Finance and Business Strategy

Karin Chernoff Kaplan reviews the basics—and the importance—of establishing consistent processes for setting up and managing physician compensation agreements and thresholds that avoid regulatory problems.

Providers and health plans are turning to predictive analytics as a tool for identifying actionable insights that can be used to control costs and improve outcomes.

Systemness, or operating in a way that enables the system to create more value than the sum of its parts, enhances an organization’s business resilience. The most important manifestations of systemness are patient access and provider network management.

John Baackes, CEO of L.A. Care Health Plan, describes a long-term initiative to ensure a strong physician pipeline is available to serve the healthcare safety net in the market.

Recognizing the transition to value-based payment and care coordination, HHS is asking interested parties to identify regulatory obstacles to achievement of that goal.

The sheer number of networked healthcare devices means larger cybersecurity attacks are easier to execute. For healthcare providers, these breaches are not only disruptive, embarrassing, and expensive, but they can lead to serious medical complications for patients.

If hospitals and health systems know the patients for whom they’re at risk and the benchmarks against which they are held accountable, they can lower costs and improve outcomes for an entire population—not just a single patient.

Oct. 10—Providers and insurers are seeing a range of obstacles and new opportunities in efforts to better address the most powerful factors affecting patient health.

As commercial health plans adopt a case-rate approach to payment based on Medicare’s MS-DRGs, modifications are needed to account for how health plans’ populations differ from the Medicare population.

A proposal to eliminate required outpatient medical histories and physicals could reduce costs for healthcare providers by $454 annually.