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    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.

    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.

    My Thoughts on Building a Better Clinician Value-Based Payment Program in Medicare

    I think the factors and discussion outlined here apply to all payers transitioning from FFS to value. The bottom line is that you can only do so much with the FFS chassis as the foundation to your value programs. For commercial payers, this presents an important problem that is often not discussed… benefit design and translating the value to purchasers. In many cases the entire business model, from product to distribution channel (think consultants and brokers) to large employers, is based on a measurement of value based on a discount of charges. This archaic metric persists but is buried within the overall process and is only rarely discussed by those trying to transition to value. Employers need to insist on a more contemporary definition of value from their consultants and the plans.

    The COVID-19 Vaccine and Trust

    There is much to unpack here. Trust, Influence and Adherence are tied together. I have rambled on at length about the healthcare delivery system being fragmented. Now layer in the public health system, our federal system of government, employers and unions, special populations who are housed together, and the overall distribution complexity (2 x doses) and I think you begin to see the enormity and task ahead related to distribution to the states… and then from there to the person. The Nascate team focuses on relationships and behaviors to “work” the Gordian Knot that is intervention in healthcare. This is an urgent opportunity and we have some of the answers, I think 🙂 .

    The Linkage Between Attribution and Beneficiary Care-Seeking Behaviors

    I think this pair of blog entries are worth a read. I also think this entry gets at some important suggestions for transitioning the MSSP program. I am not sure I agree with all of it but it is specific and therefore the basis for options, decisions and action. Nice Job!
    I do think they have missed perhaps the most crucial issue — either by choice or simply an oversight. The linkage between attribution and beneficiary care seeking behaviors. As I have posted before the Nascate team believes improving attribution is key to the fairness of all subsequent program specifics. In the past I have asserted that most of the “performance” touted about small vs. large MSSPs is in fact an artifact of adverse selection bias and little to do with performance or population outcomes. The populations themselves are dynamic and pro vs retrospective does not solve the issue. Beneficiaries behaviors and choices need to be accounted for.
    What is important is that providers actions and performance be aligned with incentives that they can influence. This is not currently being accomplished in the program. Large MSSPs with tertiary providers (often linked by large TINs) attract intense treatment burden not necessarily related to clinical risk — but tied to temporal needs for higher levels of care.

    Driving Change in the Post-Acute Care Market

    This is a very useful overview of what is driving change in the Post-Acute Care (PAC)  market. I might add that the COVID disruption needs to be more aggressively integrated into the possible options and overall response. Nascate believes that COVID needs to be the primary factor in PAC strategy development – as it is the immediate challenge. At this point in time it is driving increases and decreases in hospital utilization which will result in changes in who is being discharged AND the appropriate/acceptable referral choices. We find significant power in understanding how patients arrive (inbound journey), the traditional hospital stay, and then both their PAC trajectory and options. The value perceived by the patient and the family in the experience is influenced by the patients reality before, during and after discharge. Information Needs and analytics precede admission.