In today’s transaction-based service model, patients make their own appointments, the care they get varies depending on the provider’s memory and skill level, and it is up to patients to coordinate and manage their own follow-up.

Population health management (PHM) is a broad term that will generate untold millions in consulting fees in the years to come, but if you add “business model” to the back of the term, we start to get closer to how health care will make the transition from transaction to value. Inevitably, this involves capitation and risk assumption.

Blue Cross Blue Shield Association’s 37 member companies cover one in three Americans, giving senior VP and CFO Robert Kolodgy an excellent vantage point from which to view the economics of health care reform. In “Transforming the Payor Provider Relationship to Improve Value” at the Healthcare Financial Management Association’s annual national institute meeting in Orlando, Florida, Kolodgy put reform into financial context, enumerating the costs associated with the benefits of the nation’s health care law and describing some of the innovative partnerships BCBS has entered into with providers as part of a four-part plan to address health care’s well-known problems.

Data governance and discipline are keys to building a modern, maximally efficient enterprise business intelligence (EBI) platform for health care. The actual technology must be secondary to the organizational activities that go into building an EBI platform designed to serve the business information needs of the organization. The data, not the technology, should be the point of control.

Change isn’t easy, especially when it affects how much you are paid for services rendered. But the writing on the wall is clear: the fee-for-service model, especially for Medicare patients, is slowly but surely disappearing into the Affordable Care Act sunset. What’s a physician to do: work more and get paid less?

The press was full of stories earlier this month about the Pioneer ACOs that would exit the program. Are we surprised? If my employer told me I could play a game that, at the end of the year, would give me either a 10% bonus or a 10% penalty, I might be down with that—until I earned a penalty. What incentive would I have to put money at risk the next year? The only incentive I would have would be the lessons I learned in the process of trying to earn the bonus if—and this is a big if—I knew that the new game ultimately would become the only game. As these organizations exit the ACO program, I think they deserve a round of applause for giving the concept a whirl.

More than any other concept in health care, value has become a guiding principle for health care leaders and stakeholders as they wade into the era of health care reform. To assist health care financial leaders in their drive to value, the Healthcare Financial Management Association (HFMA) launched the HFMA Value Project, yielding a collection of case studies, presentations, and assorted educational resources that can be found on its website. HealthCXO spoke with HFMA’s Richard Gundling, VP, Financial Healthcare Practices, to identify the key financial issues facing hospitals and physician practices in 2013.

In 2009, the recession was in full swing, unemployment rates were high, and health care facilities were providing more than $39 billion a year in uncompensated care for the uninsured. Instead of riding out the recession with uncertainty and accruing more debt, Sharp HealthCare (San Diego, California) joined forces with the nonprofit Foundation for Health Coverage Education (FHCE) (San Mateo, California) to meet the problem head on. Sharp leveraged a Web-based eligibility software program and took on a strong patient advocacy role to provide uninsured patients with much-needed eligibility assistance.