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DisruptionTechnology
Generative AI: Seven Steps Health Care Companies Can Take Now to Prepare
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...
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Payment Evolution
CMS Announces MultiState Initiative to Support Primary Care Practices with Varying Levels of Value-based Care Experience
Making Care Primary Model Overview On June 8th, CMS announced the upcoming launch of the Making Care Primary (MCP) model. This new CMS model aims to achieve three goals: Provide patients with primary care services that are integrated and coordinated with specialty care as well as leverage community-based connections to better address patients’ social determinants of health (SDOH) needs...
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Strategic PlanningPartnershipsConsumer Strategy
Optimizing Health Care Network Referrals Through "Blended Family" Approach
Health care providers in many markets have found themselves becoming a part of something larger than they originally signed up for. For hospitals and health systems to be sustainable during current workforce challenges and margin pressures, they are increasingly joining large networks to drive revenue. As a result, the health care industry is seeing record numbers of mergers and acquisitions, ofte...
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Payment Evolution
Five Observations From 2023 First Quarter Earnings Calls: Legacy Payers and VBC Market Entrants
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 they tie to VBC. The following post draws from recently released earnings call transcripts fro...
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Consumer StrategySmart GrowthStrategic Planning
Customer Loyalty: A Strategic Opportunity in Challenging Economic Times
The health care industry is facing economic headwinds: surging inflation, pandemic-driven staffing shortages and rising competition from novel disrupters. About half of all hospitals reported a loss in 2022, according to Kaufman Hall, and the outlook for 2023 isn’t much better. Today’s conditions demand a new business model, one that centers on customers first—not products or s...
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Consumer StrategySmart GrowthStrategic Planning
Shifting Health Care Mindset from "Patient" to "Customer"
Our opinions, beliefs and values influence our choice of words and phrases. However, we are not always conscious of the reverse — that our choice of language can influence our opinions, beliefs, and values. This is a highly overlooked factor in humans’ adaptability to change. When we use terms that have a significant and emotional meaning in one context to another, we bring that contex...
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DisruptionPayment Evolution
Risant Health: a New Disrupter on the Scene
The Kaiser-Geisinger Partnership Enables Value-Based Care The newly announced deal between Kaiser Permanente and Geisinger could turn out to be one of the most impactful health system partnerships in recent years. The deal is subject to regulatory review, but if it goes forward, Geisinger will join Risant Health, a new nonprofit formed by Kaiser Foundation Hospitals with an emphasis on value-ba...
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Health EquityPayment Evolution
Taking an All-Patient Approach to Advancing Health Equity
As payers incorporate much-needed financial incentives to advance health equity, provider organizations and clinically integrated networks (CINs) should adopt payer-agnostic approaches for true transformation. Both public and private payers have begun incorporating financial incentives into contracts with providers to advance health equity. The ACO (accountable care organization) Realizing Equity...
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Consumer Strategy
Leveraging Network Integrity to Achieve Customer Loyalty
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...
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Payment Evolution
The BPCI-A Program Has Been Revised and Extended; Should Your Organization Participate?
The Centers for Medicare and Medicaid Innovation (CMMI) has opened the application window for the Bundled Payment for Care Improvement Advanced (BPCI-A) program for the third and final time. Through May 31, 2023, provider organizations can submit a non-binding application to participate in the program’s two additional model years. The program extension may be an opportunity to work towards o...