Maximize Practice Value with Enhanced Contracting Strategies
Practices trying to improve their viability or considering or pursuing an equity transaction should look at ‘low hanging fruit’ opportunities for commercial payment increases.
Understanding Provider Financial Losses in Value-Based Contracts
The shift from fee-for-service (FFS) healthcare models to value-based care (VBC) has been a monumental transformation in the healthcare industry. However, as this transition unfolds, it has added significant complexity to the healthcare system...
What is the “Value” in Value-Based Care?
In the ever-evolving landscape of healthcare, the terms "value-based reimbursement" and "value-based care" (VBC) have become buzzwords that signify a shift in how we approach...
Paying the Piper: How 2020 Could Make 2023 Even Tougher for Value-Based Care Providers
It’s widely predicted that 2023 will pose broad economic challenges. Reasons abound for a potential recession, but in many ways, it’s time to pay the piper for actions taken during COVID. That’s not to suggest no fiscal...
Intelligent Capitation Rates – Strategically Aligning Risk Adjustment with Costs
Aligning capitation rates with the line of business and risk selection of attributed members is an important component of provider contracting. Furthermore, doing so can illuminate hidden dynamics in financial...
Utilization Profiling for Care Management (and Profitability!)
Although there are many variables influencing healthcare costs, the most important are unit cost and utilization. Unit cost is subject to many constraints in relation to both healthcare and the broader...
A Provider’s Primer for Shared Savings Arrangements
Shared savings arrangements have increased in popularity as healthcare shifts towards value-based care. In its most basic form, the total healthcare costs of members associated (i.e., or those attributed)...
Value-Based Care’s Impact on Healthcare Mergers & Acquisitions
Provider reimbursement models are evolving as the healthcare system attempts to combat rapidly rising healthcare costs. A major development has been the push towards value-based care (VBC). Value-based payment
An Actuarial Guide to Medicare Direct Contracting
On April 1, 2021, the Global and Professional Direct Contracting (GPDC) Model began its first performance year. Effective through 2026, the CMS GPDC Model introduces risk sharing arrangements with the goal of reducing...
Physician Fee Schedules: How Do They Compare and What’s Next?
When you visit your doctor, you will typically be charged a small copay, coinsurance amount, or may not even have to make a payment at all. This is done because you know that your...