"Virtual Detailing in Life Science Organizations"

By: Athena Health

At varying paces nationally, payment models are shifting from fee-for-service to fee-for-value, including new models in which leading provider organizations take on the financial risk of providing health care to a pre-defined population. While many agree that value-based reimbursement will become increasingly common, fee-for-service contracts remain the dominant form of reimbursement in most markets. A recent poll found that 81 percent of health systems and hospitals are participating in a mix of value-based reimbursement models combined with fee-for-service.1 For the foreseeable future, hospitals, health systems and other large provider organizations will have a foot in two boats and the engines in both must be able to run efficiently.

By: Athena Health

The pressure exerted on practices to grow, often through integration with additional practices or with larger health care systems, has been strong for years, and the trend shows no signs of abating. There are multiple reasons for this trend. One is the desire for critical mass to gain leverage with payers in specific markets as payer reimbursement declines relative to increased cost. Another is the shift to quality-based reimbursement, risk contracts, and Accountable Care models—all of which require actuarial data and expertise in pricing insurance along with the infrastructure to handle population management.