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Payment Evolution
Clinically Integrated Networks: Looking Back at Key Learnings and Looking Ahead to Possibilities
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 ...
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Consumer Strategy
Employ a Customer Mindset for Future Viability
Consumerism in health care must transform to meet changing consumer expectations. Consumers increasingly expect to be at the center of their health journey, yet the industry has lacked the ability to translate a retail-like experience—to the benefit of innovative disrupters. To compete and drive profitability, health systems must acknowledge the transformation in health care driven by compet...
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Payment Evolution
Provider-Sponsored Health Plans: a Cure for Health System Woes or "Out of Their Wheelhouse"?
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...
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Payment Evolution
The Great Medicare Advantage Debate: Too Big to Fail, or Failing Because It's Too Big?
Perhaps one of the hottest topics in healthcare today, Medicare Advantage (MA) is anticipated to have a monumental year in 2023. Not only do Congressional Budget Office (CBO) projections indicate 2023 will be the year MA penetration surpasses the symbolic majority threshold of 50% nationally, but also major regulatory changes are set to be enacted or finalized that will impact both plan sponsors a...
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Payment EvolutionStrategic Planning
Key Parameters for Evaluating a Value-Based Care Program
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...
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Strategic Planning
Strategic Planning Is a Journey... Prepare For It
Sg2 partners with chief strategy officers and executives from leading health systems to understand the role of strategic planning and how it continues to evolve in response to broader industry trends. Learn how organizations are currently approaching the planning process by checking out findings from our recent survey of senior strategy leaders. Download our Strategic Planning Placemat to better u...
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Payment Evolution
Observations From 2022 Fourth 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 these tie to VBC. The following post draws from recently released earnings call transcripts fr...
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Care RedesignChildren’s HospitalsService Lines
Addressing the Pediatric Mental Health Crisis with Integrated Behavioral Health
As children's hospitals and providers of complex pediatric care emerge from the pandemic, we have seen familiar challenges and priorities tenaciously reemerge. Chronic inadequacies in pediatric behavioral health service delivery, combined with pandemic-induced disruption and stress, have worsened today's acute pediatric mental health crisis. The rising prevalence and severity of pediatric behavior...
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Health Care LandscapePolicyPayment Evolution
Working Toward a New Normal: Insurance Coverage After the Public Health Emergency
Each year Sg2 debuts the latest enrollment projections from our five-year Insurance Coverage Estimates (ICE) demand forecast. The team considers ZIP code level, age, federal poverty level, ethnicity and gender data to meaningfully distribute the population across financial groups. The following national trends were key inputs to the 2023 ICE model. Note: Numbers may not add due to rounding. Sourc...
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Strategic PlanningSmart Growth
The Growth Mindset for 2023
Note: Vizient's David Levine, MD, FACEP, Group Senior Vice President, Advanced Analytics and Product Management and Simrit Sandhu, Executive Vice President, Strategic Transformation and Clinical-Supply Solutions also contributed to this report. Health system leaders have faced unprecedented challenges over the past three years. The pandemic caused a sharp decline in inpatient volumes and a tempor...