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Why Medicare Advantage Can Be a Golden Opportunity for US Health Systems

For US health systems, launching a Medicare Advantage health plan is no longer just a strategy for diversification. It’s a path to faster growth, a way to leverage assets that provide a unique competitive advantage, and a key strategy for protecting an organization’s future and relevance in a changing market.

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Succeeding in the Medicare Advantage Market

While entering the MA market provides significant opportunities—including new revenue sources and greater leverage with existing payers—reaching those goals can be challenging without the right approach.

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Lessons from Priority Health on Winning in the Medicare Advantage Market

Winning in the Medicare Advantage market is not easy for health care providers. But for provider-sponsored plans that execute effectively, the upside can be enormous. Priority Health, a provider-led health plan in western Michigan, is one such example.

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The Closest Hospital May Not Be the Best

A comprehensive study of health outcomes in hospitals reveals significant variations in performance across the US that cannot be explained by patient demographics, health upon admission, or a variety of other factors. The results show that health care reform must move beyond a focus on cost and include a push for outcomes transparency. Measuring and improving outcomes will lead to higher innovation and competition—and an improved quality of health care overall.

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BCG’s Latest Health Care Insights

Follow BCG on Health Care on LinkedIn for a collection of insights and news on innovation, digital disruption, M&A, and improved value-based systems in the health care industry.

View our LinkedIn showcase page for more news and insights

What Doctors Can Learn from One Another

BCG’s Stefan Larsson, a doctor by training, looks at what happens when doctors measure and share their outcomes with fellow physicians to see which treatments and techniques are the most effective. In this TED talk, Larsson describes how health care can get better—and cheaper—when health outcomes are measured and the results are shared.

According to BCG's Sanjay Saxena, the opportunity for using big data and analytics in measuring outcomes is huge. But the trick for payers and providers will be understanding the data—and knowing which questions to ask about it.

Six Steps for Building a Value-Based Hospital

With a sharp focus on improving patient outcomes, value-based hospitals are improving cost efficiency while increasing competitive advantages in their regions.

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The Path to Accountable Care

Health care systems around the world are increasing their focus on accountable care, an approach that aligns health care payments with patient-focused outcomes.

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The Value of Bundles

Value-based bundling—integrating all the care for a specific procedure under a single price—is an effective strategy for providers competing on outcomes.

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