Providers

Money for Nothing: How COVID-19 Could put Provider Value in Dire Straits

Payers, Providers, Quality, Transparency

Health care costs have been a concern in this country for many decades.  It has been well-documented that the United States spends substantially more on health care services than other developed countries for similar, if not worse, outcomes.  Additionally, high health care costs represent major challenges to government budgets, employer competitiveness, and household finances.  During …

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Occam’s Rate Razor

Alternative Payment Models, Health Care Reform, Payers, Providers

In the next decade, high-cost case management, population health, and social determinates of health will remain active and important approaches to rein in the increasing costs of healthcare services.  However, there is a risk that trend-bending savings from these efforts could remain elusive.  Moreover, while some progress has been made to shift providers to value-based …

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Looking to Impress the Actuary at the Company Holiday Party?

Payers, Providers, Reinsurance, Risk Adjustment, Risk Corridors

While the answer may be no, with health insurance risk-mitigation mechanisms again in the news—related to the forthcoming release of the 2021 Notice of Benefit and Payment Parameters and 2021 CMS-HCC methodology, continued state interest in 1332 waivers, and upcoming oral arguments in the Supreme Court, it may be time to brush up on the …

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Black Friday Sale on Direct Contracting?

Alternative Payment Models, CMMI, Providers

On November 25th, CMS announced that it is reopening the opportunity submit a Letter of Intent (LOI) to participate in its Direct Contracting: Professional and Global demonstration (through December 9th).  This model allows providers that participate in Fee-for-Service (FFS) Medicare to take on a risk/reward-like Medicare Advantage (MA); however, depending on the practice geography and …

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Competition in the Age of Transparency

Payers, Providers, Transparency

Among its most prominent health policy initiatives, the Trump administration has made transparency, especially related to prices, a top priority.  Efforts include pending interoperability regulations, the recently finalized 2020 OPPS rule, and the currently proposed transparency in coverage rule.  While there remains uncertainty about how these rules will stand up to legal challenge, health care …

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