Payers Archives - Page 3 of 3

ACO proliferation and provider “all-payer” care models inexorably lead to tighter network strategies

Tory Wolff September 1, 2013

A new study in JAMA (by McWilliams et al.) looks at the Medicare expenditures of patients seeing providers enrolled in the BCBS of Massachusetts version of the ACO (Alternative Quality Contract or “AQC”). The AQC model covers only commercial lives and all of the relevant providers had FFS reimbursement from Medicare during the time of the study (several later became ACO Pioneers). The study tests whether providers rewarded to be more efficient for one pool of patients (BCBCMA commercial HMO lives) will take the same approach to care with other

Making flanks something for the enemy to worry about: the Cleveland Clinic-Promedica deal and the emerging battle for northern Ohio

Tory Wolff August 20, 2013

Summary Earlier this year, Catholic Health Partners, the largest provider in Ohio, signed two deals which put it on a competitive collision course with Cleveland Clinic Cleveland Clinic has few options to further solidify its already strong position inside Cleveland, so it had to look elsewhere for a competitive response With a clinical affiliation with Promedica, Cleveland Clinic can competitively threaten Catholic Health Partners in Toledo / northwest Ohio If Cleveland Clinic’s relationship with Promedica matures into a full affiliation, they could acquire Promedica’s Ohio insurance license, opening a whole

Could the Employer Mandate lead to reduced coverage?

Nikhil Bhojwani August 7, 2013

When it comes to employee benefits, employers need to be generous either to attract and retain talent or because it is “the right thing to do”. The recession and jobless recovery has unquestionably reduced the first imperative and it appears now that the employer mandate penalty may perversely be gutting the second. Why? A classic paper in the Journal of Legal Studies (Gneezy, Rustichini 2005) looked at the impact of introducing fines for parents who were late to pick up their kids at daycare centers. Lateness INCREASED. Subsequently when the

Ambidextrous strategy: PART 2 – Scenario Implications

Nikhil Bhojwani July 17, 2013

In our last post we introduced two potential scenarios. “Provider bastions” in which buyers of health care services select upfront the network that they will trust to deliver their care in a coordinated manner. “Value-based deconstruction” in which buyers of healthcare choose the site-of-service for every interaction with the delivery system based on incentives built on micro level information about value – outcomes and cost. Obviously there are factors unique to firms that will have a tremendous impact on optimal strategic choices for them. All we do here is raise

Ambidextrous strategy: PART 1 – Payer and provider strategy for two very different worlds

Nikhil Bhojwani July 17, 2013

It seems like every day there’s some news outlining strategic actions that various players are taking or other developments with respect to health reform. Here’s a sample of recent news: Employer adopts a tightly limited provider network Customers sign on to private exchange Hospital chain grows through acquisition Insurers boycott state exchange Health systems drop out of ACOs Payer collaborates with provider systems to target Medicaid population All of these represent choices or “bets” that firms are making based on a view of a healthcare world facing clear trends. More

Could a delay in the employer mandate be a boost to government run exchanges?

Nikhil Bhojwani July 3, 2013

In 2011 we commented that while the health reform law, the ACA, had several positive intended consequences, it also could spawn several perverse effects and side-effects. Now in an attempt to ward off some of those unintended consequences, the administration has delayed the employer mandate from 2014 to 2015. Reactions range from praise (from the unlikely alliance of Democrats and business groups), derision (from Republicans and right leaning think tanks) and bemusement or befuddlement (across the spectrum). Of course, perturbing a portion of a complex system has ripple effects of

When do you know ACOs are here to stay?

Tory Wolff April 11, 2013

Answer: When they form an industry association! Back in February, a group came together to form a national association for ACOs (NAACOS) to, according to the announcement press release, promote the growth of the model, industry standards, best practice sharing and vendor engagement. What was missing from the press release was fixed on the web site which adds as goal #2: “Participate with Federal Agencies in the development and implementation of public policy”. In other words: lobbying. And, of course, as the model evolves from Medicare to commercial and Medicaid populations, state level policy will also need

Category: Payers

Recon takes an analytical look behind select developments in healthcare

ACO proliferation and provider “all-payer” care models inexorably lead to tighter network strategies

Making flanks something for the enemy to worry about: the Cleveland Clinic-Promedica deal and the emerging battle for northern Ohio

Could the Employer Mandate lead to reduced coverage?

Ambidextrous strategy: PART 2 – Scenario Implications

Ambidextrous strategy: PART 1 – Payer and provider strategy for two very different worlds

Could a delay in the employer mandate be a boost to government run exchanges?

When do you know ACOs are here to stay?

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