Value-based success,

The relative success of PCP capitation, and the failure (lack of market uptake) of episode based payment for me points to an opportunity. Nascate has developed a powerful Attribution Engine that develops insights into existing member/patient to provider relationships and can be used to support accountability and payment. These relationships insights are based on behavior

This has always been a poorly implemented distortion within the existing FFS structure. It helped inflate practice values for acquiring hospitals, confused countless patients in terms of co pays … and sown overall disruption on fairness and continuity. Now it appears to be on the cusp of being rolled back for Medicare FFS.What will be

Commitment to improving care needs to be matched by ongoing efforts to understand the results of our efforts and continued redeployment of resource investments to scale what works. Nascate is focused on both providing insights, and working with partners to scale what works. Unfortunately improving care delivery – requires ongoing management and portfolio adjustment. This is a

I thought this is a useful quick read. The idea of defining the outcomes being solved for via a framework is a good place to start. Nascate has been focused for the last few years on segmenting and targeting patients/members to improve the likelihood of “success”. But success needs to be defined by predetermined outcome definitions

This is a very realistic vision for telemedicine. It will be a very useful advance in care delivery … but it is not an attractive investment.  The key point made — Medicare will reimburse telemedicine visits the same as in-office visits (a massive change), more providers will provide telemedicine WITHIN their own practices. Counterintuitively, this

I find this an interesting discussion — on the assumed sustainability of the MSSP program and shared savings. For me it misses the BIG POINT of all this. We can mitigate the impact of COVID – related to spending baselines (Budgets) and attribution but in doing so exacerbate the disconnect and correlation between a provider’s

Should this be a surprise? There may be many valid reasons to deploy a wellness program across a broad non-targeted employee population – making employees healthier seems to me to be the least persuasive one… and the clinical outcomes are not the ones I would be interested in. What would I care about — PTO

The criteria here applies to more than home care … it really boils down to flexibility and innovation – enabled by some form of risk based payment. Capitation is one — and the more broadly applied the better …. if the risk is understood. I think the pandemic will bring innovation to healthcare in the

Is this the future of adult primary care? Does it offer a better member/patient experience? Can the SDOH barriers be addressed? I think the answer is most likely YES. But the key enabler of all of this is a subscription member focused payment model. It is the game changer. One thing to consider – could

Remember Little Red Riding Hood -the porridge was too hot, too cold and just right. Well payers and ACOs have been trying to change behavior and reduce “inappropriate” use of the ED — but the headwind of FFS incentives and cross subsidies among payer types and settings made it a sysphisian task. Along comes COVID

An important objective that has, unfortunately taken on a life of its own and has outlasted its utility and value. I don’t have the answer. I do have an opinion, don’t conflate quality with payment incentives. Quality is a floor and providers who don’t demonstrate sufficient initial quality should be curated out — think about

I think this is an important read for both payers and providers … and does a nice job of outlining going forward considerations and challenges. In essence much of healthcare delivery will no longer be directly tied to geography and increasingly tied to relationships and loyalty based on consumer preference. Not to get over hyped

I think the ACO programs that are based on shared savings are in an untenable position. Shared savings is a middle ground … between “no risk” and risk … and that middle ground is undergoing a profound disruption. For providers seeking to hedge their bets … this is a problem. As I have stated previously

The speed of change in how care is delivered is impressive. The reality however should be sobering to all — the business models that support US healthcare — and manage the flow of funds from person to payer to provider – will not support the changes taking place. While everyone has complained about FFS amid

Looking for something to listen to while working from home? Check out this podcast that takes a deep dive into how COVID-19 is changing the world of healthcare.

I have a sense that this current crisis may be the push that value and risk needed to push FFS payment methods off their perch atop the hierarchy. Providers whose business models are predicted on seeing patients and using high cost settings are now experiencing a new vulnerability. When you can not generate revenue directly

Our team at Nascate has, from the beginning, based our work on a simple idea – People and their behaviors have been under-valued in trying to achieve and sustain value based care. We believe that existing care delivery norms fail to understand and address people and instead focus on patients exclusively (recent emphasis on SDOH

This is an extreme example of what I think will increasingly be clear in the future. Providers and payers focused on a marketshare driven future, built around sustainable growth in covered lives and related services. Our work at Nascate is built around this premise – and the results are eye opening. If systems can focus

The tradeoff outlined here is between choice and administrative costs. Nascate is hot on the trail of the costs associated with excess choice in terms of provider networks and the ability to “get lost” in the delivery system. We have consistently found that choices need to be informed and intelligently managed. We believe that if

The press on ACOs has been mixed at best… and policymakers and academics seemed puzzled by the lack of sustainable results. But I think that the results are mixed because the incentives for providers and members/beneficiaries/patients are mixed or non-existent. Shared savings as the fuel and the resulting weak incentives once the low hanging fruit

This change is long overdue. We want closer relationships, they produce better results. We want coordination, it improves the patient experience. Both closer relationships and better coordination produce value and lower costs. Nascate is leading the way in changing how we get to value and success.-Bill KellyWilliam P. Kelly is our Chief Executive Officer. He

The low hanging fruit have been harvested. Disillusionment with marginal efforts (and they are marginal) and results is growing. Nascate supports the long road ahead with our metrics, tools and AI insights. If costs and affordability are not addressed Healthcare will be changed from the outside. It may seem like we are rushing through a

I think this article highlights some important and to an extent nuanced ideas related to improving healthcare performance. In much of the press, both commercial and academic, measurement and metrics — the technical detail and caveats – are often overlooked as we search for solutions and try to improve. At Nascate we have spent years

Though it’s a fun ribbing often heard between men and women- the data supports the anecdotes. According to the National Center for Health Statistics, the number one reason men avoid going to the doc is that they “only go if they are extremely sick”.As we transition from “sickness” to “wellness” in healthcare, finding these types

The ideas outlined here … apply to all plans, but the authors emphasis on provider led is well articulated. The lack of strategic clarity; are we in the member business or the patient business? is a significant issue. But I would suggest that this headline/takeaway – Integrated delivery networks (IDNs) can generate more than twice

I think United “gets it” — whether they are the best solution is another story. Nascate is built upon the premise that value comes from successfully de-fragmenting care. We see substantial performance differences (that can be exploited) based on our measurements of the strength of relationships, Social Determinants, etc… the “people” factors that are under

I think United “gets it” — whether they are the best solution is another story. Nascate is built upon the premise that value comes from successfully de-fragmenting care. We see substantial performance differences (that can be exploited) based on our measurements of the strength of relationships, Social Determinants, etc… the “people” factors that are under

Post-acute care (PAC) is one of the fastest growing areas of US healthcare spending. Hospitals must identify ways to decrease PAC spending, but they’re overlooking crucial factors responsible for variation in spend. Nascate looks backward (and beyond the clinical data) to predict needs moving forward.Chrissie Classen is our Education Lead and Head of Content Creation.

There’s no way to avoid transitioning to value-based care, but there are ways to make it easier. At Nascate, we have the tools and expertise to make the transition smoother and more effective. Check out this article on other best practices to enhance value-based care.

Almost 33% of millennials don’t have a primary care provider. This is just half of the 67% that only see a doctor in urgent situations. We know the impact this has on a person’s health, and on the health of the economy. We not only identify those who have financial liabilities, but can match them

There’s no way to avoid transitioning to value-based care, but there are ways to make it easier. At Nascate, we have the tools and expertise to make the transition smoother and more effective. Check out this article on other best practices to enhance value-based care. Chrissie Classen is our Education Lead and Head of Content Creation.

The challenge of shared savings is the need to continually find performance opportunities. Our work with ACOs on Post Acute Care indicates that it can represent such an opportunity. The Nascate data science team has developed predictive tools that can be used to make the most of those opportunities, meet emerging CMS PAC referral requirements

The challenge of shared savings is the need to continually find performance opportunities. Our work with ACOs on Post Acute Care indicates that it can represent such an opportunity. The Nascate data science team has developed predictive tools that can be used to make the most of those opportunities, meet emerging CMS PAC referral requirements

Check out the ROI on “connecting” consumers to the right primary care providers. Organizations only need 15% engagement to capture millions in savings!Chrissie Classen is our Education Lead and Head of Content Creation. She has extensive experience including roles at Treo Solutions/3M HIS, Autotask Corporation, and Datto, Inc. Her incredible work has been incorporated in

I suspect that this article represents the tip of a growing iceberg. We at Nascate have begun to appreciate that “the consumer based revolution” in healthcare is fundamentally changing the liquidity of members loyalty and impacting retention across all lines of business. Consumers are voting with their enrollment … and long held assumptions around retention,

Traditional predictive algorithm used in population health management can be incredibly biased. At Nascate, organizations can leverage our proprietary algorithms and metrics to sidestep the inherent bias. The result? Risk prediction that is more accurate, better identification of who will benefit most from care management programs, increased savings, higher retention rates, and more.

These results are impressive … but I have a question for those involved… if low revenue = physician led then can we eliminate adverse selection (bias) within the attribution results from being a contributor to “performance”? I have been beating this horse over and over but based on our analysis of larger delivery systems, and larger

I want to re-emphasize the importance of attribution to all value based and pop health efforts. You can not have “accountability” if no one is accountable – and that for better or worse needs to be based on some agreed to attribution or assignment – by the person, by choice, by utilization (not my favorite)

If you are not UnitedHealthcare but want the same capabilities that are being outlined here reach out to our team here at Nascate. We have independently developed capabilities that match what is outlined here. The business rationale is similar but we need independent payers and provider partners to make our insights and capabilities change healthcare!

Risk. Opportunity. Competition. Market Share…Smart growth in the Medicare Advantage world means effectively managing and measuring what matters is necessary . Check out this video to see how our Medicare Explorer Module(TM) makes a difference.

I liked this article. But I think there could be more in terms of simply defragmenting the delivery system. Treatment complexity was not identified.  Most integrated delivery systems don’t fully live up to the name — it is a work in progress. At Nascate, we are working hard to provide the insights to achieve these

This is a nice UnitedHealth report highlighting the importance of person-provider relationships … At Nascate we have studied the importance of connecting with the right provider and how it is associated with better outcomes, we’ve also found that as the numbers healthcare services a person requires increases so does the benefit of being connected. For

Our employees do some pretty incredible things, whether it’s creating a new way to interpret data, or representing Nascate at an event with industry leaders. Our Principal Data Scientist, Kevin Buchan Jr., had the opportunity to introduce Hearst Health’s president, Dr. Gregory Dorn, at the University at Albany, SUNY’s Cancer Research Center on September 19.Kevin

Medicare Advantage enrollment is steadily growing. Constructing a high-performing network of providers is critical for ACOs preparing to grow in this market, but successful network curation requires more than looking at traditional provider performance. Nascate’s Medicare Explorer solution combines public and client data to provide necessary insight into how people and providers behave, existing relationships

The complexity of life is impacting how Sam, Bob, and Ted each interact with the healthcare system. Things like family dynamics, geography, the choices a person makes in how they receive care- all give us the full picture of a person and what drives their utilization, or lack thereof. Better healthcare, unlocking value, managing cost

There is much to sort through in this… but the blog did again raise what I consider to be an important point. Any of the Value Based initiatives of CMS (and other payers) put forth are based on two seemingly innocuous bits of math/method — Attribution  and Risk Adjustment. All the evaluation work of the

A person’s healthcare journey happens over time. The order of events, changes in patterns, and the interaction of multiple events…all matter significantly, and can only be adequately captured with LONGITUDINAL data. And yet, most healthcare organizations rely on snapshot information. That’s because the cost, complexity and technical resources required to leverage longitudinal information can be

I thought this article was interesting … not because of the specifics, Mayo may not scale to your organization, but because of the idea of making huge bets. Annie Duke wrote a book that I found to be very useful … “Thinking-Bets-Making-Smarter-Decisions”, that highlights the utility of probabilistic decision making. Too often we focus on

Data liquidity and access leads to innovation. I ran across this resource and thought — that could be really powerful if put to use. But as I delved deeper it seems my hopes may need some time to become reality. I would love to learn more from anyone who has made some progress with this

Healthcare organizations need to target resources on those whom would benefit the MOST from timely intervention. We optimize the entire process by providing the insight needed to identify people early on, and give them viable and local options.Chrissie Classen is our Education Lead and Head of Content Creation. She has extensive experience including roles at

I think “value-based” does work. Let’s face it, it has to. The challenges are more around the journey than the destination. The emerging obstacles are around scaling and accelerating the maturing process at a local level. Outstanding issues persist around; attribution, defining the right metrics and value, the influence of SDOH, and the importance of

I believe Human Capital is the key differentiator in our cloud based and virtualized world. So success in any endeavor is predicated on recruitment and retention. Both need to be attended to, but if you cannot retain the best you will be spending way too much time on the recruitment treadmill. We make a significant

I continue to follow the back and forth (mostly in the academic press and echoed by the healthcare media) on ACO or MSSP effectiveness. I wonder about the usefulness of the dialog. It appears to me that the conversations are retrospective and about measurement – I understand the conversations, but question practical value. Program changes

Getting to people early, instead of chasing dollars that have already been incurred, has major advantages for healthcare payers, providers, and most importantly- the person. Nascate Early Action means intervening “before”, and micro-targeting action/intervention on a very small group of people, but with substantial results. The power of these results continues to surprise me (I

MedPAC’s recent report to Congress examines a variety of Medicare payment system issues, including analysis that brings to light the unintended consequences of assignment, and the “problematic connection between changes in beneficiaries’ ACO assignment and changes in spending”. At Nascate, we’ve been talking about the importance of attribution for some time. Our advanced data models

ACOs need to manage the unknown risk of beneficiaries. Nascate can help you pinpoint who you want attributed to you by predicting who will match well with your providers, which beneficiaries are at risk of leaving, which providers are impacting the folks you’re attracting, and much more. A recent study by Harvard Medical School found that primary care doctors have more “sticking power” than specialists,

Fairness, Accountability and Attribution. When you discuss value-based care, payment or simply performance measurement these words seem to be disconnected, at best, and often in conflict. At Nascate we have been busy dissecting the Selection Bias that goes along current Attribution Methods — and the results have been both enlightening and hopeful. The source of