NextGen Advisors

Where is the Value in Value-Based Care?

With all the focus on value-based care it’s interesting that there is no single definition of value. In trying to reduce the definition for healthcare to a formula there is general agreement that the denominator of value is cost.

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The Payer Landscape

“Health plan” is a generic term that refers to any organization that provides coverage for healthcare expenses. Examination of the historical context will elucidate the important distinctions between an insurance company and an MCO.

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The Self-Insured Healthcare Market – What You Don’t Know Can Hurt You

According to a 2009 CDC report, in the 1990s there were approximately 175 million Americans covered by commercial insurance with about 40 percent (70 million) in self-insured plans. Compare that to a 2019 report showing that commercial coverage was down to 154 million, but the number of people participating in self-insured plans had increased to 92 million, constituting 60 percent of the commercial total.

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COVID-19: Does the Quality of the Test Matter?

The pandemic has brought testing to the forefront of healthcare issues. As we hear and see all of the media buzz about the accuracy, reliability, validity, and timeliness of tests for coronavirus, a review of the epidemiological concepts that underlie these discussions can shed some light on the best clinical approach to testing.

COVID-19

COVID-19 Stands on the Shoulders of Giants

In the midst of the COVID-19 pandemic, it is difficult to assimilate the global transformation that has taken place in just a few short months.

COVID-19

Scientific Method: The Key to Conquering COVID-19

As those of us with medical backgrounds are bombarded with questions and opinions from patients, family and friends, let’s take a moment to reflect on how advances in medicine actually occur.

COVID-19

Keys to Sustainable Telehealth Post COVID-19

As we've listened to providers describe their reactions to this pandemic, telehealth continues to be a pervasive theme at the foundation of their response.

COVID-19

N95 vs. Regular Surgical Masks – Distinction Without a Difference?

CDC updated its recommendations for health care providers regarding the use of masks in the context of known or suspected COVID-19.

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The Impact of COVID-19 on Other Health Conditions

Several studies, looking at the secondary health implications of the pandemic, give us an inkling of how broad and deep its impact has been.

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Back to the Future with the Comprehensive Care Physician

In our August 3rd blog we introduced various alternative models of care as a window into potential visions of the future. In this blog, we explore one of those models, the Comprehensive Care Physician (CCP) in greater detail.

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Behavioral Health Providers Face Challenges in Value-Based Care

Value-based care continues to be a popular expression across the health care landscape, but the challenges and opportunities it offers are quite different across specialties. As NextGen Advisor Dr. Martin Lustick explores in this blog post, behavioral health providers are an important case in point.

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Three Ways Interoperability Will Improve Healthcare

To mark NextGen Healthcare's new Cures Act certification, Dr. Martin Lustick looks at the substance behind healthcare's latest buzzword: interoperability.

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Open Notes are Here to Stay

It’s been ten short years since the “OpenNotes” experiment was launched in three major hospital systems in Massachusetts, Pennsylvania, and Washington. That pilot began with 105 Primary Care Providers (PCPs) and about 13,000 patients.

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Transgender Type 1 Diabetes: The Oneness of Mind & Body?

In the face of genetically engineered therapies for many cancers and the incredibly rapid development of effective vaccines for COVID-19, it’s easy to lose sight of the breadth and depth of unsolved puzzles in medical science. Many of these remaining mysteries may be at least partially resolved as we overcome the mind/body dichotomy.

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The COVID-19 Pandemic: Shining a Light on our Better Angels

This blog by Dr. Martin Lustick takes a look at the ongoing COVID-19 pandemic from the point of view of how the role of scientific discovery can be a sometimes messy but, in the case of the current pandemic, an ultimately triumphant endeavor.

COVID-19

Partial Capitation for Healthcare in the Aftermath of COVID-19

The COVID-19 pandemic has served as a stunning reminder of both the critical role that healthcare plays in society and the inherent risks associated with working with sick patients. At the same time, this crisis has already left an indelible mark on the economics of healthcare.

COVID-19

Partial Capitation for Healthcare in the Aftermath of COVID-19

The COVID-19 pandemic has served as a stunning reminder of both the critical role that healthcare plays in society and the inherent risks associated with working with sick patients. At the same time, this crisis has already left an indelible mark on the economics of healthcare.

COVID-19

Pandemic Modeling - An Evolving Science

Even as our experts and leaders use predictive models to help guide us through this pandemic, we all need to acknowledge the significant limitations in trying to predict the future.

COVID-19

Post-COVID-19 Contracting - a Lot to Think About

As provider groups approach contracting with Medicare for a value-based option, they have some choices, but no real opportunity to negotiate. Fortunately, with commercial payers, that's not the case.

COVID-19

The Search for a Solution

At times like this, lots of wild ideas circulate around the Internet about the latest “cure” for coronavirus (COVID-19). Clinicaltrials.gov is a reliable source of information on what is being done to better understand, treat, and prevent COVID-19.

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To V or not to V? That Is the Question

This blog by Dr. Martin Lustick talks about the scientific history behind the COVID-19 vaccines and the continuing vaccine hesitancy.

COVID-19

Will this Pandemic Resurrect Capitation?

The fallout from the current pandemic will likely be a watershed moment for healthcare in the U.S. Many are already predicting that the rapid acceleration of telehealth in the context of social distancing will result in a permanent shift toward virtual visits.

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Five Fundamentals for Effective Care

In our continuing exploration of innovative models of care, in this blog we will examine the efforts of the Cambridge Health Alliance(CHA) to advance primary care in the context of a diverse and vulnerable urban population.

COVID-19

COVID-19 – Viral Lifecycle and Treatment Options

As researchers rush to find treatments and cures for COVID-19, the first impulse is to turn to currently approved treatments where safety is already established.

COVID-19

Comparing the Impact of COVID-19 to Influenza

In October 2019, the Agency for Healthcare Research and Quality (AHRQ) published statistics regarding Influenza in the U.S. from 2005 through 2016. During that period, the country experienced huge variation in the burden of influenza from a low of 31,500 hospitalizations in 2006-07 to a high of 223,300 in 2014-15.

Telehealth

How to Move Healthcare Forward by Looking Back

With our recent blogs on August 3 and August 17 focused on innovative care models, it seems appropriate to pause and review the historical context that served as the foundation for many current innovative efforts. While the focus of today’s article is primary care, many of the learnings have broad applicability.

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How to Reduce Healthcare Disparities in the U.S.

Those of us in healthcare understand that the pandemic represents just one more example of the disproportionate negative impact of health issues on people of color.

COVID-19

Is Your Local Health Plan Afraid of You?

Health plans with a dominant local market share face the ongoing strategic challenge of maintaining that position.

NextGen Advisors

Filling the Cavity Between Dentistry and Medicine

Dentistry has a long and storied history. In Pakistan, evidence was found of a flint crafted drill to treat tooth decay dating back 7,000 years. Today’s challenge is to understand how and why this ancient skill separated from medicine, and what can be done to fill that “cavity”.

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The Claims Data Dilemma: 4 Things to Consider

In providers' ongoing struggle to obtain timely, essential claims data, NextGen Healthcare Advisor Dr. Martin Lustick underscores the obstacles and opportunities.

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The "Wonder Years" of Healthcare

NextGen Healthcare Advisor Dr. Martin Lustick gives us a sweeping—and informative!—overview of 60 years of "interoperability."

NextGen Advisors

The "Wonder Years" of Healthcare

NextGen Healthcare Advisor Dr. Martin Lustick gives us a sweeping—and informative!—overview of 60 years of "interoperability."

NextGen Advisors

Three Ways a Health Plan Can Help Providers

Just as providers have reimagined their clinical and business models in light of the pandemic, there is an opportunity to reimagine their relationship with health plans.

COVID-19

Prior Authorization Reform Post COVID

As hospitals and physicians begin to figure out safe ways to resume elective procedures, health plans will likely reinstitute prior authorization and providers will be back in the position of including this process in their workflow.

COVID-19

Prior Authorization Reform Post COVID

As hospitals and physicians begin to figure out safe ways to resume elective procedures, health plans will likely reinstitute prior authorization and providers will be back in the position of including this process in their workflow.

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How to Integrate Social Services with Healthcare – an Evolving Story

Today we will explore the challenges of implementing effective interventions for SDoH.

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How to Manage Risk in Value-Based Contracts

As providers turn their attention to commercial contracts, they would be well advised to pursue opportunities to manage risk during these particularly uncertain times. Following are some approaches to consider.

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Five Reasons Health Plans Make Payment Errors

When the health plan says a claim is lost or they send an incorrect payment, providers often feel like victims of an evil plot. In trying to decipher health plan motives, it may be helpful to consider the scale and complexity of their operations.

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The Expanding the Role of Specialists in Value-Based Care

Value-based care has become a buzzword over the past decade with early experiments in Massachusetts followed by the creation of Medicare Accountable Care Organizations (ACOs) as part of the Affordable Care Act. As commercial insurers jumped onto this bandwagon, most providers became familiar with the concepts of gainsharing, upside and downside risk, and bundled payments.

COVID-19

COVID-19 Proves that Ambulatory Practices can Transform

Amid the ongoing COVID-19 pandemic, providers across the U.S. quickly adapted to rapidly changing circumstances.

COVID-19

Search for a COVID-19 Solution – the Sequel

In our March 24th blog, Search for a Solution, we shared a list of nine studies related to COVID-19 that were open for recruitment.

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The Impact of COVID-19 on Those with Disabilities and Serious Mental Illness

As early as April 6,2020, the New York Times (NYT) published an article revealing early pandemic statistics that showed the death rate for people with Intellectual or developmental disabilities (IDD) who received residential services in New York State (NYS) was double that for the general population.

NextGen Advisors

The Impact of COVID-19 on Those with Disabilities and Serious Mental Illness

As early as April 6,2020, the New York Times (NYT) published an article revealing early pandemic statistics that showed the death rate for people with Intellectual or developmental disabilities (IDD) who received residential services in New York State (NYS) was double that for the general population.

NextGen Advisors

The Resurgence of the Small Practice

Who says small physician practices are a thing of the past? NextGen Advisor Dr. Martin Lustick points to signs of life in the healthcare universe.

NextGen Advisors

The Resurgence of the Small Practice

Who says small physician practices are a thing of the past? NextGen Advisor Dr. Martin Lustick points to signs of life in the healthcare universe.