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In late December 2022, CMS published the ACO REACH Health Equity Plan Templates, Guide and FAQ, outlining the standards and requirements REACH ACOs must meet in their efforts to address targeted health disparities in underserved communities in their service area. Health Equity is a hallmark ACO REACH initiative and a significant differentiator between the program […]

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1. Continued transition to more value-based payment and risk for all lines of business: Payers partnering to create more collaborative platforms and relationships with providers Focus on improving outcomes and support strategies to mutually gain market share while leveraging value-based payment arrangements Providers realizing the need to develop a clear strategy and goals for […]

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CMS has released the final ACO REACH Model Performance Period Participation Agreement (MPP PA) for PY2023 starters as well as a redlined version of the MPP PA compared to the GPDC Model Performance Period PA for PY2022 starters that highlights the updates made to the PA. Here are the key five considerations every ACO entity […]

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Background: Our client is a large Academic Medical Center located in the Northeast with a direct-to-employer contract managing a commercial employee population. The health system uses Analytics for Risk Contracting (ARC) and the COPE Health Solutions (CHS) Data Analytics as a Service (DaaS) solution to identify specific opportunities and track performance in specific aspects […]

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Payer/Provider Partnership
November 16, 2022

Background: Hawaii Health Network (HHN), based in O’ahu, HI, is a recently formed Clinically Integrated Network (CIN) composed of four partner medical groups/IPAs and is the state’s largest post-acute care provider. HHN’s mission is to be a clinically integrated network that systematically supports independent physicians and provides others in the transition from volume to […]

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CIN/IPA MSO Co-Source
November 16, 2022

Background: Our MSO Co-Source client is a provider-led health system, physician governed clinically integrated network (CIN), and independent physician association (IPA) in the Northeast. The IPA is committed to enabling network providers to successfully perform in value-based payment (VBP) contracts with payers through strategic collaboration, powerful data & analytics, enhanced provider engagement strategies and […]

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As medical groups, health systems and health plans across the U.S. continue to feel the impact of COVID-19 and the Great Resignation, many are struggling to build sustainable pipelines of qualified staff and providers. Physician burnout, retirement and inflation are all factors leading individuals to leave the profession and/or retire. Recent studies have indicated that […]

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With the heaviest burdens of the pandemic falling disproportionately on Californians who are low-income Black and Latino and on frontline workers, the need to implement targeted solutions to address long-standing Social Drivers of Health (SDoH) and health equity is at an all-time high. This is reinforced by the principles and goals of California’s newest Medicaid […]

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Risk-bearing organization strategy and governance alignment Consider how ACO REACH plays into your overall strategy for growth and complements the capabilities necessary for greater risk across all lines of business Align and integrate the governance of your REACH ACO with your existing medical group, integrated delivery system, CIN or IPA; including boards and key committees […]

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The 1115 Medicaid Waiver Program was developed to enable innovation and access to services by waiving the Medicaid rules or law and allow for a programs, benefits or expansion of coverage that would not normally be covered within the state’s Medicaid plan. This allows the states to better tailor the benefits provided by Medicaid to […]

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