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  Health care providers in Texas continue to work diligently to improve care delivery systems to all patients through Medicaid 1115 waiver transformation initiatives, specifically focusing on the Medicaid and low-income uninsured populations. The work of the Anchors and Delivery System Reform Incentive Payment (DSRIP) program providers in 2017 and previous years is evident in […]

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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 with effectively partnering with their physicians to achieve high quality outcomes and reducing the total cost of care. Those organizations most successful […]

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California public hospitals have a unique opportunity to leverage the PRIME program to help build the competencies needed to thrive in a risk-based environment. Public health systems and hospitals that make strategic investments in data analytics, network optimization, care management and quality improvement will be set up for success and long-term sustainability. Overview: The […]

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COPE Health Solutions has named Michael Zaccagnino as an executive vice president. In his new role, Mr. Zaccagnino will work with health systems, medical centers, physician organizations, and health plans on strategy development and execution and performance improvement, with a special focus on population health. He also will oversee business development and project delivery for […]

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On October 12, 2017, the President halted federal payments for cost-sharing reductions (CSRs) for insurers that subsidized the cost of coverage for certain low-income eligible enrollees. A parallel executive order instructed the Department of Labor (DOL) to study how to relax rules on association health plans, allow short-term health insurance policies with limited benefits, and […]

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Last month, COPE Health Solutions and Montefiore Health System brought together health care leaders from across the country to New Orleans to devote two days to discussing population health. This invitation-only event provided an opportunity for an intimate discussion of hot topics, shared experiences, strategy sessions and networking with other industry professionals. Throughout Population Health […]

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Tom Dougherty, FACHE, Executive Vice President, has extensive expertise in risk-based coordinated health care delivery models, health plan network management and administration of hospitals, nursing homes, and home health. COPE Health Solutions draws on Tom’s experience and knowledge for its health system clients that are developing or enhancing their risk-based care and capitation models.  : […]

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Background: In 2010, the Affordable Care Act provided states the option to implement a “health home” (HH) care management model, with the goal of improving care coordination, reducing costs and improving health outcomes for high-need Medicaid members with chronic conditions. In an attempt to bridge resource gaps for a particularly complex segment of the […]

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Overview: On January 9, 2017, Washington State Health Care Authority (HCA) released highly anticipated Special Terms and Conditions (STCs) outlining the provisions of the Section 1115 Medicaid demonstration waiver. The five-year waiver is active now through December 31, 2021. Under this demonstration, a delivery system reform incentive payment (DSRIP) program aims to increase access, […]

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Abstract: : Health care reform has evolved over the past few decades, but one constant in this transformation has been Section 1115 waivers. These waivers broadly permit states to conduct “Medicaid research and development” programs to better meet the health care needs of their unique populations. Thus, the onus of health care reform is shifted to […]

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