Sg2 Blog

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...

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...

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...

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 ...

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...

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...

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...

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...

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...

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...