Business Strategy

Despite their proliferation, at-risk pharma contracts are still little more than value-based window dressing. Here are four critical components of contracts that can actually move the value meter in the right direction.

Industry experts are using their proprietary data/analysis to help structure contracts between pharmaceutical companies and plans.

Preventing hospital readmissions must be top of mind for payers and providers, says Jill Duncan, RN, executive director at the Institute for Healthcare Improvement, where she leads the Joint Replacement Learning Community.

Successful healthcare systems share their strategies for reducing hospital readmissions.

A value-based cancer care model focuses on better aligning providers with health plans and employers through an IPA.

The ACA risk-adjustment model applies to plans sold in the individual and small group commercial market, including plans sold through exchange marketplaces. Here are four main limitations.

CMS’ Comprehensive Care for Joint Replacement model will hold hospitals financially responsible for the quality and cost of hip and knee replacements.

Participants in a new CMS payment program will attempt to improve the effectiveness and efficiency of cancer care delivery. Here’s how.

Researchers from Leavitt Partners are using a combination of public and proprietary data to report on some early findings about ACOs.

The combination of unsustainable healthcare spending and the rapid growth of value-based reimbursement revenue models is driving the shift to patient-centered care across the continuum-or continuum-centered care.

Healthcare organizations are looking for new ways to engage consumers, streamline information sharing and transparency and collaborate with other industry stakeholders. As a result, healthcare stakeholders need to focus on three key strategies.

How approaching the open-enrollment process with a customer-centric mindset promotes member retention.

A recent survey reveals how generational differences affect consumers’ health plan and provider preferences and selections.

Creating a national data policy framework for empowered consumer choices.

With new requirements from CMS on the horizon, how will the shift to value-based care impact consumers, payers, and providers?

As pharmaceutical companies of all sizes continue to adapt to the ongoing internal and external pressures of the new health economy, it remains imperative that strategy maintain distinct capabilities to position the company ahead of its competitors.

Insights from the 2016 edition of the largest gathering in specialty pharmacy.

MACRA, which will further the shift to value-based reimbursement, has industry insiders grappling with the complexities, particularly those related to reporting guidelines for providers.

An expansion of the ACA requires health plans to cover a new preventive service: Regular nutritional counseling for millions of overweight Americans with other health risks.

Health insurance coverage remains a huge challenge for small businesses due to cost. Health plan providers and brokers are in a unique position to address these challenges and target the working uninsured with affordable options for coverage.

Colorado could have the first statewide universal healthcare system in the country if proposed legislation passes in November. Will it happen? Experts weigh in.

Insight from Paul Markovich, CEO, Blue Shield of California

Doug Chaet, senior vice president, Provider Networks and Value-Based Solutions at Independence Blue Cross, shares five strategies that can help providers succeed in value-based reimbursement models.

Democratic presidential candidate Hillary Clinton vows to provide more affordable, cost effective, accessible, and higher quality healthcare and insurance coverage. Here’s a closer look at seven key ways Clinton would change the healthcare system if elected president.

Hospitalizations represent up to 80 percent of the direct medical costs of heart failure; reducing heart failure hospitalizations can help bring down overall healthcare costs.

New regulations will check the drive to narrow networks, just as the business case for forming them grows more compelling.

Democratic presidential candidates Bernie Sanders and Hillary Clinton both vow to make healthcare more affordable, accessible, and higher quality. Here’s a closer look at two of the ways Sanders proposes to do this.

The Leapfrog Group announced its Hospital Safety Scores, which gives hospitals a grade of “A” through “F” for patient safety.

After suffering significant losses on the health insurance exchanges in 2015, insurance giants UnitedHealth Group and Aetna announced they may leave the exchanges next year.