Sg2 Blog

Health systems and providers have participated in alternative payment models ranging from pay for performance to full risk across all payer classes. Not surprisingly, many participants have exited these models as the industry experiments while navigating the transition to value. Too many organizations have drawn conclusions about the efficacy of value-based care (VBC) based on incomplete informati...

Clinically integrated networks (CINs) gained a foothold more than a decade ago amid the backdrop of an unsustainable trajectory for fee-for-service (FFS) health care delivery. CINs could function as a vehicle for value-based care (VBC) models in providing an alternative for clinical and payment model advancement. Since then, CINs have become a cornerstone of care delivery, enabling clinical value ...

With the Strategy Accelerator program, efforts to strategically prioritize care at home programs for deployment take shape. Amid increasing inpatient lengths of stay; capacity limitations; and pressure from competitors, policy makers, payers and patients, the forces pointing to care at home as an opportunity continue to mount. However, success requires careful planning and analysis to craft a tail...

For some, value-based care (VBC) is just a trendy term that replaces other expressions that have come before it (eg, population health, accountable care, managed care). It often connotes a payer contracting strategy that involves some degree of risk sharing and quality reporting, but for those providers who fully embrace it, it’s much more. VBC is a vital part of addressing the challenges th...

Clinical and technological advances continuously reshape healthcare services and the workforce that delivers them. In a cycle of creative destruction, new roles emerge while some legacy positions are reconsidered. Multiple drivers will also impact workforce needs in coming decades. Examples include an older and more diverse population, environmental impacts that disproportionately affect vulnerabl...

Generative artificial intelligence (AI) has seized the public consciousness, signaling a potential disruption that could be one of the most profound in generations. Large language models, such as ChatGPT, are advancing rapidly, demonstrating an uncanny ability to process natural language and write compellingly (if not always accurately) by predicting word sequences. As more AI tools become avai...

Just because healthcare organizations open their doors doesn’t mean that patients will show up. This was especially true during the pandemic as a pause on elective surgeries, lack of a transactional care and revenue led healthcare systems to struggle. Add to that inflation and the increase of nontraditional disruptors — whether tech, private equity or venture capital-backed firms or pa...

As part of Sg2’s value-based care (VBC) analysis and market research, we review the quarterly earnings calls from a subset of publicly traded legacy payers and VBC-focused entrants. The summary is designed to highlight emerging trends and dynamics in these closely related industries, especially as these tie to VBC. The following post draws from recently released earnings call transcripts fr...

We have been here before; some have succeeded, or at least gotten by, while many have failed. At what? Building an integrated model where the health system is both the provider and the payer. Lessons were learned, yet today’s economic uncertainty, rising costs and hospital financial performance coupled with major insurer reluctance to continue fee-for-service (FFS) rate increases have hospit...

Physician referral analytic tools have existed for decades to help health care organizations understand referral patterns, prioritize outreach efforts and monitor progress, and organizations have long considered physician outreach teams as tools to improve leakage and increase revenue. While both of these still hold true today, there is actually more to the story. Leakage from affiliated physician...