Blog

Since the senseless murder of the UnitedHealthcare CEO, Brian Thompson, there has been a lot of discussion regarding managed care and the companies that administer services on behalf of government and private payers. The use of the inscription on the bullet casings fired from the gun that killed Mr. Thompson, “Delay, Deny, Defend” have been […]

Introduction: Medical practices are now receiving copious amounts of data that were unheard of only a few years ago. The information includes not only the results of labs and other diagnostic studies or specialist visits, but information on both cost and quality, as reflected in gaps in care as well as patient satisfaction with […]

On December 18, 2024, CMS announced that Oklahoma (statewide) and Michigan, New York, and South Carolina (sub-state regions) were accepted to participate in the Innovation in Behavioral Health (IBH) model. IBH is a new state-based model in which states are awarded $7.5 million to invest in specialty behavioral practices that serve the Medicaid and Medicare […]

Many of us have sat and wondered, if one could define something as high quality, what would that sound or look like? Many times, we would come up with multiple meanings and visions, depending on the circumstances we were involved in, or what we were looking for at a given moment. While many physician practices […]

Introduction: It is well noted that primary care and medical subspecialists who are not interventionalists, spend a great deal of their time caring for patients in the office. Over recent years, with the focus shifting to value based care, the primary role of the office visit has been to capture data for the EMR […]

Care management is best defined as a comprehensive suite of services and activities that are patient-centered to assist patients and caregivers in controlling complex and chronic conditions to better manage their own health. These programs focus on patient engagement, care coordination, and education to reduce hospitalizations, emergency department visits and improve the total cost of […]

Capacity and Infrastructure Transition, Expansion and Development (CITED) is an incentive payment model available to Enhanced Care Management (ECM) and Community Supports (CS) providers which includes Federally Qualified Health Centers (FQHC), county and social services agencies, community clinics, and other community-based entities. CITED is one component of the Providing Access and Transforming Health (PATH) Initiative […]

On October 28, CMS announced that Rhode Island and Downstate New York were accepted to participate into Cohort 3 of the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. Cohort 3’s first Performance Year is 2027. Downstate NY will consist of the following five counties: Bronx, Kings, Queens, Richmond, and Westchester. AHEAD is […]

For the last 10+ years, most providers participating in Medicare Accountable Care Organizations (ACOs) have done so under the umbrella of an ACO aggregator. These aggregator organizations form risk-bearing entities, contract with CMS, and then recruit physician groups to participate in their ACO. While this “I’ll drive, you can ride in the back seat” type […]

As Medicare open enrollment begins for 2025, major reductions in Medicare Advantage (MA) plan offerings are expected to lead to major shifts in patient enrollment in plans. Existing enrollees will need to decide whether to explore alternative plans or switch to traditional Medicare. It’s imperative that providers keep a close track on enrollment trends for […]