Make no assumptions about reference-based pricing! Not yet, anyway… Reference-based pricing in healthcare is an interesting concept. What it is and how it works: Reference-based pricing is a relatively new healthcare reimbursement model where employers contract with a company to negotiate payment rates outside a traditional HMO or PPO contractual relationship and...
Continue readingWhat’s the difference between “best efforts” and “reasonable commercial efforts”?
This morning, as I was contemplating what to write about for today’s article, I received an email from a client who red lined an offer from a health plan for the new Medicaid Managed Care initiative in Illinois. It seems the payer did not want to accept...
Continue readingVertical Integration Returns to U.S. Healthcare: What You Need to Know Now
In the 1990s, during the Clinton Administration, the USA saw many attempts to achieve vertical integration in healthcare. Here we are again! New acronyms were initiated and made popular to describe Independent Practice Associations (IPAs), Physician Hospital Organizations (PHOs), which were managed and administered by entities known as Management Services Organizations (MSOs). Physicians felt the...
Continue readingThe 340B reductions
So… 340B changes making you nervous? Pull up a chair and pour a cup of tea or coffee. Let's talk about it. As you may have heard, new 340B guidelines announced in November 1, 2017 and became effective January 1, 2018. Since the announcement I’ve been working with hospitals on strategies to implement,...
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