Guest Introduction: Maria has extensive experience in healthcare, focusing on value-based care from both provider and payer perspectives. Her career spans consulting, payer space, tech, and starting her own company, Revelar Analytics.
Importance of Data in Value-Based Care: Data is crucial for driving strategies and initiatives in value-based care. Without data, it's challenging to implement and measure value effectively.
Career Journey: Maria's career included consulting on patient-centered medical homes, developing CareFirst's PCMH program, and working with Aledade on accountable care organizations. She later joined Salient Healthcare to build a multi-payer platform and then Closed Loop AI for partnership programs.
Revelar Analytics: Maria founded Revelar Analytics, focusing on price transparency to help value-based care organizations and those on the fee-for-service continuum use publicly available data meaningfully.
Price Transparency Data: Revelar Analytics leverages publicly available price transparency data to provide insights into fair market value compensation. This data helps organizations understand and negotiate fair reimbursement rates.
Challenges with Price Transparency: Despite regulations, hospital and insurer price transparency data can be difficult to decipher. Revelar Analytics makes this data human-readable and accessible.
Impact on Providers: Small provider organizations and large hospital systems can benefit from understanding fair market value compensation. Self-funded employers and investors are also interested in this data for mergers and acquisitions.
Variation in Reimbursement: There is significant variation in reimbursement rates across regions and payers. Understanding this variation is essential for negotiating fair rates and ensuring sustainability.
End-of-Life Care Costs: End-of-life care is costly, with significant spending in the last days of a patient's life. Value-based care aims to reduce these costs by keeping patients healthy and avoiding unnecessary hospitalizations.
Use Cases for Price Transparency Data: Beyond healthcare providers, medical device companies can use this data to understand reimbursement rates and develop pricing strategies. Remote patient monitoring and other services can also benefit.
Evolution of Value-Based Care: The data can be used across the value-based care continuum, from fee-for-service to full-risk contracts. Understanding bundled payment rates and quality metrics is crucial for effective value-based care.
Conferences and Networking: Maria and her team attend various conferences to share insights and developments in price transparency and value-based care. These events are opportunities for networking and learning about industry trends.
Potential Follow up Guests, Questions and how to make this a reality….
1. Farzad Mostashari, MD - Co-Founder and CEO of Aledade
Organization: Aledade
Background: Dr. Mostashari has been a significant figure in healthcare reform, especially in advancing accountable care organizations (ACOs) and value-based care models through Aledade. He has extensive experience in public health and health IT.
Questions to Ask:
What have been the biggest challenges and successes in implementing value-based care through ACOs?
How can smaller practices successfully transition to value-based care models?
What role does data analytics play in improving patient outcomes in value-based care?
2. Dr. Patrick Conway, MD, MSc - CEO of Care Solutions at Optum
Organization: Optum
Background: Dr. Conway is a former Deputy Administrator for Innovation and Quality at CMS and Director of the Center for Medicare and Medicaid Innovation (CMMI). At Optum, he focuses on driving innovation in care delivery and payment models.
Questions to Ask:
How do you see the role of private sector organizations in driving value-based care forward?
What are the key components of a successful value-based care initiative?
How can data transparency and interoperability be improved in the healthcare system?
3. Elizabeth Mitchell - President and CEO of Purchaser Business Group on Health (PBGH)
Organization: Purchaser Business Group on Health
Background: Elizabeth Mitchell leads PBGH, which works to improve the quality and affordability of healthcare through the collective purchasing power and expertise of large employers and public purchasers.
Questions to Ask:
How can large employers leverage their purchasing power to drive value-based care?
What are the most effective strategies for improving healthcare price transparency?
How do you measure the success of value-based care initiatives from the perspective of large purchasers?
Follow-Up Questions & Next steps for this Show:
Challenges and Solutions:
What are the primary obstacles your organization faces in implementing value-based care and how are you addressing them?
What are specific examples of successful value-based care initiatives and their outcomes?
Data and Analytics:
How can we ensure the accuracy and usability of healthcare data for value-based care initiatives?
What advancements in data analytics have been most impactful in driving value-based care?
Policy and Regulation:
What changes in healthcare policy are necessary to support the expansion of value-based care?
How do current regulations impact organization's ability to innovate in value-based care?
Patient Engagement:
How do we involve patients in their care to improve outcomes and satisfaction in value-based care models?
What role do technology and digital health tools play in enhancing patient engagement and care coordination?
Future Trends:
What trends are foreseen in the next 5-10 years for value-based care and price transparency?
How are organizations preparing for the future of healthcare delivery and payment models?
Collaboration and Partnerships:
How do you collaborate with other healthcare stakeholders (providers, payers, employers) to advance value-based care?
Can you discuss any successful partnerships that have significantly impacted your organization's approach to value-based care?
These questions will help delve deeper into the strategies, challenges, and innovations driving value-based care and price transparency, providing valuable insights for your audience.
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Ep 102 Leveraging Price Transparency Data with Maria Nikol, CEO Revelar Analytics