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    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?

    This is a report that echos so many others … but the point is a useful reminder – and clearly knowing and addressing are two different things. My general agreement aside I do believe that the notion of “10 percent of the population (commercial) account for 70 percent of the costs” is not adequately actionable. Identifying 70 percent of the costs includes many costs that can not be impacted or are identified late. 20/20 hindsight does not help providers or those seeking to improve care. In addition, behavioral health can be both a precursor and a result of deteriorating physical health. The point that they are linked is a powerful one. Our Nascate models make it possible to segment that “10 percent” to more specifically identify both individuals and families that can most benefit from carefully curated interventions and providers.
    Increasingly I think we need to press on timing, interventions and specificity. While useful, and a welcome call to action — we need to take the next step and map the actions and improve the timing. We are all seeking results and partnerships that lead to them.
    We believe that if you focus on how people act (behaviors) and who they interact with (relationships) you can be more effective.

    Nascate Reframes Provider Performance Questions

    Nascate has begun to address the key questions around network curation, provider options and more. The Nascate Provider Recommendation Engine builds on a proven AI model, our obsession with the relationships and behaviors that predict healthcare performance, and Nascate metrics to help plans and systems of care achieve sustainable value.

    When it comes to picking a specialist or curating a network – fairness and informed choice can be in short supply. Uncertainty around the link between decisions and outcomes hinders decision making and resulting action – but the need to inform persists. Nascate has chosen to rely on the most fully informed local decision maker – the referring physician and advanced AI. The challenge is to aggregate those often qualitative and quantitative inputs across many providers into better informed individual choices.

    The pandemic continues to challenge healthcare in many ways across many contexts … and ongoing ripples of discontinuity are emerging. For those tasked with network management, understanding provider performance, and patients needing to make a provider choice, this gap can not be ignored. The year 2020 may be an outlier but the need to make informed decisions can not take a year or more off. By leveraging tools used by Google and others we can provide insight and guidance that reflects the current reality of provider performance.

    The Need for Alternative Payment Models

    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 rather than simple utilization or gatekeeper rules and can include a variety of possible “provider of record” endpoints.

    The need for alternative payment models related to chronic conditions, cancer care, etc., and include specialists is important, but should not start at the condition level. Instead I believe that the Nascate ability to reflect existing member decisions and preferences at the hyper local level (in our relationship metrics) should be the starting point. Leveraging existing behaviors and local realities can produce better results with less disruption as to the “provider of record” and more comprehensive alignment between payment and accountability. Being overly proscriptive with regard to “a primary care provider” or trying to carve out specialist related utilization, or artificially creating an episode for payment, all distort alignment and subsequently payment incentives. We can do better.

    Nascate Personas™

    This white paper delves into the science behind our segmentation methodology, and the role personas play into effectively making decisions.

    Open White Paper (PDF)

    FFS Structure in the Future

    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 the implications for payers and employers? I suspect it depends on local market conditions … but hospitals will first try and rebalance overall revenue by asking for more …

    So I would suggest that commercial payers need to take the initiative and try and buffer themselves from this reflexive reaction.

    Our Commitment to Improvement

    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 reality that program staff tend to resist – if you are motivated by doing good – and you see results, it is hard to move on even if greater good can be achieved.

    For this article here is the punchline – “findings suggest that program participants who are proactively targeted via predictive stratification and consistently engaged with high-value program activities experience postprogram cost reductions that are nearly 2 times greater than average” We have seen similar results … so I like the confirmation.

    But what I most appreciated were the detailed methods to sort through the confounders that many, if not most, explorations of interventions tend to ignore. The authors did a nice job here.

    Embracing Capitation

    I agree ,agree, agree with this. If payment incentives drive care – and they do — then this needs to be a cornerstone. But providers need to be supported in the transition and the right information is critical to success. I think that the clarity inherent in capitation and alignment around members/patients, retention of those members and the payment model addresses much of what currently inhibits provider success. Being halfway is being nowhere … and the transition to true value has taken too long and the costs to all parties too great. The success and growth of MA is in part due to the clarity of the payment model (often shared downstream) and incentives. I think that risk adjustment has been poorly implemented but that is a relatively minor complaint given the growth and changes begin driven in that market.

    Healthcare Spending and Health Burden

    This is interesting but rather dense … so here are my take aways …

    1. Healthcare spending is not perfectly associated with health burden, and for some health conditions, a large amount of spending occurs independent of health burden.
    2. Several of the health conditions that have the most attributable health burden actually have relatively little health-care spending.
    3. Healthcare spending and health burden are not well aligned, and many of the health conditions with the most spending are less attributable to the risks considered in this study.

    This is an important context for our work Nascate.

    Subscription Payments are the Answer

    When you weigh the need to preserve our healthcare providers, and physician access in particular, and you think about FFS and COVID you can only be concerned. For payers — the networks they have curated over the years, a key asset, need to be preserved. I continue to believe that some form of subscription payment — capitation or partial cap is the only answer that is capable of addressing this pressing need. Nascate has developed solutions that can be deployed quickly to address the emerging problem.

    Check out the article that got me thinking about this here.

    Does Behavioral Health Make a Difference?