Tag: IBC

Recon takes an analytical look behind select developments in healthcare

Lumeris, NaviNet and the emerging battle for cloud-based ACO enablement

Tory Wolff February 16, 2012

Summary Administrative clearinghouse NaviNet has been acquired by 3 Blues plans and a provider of analytics capabilities for plans and providers (Lumeris). Both NaviNet and Lumeris appear to need a strategic breakout. The key opportunity is coupling sophisticated cloud-based (=EMR agnostic) analytics with a real time communications platform touching 130K physician offices. If viable, cloud approaches to ACO enablement could reduce the upfront infrastructure cost for providers to go at-risk, therefore allowing smaller scale provider groups to participate in the new economics – an attractive proposition for payers unnerved by

Medicaid going mainstream: thoughts on the IBC / BCBSM / AmeriHealth deal

Tory Wolff August 10, 2011

Historically Blues have shied away from Medicaid. Two thirds of plans do not serve any Medicaid and those that do often have disproportionately small shares. No real surprise: Medicaid specialist plans can fluidly move in and out of markets depending on the rates and redeploy their capabilities wherever are the best returns. Blues on the other hand, are prime “hold-up” targets because they are largely stuck in their assigned states. They can only respond to an offer of low rates with a threat of dismantling their Medicaid operations entirely (and

Tag: IBC

Recon takes an analytical look behind select developments in healthcare

Lumeris, NaviNet and the emerging battle for cloud-based ACO enablement

Medicaid going mainstream: thoughts on the IBC / BCBSM / AmeriHealth deal

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