One of the fundamental objectives of Medicaid programs contracting out their sizeable budgets to managed care companies is to improve the quality of care for their beneficiaries. As we frequently […]
How hospitals and physicians get paid is changing as the U.S. healthcare system transitions from volume-based to value-based care. Reimbursement methodologies need to allow for a plan to control costs, […]
I attended the January 9, 2018 CMS Medicare Learning Network conference call covering the logistics of the settlement process offered by CMS for providers with pending appeals. This impacts: “The […]
Discussion of five best practices that help Medicaid agencies transition toward value-based care.
With the unrelenting pressure to reduce unnecessary costs in healthcare delivery and despite (or maybe because of) the lack of clear direction from the federal government, Medicaid plans across the […]
While Congress is finding it difficult to reach consensus on how to improve health care in the United States, the one thing we all can agree on is that ever-rising […]
In a recent perspective piece in JAMA Forum, Dr. Ashish Jha of the Harvard School of Public Health argues that increased provider consolidation is threatening the financial viability of the […]
Value-Based Payment (VBP) is top of mind for all who work with a Medicaid population in states across the U.S. Through its Delivery Service Reform Incentive Payment (DSRIP) Program and […]
I was catching up on regulatory reading today (yes, reading CMS regulations is part of my job responsibilities) and saw something troubling—providers are still balance billing qualified Medicare beneficiaries (QMBs, […]
For the last decade, we have been fortunate enough to work with many state Medicaid programs and commercial payers on reform efforts incorporating outcomes targets for health care providers. The […]
Success in population health management rests in part on being able to identify high cost/high utilization population segments and provide interventions that help achieve better outcomes. With enough of a […]
Stay on top of the latest state innovations in health care as Medicaid programs continue to shift away from volume and toward value, efficiency and analytics.