Market strategies to drive transformation of healthcare delivery and payment towards value are at a cross-roads. In response, health plan VBC strategy success will depend on their ability to develop and deploy specialty VBC models. Industry advancements in value-based care…

The Centers for Medicare and Medicaid Services (CMS) Innovation Center recently introduced the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model as a redesign of the Global Professional Direct Contracting Model (GPDC). The move represents the…

The Centers for Medicare and Medicaid Services (CMS) Innovation Center recently provided long- awaited clarification on the status of the Direct Contracting program. CMS has formally canceled the Geographic Direct Contracting Model (Geo) and is phasing out the Global and…

Section I: Introduction Over the past decade, the value movement in healthcare has grown and evolved. Driven by the development and adoption of primary care-led models (e.g., patient-centered medical homes, accountable care organizations or ACOs), payers have experienced a significant…

YOUR PROVIDER DATA QUALITY PROBLEM MAY BE BIGGER THAN YOU THINK… AND IT COULD BE GETTING WORSE Under normal circumstances, inaccurate provider data presents significant operational and financial challenges for health plans. In 2020, these problems have been exacerbated across…

As the world collectively addresses the COVID-19 crisis, we believe it is important for healthcare leaders to understand and plan for longer-term changes to the industry. In this Executive Brief, we will discuss our perspectives on how the economic environment…

The next five years are primed to consolidate the future of virtual health given the green space for innovation. By leveraging the technologies enabling virtual care and integrating health information, virtual health can provide consumers with a fundamentally different experience…

Health systems are well-attuned to the potential pitfalls of launching a provider-sponsored health plan (PSP) without the right mix of expertise, capabilities and capital. Health plans, on the other hand, are actively seeking partners that can deliver tight network alignment,…

Is your organization MACRA ready? If so, you have probably invested significantly in infrastructure, innovative policies and procedures focused on care management, and consumer engagement strategies. MACRA is here to stay, but have you considered the broader Senior Market opportunity?…