How Capitation Contracts Benefit Providers, Payers and Patients
WEBMay 11, 2023 · Capitation contracts can benefit providers, payers, and patients. But they require thoughtful planning, careful alignment between PCPs and specialists, a commitment to optimizing the patient/member experience within a narrower network of providers, and a robust digital infrastructure. Lynn Carroll is the chief operating officer of HSBlox, an ...
PBMs are Creating GPOs, and Stirring Debate as to Why
WEBJul 12, 2022 · PBMs are Creating GPOs, and Stirring Debate as to Why. The Big Three all set up group purchasing organizations recently, but some industry observers question the timing of the move and who will benefit. In 2019, Express Scripts PBM (pharmacy benefit manager) formed Ascent Health Services GPO (group …
Beyond the Big Three PBMs - Managed Healthcare Executive
WEBDec 19, 2022 · But beyond the big three PBMs is a swarm of some 60 smaller, up-and-coming PBMs. Even if they are operating in a small slice of the pie relative to the towering dominance of the big three, the PBM pie is growing rapidly. The global PBM market is projected to increase from $495 billion in 2022 to $740 billion by 2029 (a 50% jump), according to a ...
‘Hybrid Health’ Opens up Opportunities and Exposes Gaps in …
WEBFeb 16, 2022 · It is not about digital replacement of in-person healthcare, but layering in tools and services that allow for remote care and give patients (and their families) options. “A hybrid model enables both convenience and cost-effective healthcare through telehealth while still providing vital face-to-face care when appropriate,” Baethke says.
Five ways to close gaps in care and build a successful quality ...
WEBJan 8, 2017 · Face-to-face contact is the number one tool to close gaps in care, outranking mobile apps, patient portals, social media, or surveys. Timely and actionable quality scorecards also demonstrate to providers where the gaps in care are for their patients. Physicians should be engaged in how the scorecards are …
7 Skills Healthcare Executives Need to Succeed
WEBSep 23, 2020 · As a result, healthcare executives need to be transparent in a way that is more real than ever. For important decisions, they should involve more, not fewer stakeholders. True collaboration makes for greater alignment, better decisions and better execution. “Executives don’t have to give up their power to …
The Next Generation of PBMs: New Technology, Simpler Business …
WEBAug 10, 2020 · New PBM entrants have emerged to bring new technology, a simpler business model, and more transparency. I propose to lay out a road map of where we are today and a guide to the market dynamics in the making. PBM background. The PBM industry began in the 1990s to meet the needs of the employer-based health benefit market.
Five things to know about the role of GPOs in the healthcare …
WEBSep 14, 2017 · Based on our analysis, the following are 5 things to know about GPOs, their business model and role in the supply chain, and their impact on healthcare costs and competition: 1. GPOs source and negotiate prices for products and services. GPOs help source and negotiate prices for drugs, medical devices, and other products and services on …
The U.S. Healthcare System is Broken: A National Perspective
WEBJul 27, 2021 · The Center for American Progress estimated that the lack of health insurance in the U.S. costs society between $124 billion and $248 billion per year. In addition, shortened lifespans and the loss of productivity are …
5 Quality Measures That Matter for Value-Based Care
WEBNov 13, 2019 · 5. Equitability. A tricky quality measure to evaluate quantitatively, equitability is nonetheless critical in value-based care models. Equity quality measures encourage providers to provide care to patients from every portion of the population, regardless of demographic. Many value-based care arrangements put an emphasis on-and reward ...