Aligning Your Medicare Direct Contracting Model with Your Value-based Payment Strategy
Medicare Direct Contracting (MDC) is a set of mature, capitated payment models for Medicare Fee for Service (FFS), evolved from legacy accountable care models (e.g. Next Generation, Medicare Shared Savings Program), and released by the Centers for Medicare and Medicaid Services (CMS) in November 2019. MDC has recently gone live with its first cohort of 51 […]
What You Need to Know About the CMS Geographic Direct Contracting Model
The Centers for Medicare and Medicaid Innovation (CMMI) has just announced that non-binding letters of intent (LOI) from health organizations who are serving Medicare beneficiaries in one of 15 different Core Based Statistical Areas (CBSA) around the country and are ready to participate in “Geographic Direct Contracting” must be submitted to CMS by 11:59 p.m. […]
CMS Provides Relief for Quality Reporting Amid COVID-19 Crisis
On March 22, 2020, the Centers for Medicare and Medicaid Services (CMS) offered some relief for the clinicians, providers, and facilities participating in Medicare quality reporting programs – including the 1.2 million clinicians in the Quality Payment Program and those fighting coronavirus (COVID-19). This unprecedented action by CMS has been applauded by the American Medical […]
MSO Build or Buy: Strategic Considerations
Traditional management service organization (MSO) models have shifted away from purely administrative and management services in support of physician practices to more population health services organization (PHSO) models for independent provider associations (IPAs), accountable care organizations (ACOs), health systems or other provider entities taking premium risk from payors. MSOs are now focused on helping organizations […]
Health care experts forecast how hospitals must prepare for the Post-Covid-19 Crisis – Six Things to Do
Covid-19 is not the great equalizer, it’s the great revealer. It has revealed social and economic inequalities to the public. The silver lining of the pandemic is that the public can see this now.” — Edward Shin, MD, CEO & Co-Founder, Quality Reviews “Any individual in this pandemic, without healthcare, is a threat to all of […]
Observations and Post-Covid-19 Health Care in the United States
During the 20th century, two world wars and numerous regional military conflicts claimed more than 150 million lives and decimated entire countries. During the past 100 years, trillions of dollars have been expended assembling armies and building military preparedness to defend homelands and protect the citizenry. However, it has taken less than three months for […]
Considerations for Extension and/or Renewal of the Texas 1115 Waiver: A Look at Other States
The expiration of the Texas 1115 Waiver at the end of September 2022 is a call to action. With the uncertainty surrounding the Texas 1115 Medicaid Waiver renewal, the state’s Health and Human Services Commission may consider some of the policy and regulatory changes to the Medicaid program that the Centers for Medicare and Medicaid […]
Hospital COVID-19 Disaster Funding: Five Things Hospitals Must Do to Prepare
Hospitals, state associations and other stakeholders need to be prepared to address the negative financial impacts associated with the COVID-19 pandemic as it continues to have a widespread impact on our health care system. Many hospitals are likely to experience severe financial challenges, requiring financial assistance from federal, state and local governments in order to […]
Considerations for Extension and/or Renewal of the Texas 1115 Waiver: A Look at Other States
Abstract: The expiration of the Texas 1115 Waiver at the end of September 2022 is a call to action. With the uncertainty surrounding the Texas 1115 Medicaid Waiver renewal, the state’s Health and Human Services Commission may consider some of the policy and regulatory changes to the Medicaid program that the Centers for Medicare and […]
Despite Threats to the ACA, It is Time to Plan Long-Term
The Affordable Care Act (ACA) has survived for a decade despite Congressional attempts to repeal it, executive orders to weaken it, and some Democratic Presidential candidates proposing to upend it in favor of a single-payer system. Despite the political rhetoric and executive actions, participating ACA individual insurers experienced a highly profitable 2019. This resulted in […]