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 [...]
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 [...]
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 [...]
Intelligent Capitation Rates – Strategically Aligning Risk Adjustment with Costs
Introduction Aligning capitation rates with the line of business and risk selection of attributed members is an [...]
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 [...]
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, [...]
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 [...]
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 [...]
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 [...]
When is the Right Time to Move to Risk Sharing?
With all of the discussion today about Alternate Payment Methods, Value Based Reimbursement, MACRA, MIPS, etc., talk very [...]