital health ecosystems: A payer perspective

Creating or participating in a digital health ecosystem can allow payers to take advantage of their central position in the healthcare landscape and expand in new directions.


Ensuring financial sustainability while serving a growing Medicaid population

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.


For better healthcare claims management, think “digital first”

Although end-to-end digital claims management is still a distant vision, much can be gained from digitizing portions of the claims process today.


The seven characteristics of successful alternative payment models

To aid APM (re)design and support providers and payers in their value-based contracting strategy, this paper highlights seven characteristics that distinguish well-performing APMs from poorly performing models.


The Quality Payment Program under MACRA: Strategic implications for providers and payers

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.


Against the odds: How payors can succeed under persistent uncertainty

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.


Pharma spending growth: Making the most of our dollars

Pharmaceutical companies want to be rewarded for innovation, but rising drug costs are straining payor economics. This conundrum must be solved, not for one drug at a time but across the breadth of products in the pipeline.


Why understanding medical risk is key to US health reform

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.


Growing employer interest in innovative ways to control healthcare costs

Employers are showing increasing interest in new payment, delivery, and funding models. To capture the opportunity, payors must be able to target appropriate employers; educate employers, employees, and brokers; and demonstrate savings.


Value-based care: Is it sustainable?

Four fundamental questions can help payors and providers improve productivity and better control utilization—the prerequisites for making value-based care sustainable.