A framework for managing risk-based managed care contracts (article, December 2013) This article discusses the operational, competitive and financial risks associated to the patient population, the use of patient care management to manage operational risk, the competitive risk that may arise when boundaries between payers and providers are blurred and tactics to manage financial risk beyond malpractice and stop-loss insurance.
The new break-even analysis (article, December 2013) While the idea of questioning the assumptions that underlie break-even analysis will not strike analytics professionals as particularly groundbreaking, it is certainly a novel suggestion in healthcare finance, where quantitative tools are more recent. The article also has the added benefit of providing a detailed list of healthcare-specific factors that decision-makers should consider in their analysis, such as service on medical equipment and length of stay (especially when a new technology has the potential to decrease length of stay by an unknown amount). It is also important to consider patient demographics and competition to assess new capital investments. Finally, the article provides simple, illustrative examples for joint replacement technology investments and prostate surgery technology.
Collaborating with payers to deliver value (article, October 2013) I liked this article for the sidebar on Mountain States Health Alliance or MSHA, which I have been researching as part of my research. MSHA is the majority owner of Integrated Solutions Health Network, a regional health solution company, through which it has created a self-funded insurance plan, its own Medicare Advantage plan and an ACO called AnewCare Collaborative.
The structure of value (article, January 2014) The author recommends the following: compelling vision, alignment of cultures between partners, early wins, measurement of patient and staff satisfaction both before and after initiatives are implemented.
Developing an exchange strategy (article, January 2014) I was very impressed by this article, which advises (1) "understanding how both the public and private exchanges work", (2) "conducting a thorough analysis to quantify how exchanges will affect the organization's current and future patient populations and revenue base" (what the author refers to later as "anticipating changes in the payer mix", on the grounds that "in many states, a greater proportion of exchange enrollment is projected to originate from commercial lives than from the uninsured"), and (3) "determining when to participate in the exchanges, keeping in mind current market position as well as competitors' exchanges."
HFM magazine has many more fascinating articles in each issue that are must-reads for anyone interested in current practices and trends in healthcare finance.