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Payer-Provider Integration

Health insurance companies and a healthcare provider may greatly benefit from systems integration. Healthcare payer and provider organizations have different goals but need to work together to generate efficiencies. How can we bridge the gap between the two parties?

Washington State Health Care Authority Center of Excellence joint replacement elements and outcomes of program produces strong patient experience scores

New Marketplace

Improving Care by Redesigning Payment

A state-run center of excellence uses benefit design to improve outcomes while controlling cost.

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Disrupting the Health Care Landscape: New Roles for Familiar Players

NewYork-Presbyterian

Pottharst01_pullquote - value-based health care leadership personas

Leadership

Personas of Leadership in Value-Based Care

The deliberate nurturing of specific types of leadership personas seems to be a critical factor in the success of value-based care organizations.

Shrank02_pullquote IDFS

New Marketplace

Effective Consolidation: A Model for Reform Through Payer-Provider Integration

UPMC’s payer-provider partnership integrates real-time data to support improved clinical decision-making and optimizes clinical and financial performance.

Why Employers Drag Feet on Value-Based Insurance and Reshaping Health Care Coverage: A Classic Public Good Problem Panel Clip Still

New Marketplace

Reshaping Care Coverage: A Public Good Problem

The companies most capable of leading transformation in health care coverage are the ones that least need to.

Robert Gavin head shot

New Marketplace

Amazon and CVS: Short-Lived Unicorns in Health Care, or Healers of the “Tapeworm”?

Will Amazon–Berkshire Hathaway–JP Morgan and CVS-Aetna change the health care game? To one health care employer purchaser, these announcements feel a lot like Groundhog Day.

Gary Kaplan Head Shot

Patient Engagement

Improving Patient Involvement in Care

The CEO of Virginia Mason on facilitating and enhancing patient participation in care.

Simplified Chain of Production for Primary Care Services Generating Retail Prescriptions. Solid arrows indicate contractual relationships or ownership, and the dashed arrow indicates referral for prescription.

New Marketplace

Does CVS–Aetna Spell the End of Business as Usual?

What might one of the largest mergers in history mean for the health care delivery system?

Lack of Incentive Is Top Barrier to Implementing Value-Based Payment

New Marketplace

Survey Snapshot: Payer-Provider Alignment Is Difficult Even for Integrated Organizations

NEJM Catalyst Insights Council members say stronger incentives and better use of analytics could improve alignment.

How Aligned Are Payers and Providers in Working Together to Achieve Value-Based Care

New Marketplace

New Marketplace Survey: Payers and Providers Remain Far Apart

Health care stakeholders are not aligned in important goals and in large part are not working together to achieve value-based care, according to the NEJM Catalyst Insights Council. They are waiting on government regulators to change the payment model — including, possibly, single-payer health care.

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