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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 […]

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In today’s changing health care environment, one constant is the role of technology in optimizing clinical care delivery. Today more than ever, organizations face increasing pressure from regulatory bodies to increase quality and reduce cost, while doctors are encouraged to see more patients during the same 8-hour work day, and patients grow frustrated with the […]

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Value-Based Payments Require a Value-Based Business Model: Many providers today find themselves amid shifting tides. Though local markets are at different stages in this process, the trajectory away from fee-for-service and toward value-based payment (VBP) is well under way, with strong policy tailwinds and buy-in from commercial payers. Prudent health care enterprises are embracing […]

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Last summer, four of the five biggest insurance companies shook the health care industry when they announced two mega-mergers: Aetna to buy Humana for $37 billion, and Anthem to acquire Cigna in a $54 billion deal. If these mergers are approved, a trillion-dollar industry will be left in the hands of three mammoth insurers. So, […]

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Current state of health care: The traditional approach to health care delivery is quickly becoming obsolete as health care shifts from a focus on treatment to prevention. Treating an illness is often far more expensive than providing the preventative care that would deter its onset, and is imperative to developing long-term solutions for population […]

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Friends, family, colleagues and our valued clients: To say that we live in interesting times is an understatement. Having just completed a very challenging election season, many in our nation feel vindicated and excited while others are saddened and maybe even frightened. As a firm, I feel the need to share that we’re proud of […]

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More than half of the adult U.S. population has one or more chronic conditions1. In order to combat this alarming statistic, there are various ACA provisions that incentivize patient management, including provider reimbursement opportunities or federal support for disease management programs.  Programs and incentives are important enablers, but the key to active chronic disease management […]

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Role of CBOs in VBP As the healthcare industry shifts towards population health management, integrated delivery systems (IDSs) working with health plans are quickly realizing the need to reimagine traditional partnerships. As incentives drive care out of acute care settings, a focus on preventive care has alerted providers of the need for supports outside of […]

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New York State’s (NYS) Delivery System Reform Incentive Payment (DSRIP) program, a component of the NYS Department of Health’s (DOH) 1115 Medicaid Waiver, provides a unique opportunity for providers to invest in the delivery system and financial incentive transformation required for long term financial sustainability in a population health management business model. The DSRIP program […]

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Providers in California, Texas and New York are currently implementing transformation projects under various 1115 Waivers to achieve the Quadruple Aim: better health, better care, less cost, higher satisfaction.  Work under delivery system reform incentive payment programs (DSRIP) — the component of 1115 waivers that pays for outcomes if providers change practices from volume to […]

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