Key Trends in 2018 for Health Care Organizations Moving to Value-based Payment and Population Health Management
Health care is in a tumultuous time and what’s for certain is that nothing is for certain. The passing of the recent Tax Cuts and Jobs Act of 2017 (TCJA) has broad but still not completely understood implications for the business community and economy, including non-profit health hospitals and health care systems, generally adding more […]
Insurers Increase Participation in ACA Markets and Must Focus on Key Provider Partnerships
The Affordable Care law has survived for nearly a decade despite efforts to upend it, including legal challenges (one pending1 and another that went all the way to the Supreme Court), Congressional attempts to repeal it and executive orders aimed at weakening it. While fiery debate continues over the fate of the roughly 21 million Americans, […]
The Role of Medicaid Waiver Transformation Projects in Transforming the Core Strategic and business planning framework of health care organizations
Overview Across the United States over the last 10 years, 1115 Medicaid Waiver projects — initially known as Delivery System Reform Incentive Payments (DSRIP) projects — are driving health care transformation on a large scale in California, Texas and New York with other states such as Washington preparing to launch. These waiver-funded projects represent an […]
Heads You Win, Tails You Win – Roadmap to a Win-Win Path to Downside Risk in Medicare Alternative Payment Models
ACOs that started in the Medicare Shared Savings Program’s Track 1 in either 2012 or 2013 must determine whether to move to a risk-based model by their third contract periods, which begin in 20191. A number of the MSSP ACOs are making strides in improving quality, reducing hospitalization and waste in Medicare. The Centers for […]
Key Trends in 2018 for Health Care Organizations Moving to Value-based Payment and Population Health Management
Health care is in a tumultuous time and what’s for certain is that nothing is for certain. The passing of the recent Tax Cuts and Jobs Act of 2017 (TCJA) has broad but still not completely understood implications for the business community and economy, including non-profit health hospitals and health care systems, generally adding more […]
CMS announces new Medicare-Medicaid ACO model
On Thursday, CMS announced the creation of a new ACO model geared toward patients who qualify for both Medicare and Medicaid, also known as dual eligible. Dual eligible patients typically have more complex health needs, chronic conditions and social issues than the general Medicare population. Consequently, they account for a disproportionate share of spending in […]
2019 Health Care Trends and Critical Success Factors for Health Systems
Impact of the Specialty Care Access Project on Serving Uninsured Patients
Delivery System Reform Incentive Payment (DSRIP) Programs Boost the Safety Net
Seven states have adopted the federally approved Delivery System Reform Incentive Payment (DSRIP) program, but they can’t agree on the details. What they can come to a consensus on is the goal. As the health care industry increasingly shifts toward a system that aligns quality and value with reimbursement incentives and financial penalties, some hospitals […]
Call to Action Engaging Physicians to Drive Quality
It is no trade secret that physicians drive quality and medical spend in the health care industry. Across the nation, health systems, independent physician associations (IPAs), and accountable care organizations (ACOs) are challenged to effectively partner with their physicians to achieve high-quality outcomes and reduce the total cost of care. Those organizations mostsuccessful in managing […]