Minding the Gaps: How Health Plans Can Improve Value-Based Care Execution

Posted by Shreya Raghuraman on Wed, Jul 10, 2019


Peter Manoogian co-wrote this blog post with Shreya Raghuraman.

This is the third blog in a three-part series on value-based reimbursement programs.

To close our series on provider experiences in value-based reimbursements, we are shifting focus to the enablers that support providers in value-based care programs.


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The Three Value-Based Reimbursement Design Flaws that Frustrate Providers the Most

Posted by Peter Manoogian on Mon, Jul 01, 2019

 

Zander Magee co-wrote this blog post with Peter Manoogian. Josh Lacey also contributed to this blog post.

This is the second blog in a three-part series on value-based reimbursement programs.

In our last post detailing providers’ experiences with value-based reimbursement (VBR) programs, we described the first improvement opportunity for health plans: developing a deeper understanding of provider organizations.


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Three Topics That Dominated the AHIP Conference, and Two That Did Not

Posted by Peter Manoogian on Thu, Jun 27, 2019

Harbinder Raina and Colin Russi co-wrote this blog post with Peter Manoogian.

Executives from the nation’s largest insurance companies gathered in Nashville last week at the annual America’s Health Insurance Plans (AHIP) Institute & Expo conference. We attended the event, and here are our thoughts on what was (and wasn’t) discussed.


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How Health Plans Can Get Ahead of Market Disruptors

Posted by Florent Moise on Tue, Jun 25, 2019

This blog post is the second in a two-part series on Amazon’s potential impact on the delivery of healthcare. Zachary Alexander co-wrote this blog post with Florent Moise. 

It’s been more than a year since Amazon joined forces with Berkshire Hathaway and JPMorgan Chase to reduce healthcare costs and improve patient satisfaction among their 1.2 million employees in a joint venture called Haven. In our previous post, we explored the current state of Amazon’s efforts in healthcare, the creation of Haven and what a health plan for its employees could look like.


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How Vertical Integration Provides an Opportunity for Improved Member Engagement

Posted by Colin Russi on Thu, Jun 20, 2019

Vertical integration is a natural reaction from healthcare companies that face market uncertainty. A side effect of this integration is that these arrangements provide a unique opportunity to drastically improve the member experience. Historically, each link in the healthcare chain had built-in profit margins: The prescriber fee for service included a profit for the provider, the pharmacy captured its margin on any filled prescription, health plans attained their expected value in accordance with their medical loss ratio, etc. This easily managed system where each link generated a defined profit is changing due to market and public opinion, and regulatory forces. These forces, while numerous, originate from the reality that healthcare expenditure growth is unsustainable, growing from 12.5% of GDP to almost 17% of GDP in 15 years.


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