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Background Starting in 2011, the Center of Medicare and Medicaid Services (CMS) has required health care systems to deliver the Important Message from Medicare (IM) to all Medicare beneficiaries who are hospital inpatients. This admission notice provides beneficiaries and representatives a written notice about their hospital discharge appeal rights. CMS regulation dictates that IM delivery […]

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Thank you all for joining our Las Vegas Population Health 360 Conference. More than 100 health care leaders gathered for this invite-only event to discuss current trends, challenges and the future vision of the value-based payment landscape. Attendees engaged in a series of panels and round table discussions throughout the two days to learn best […]

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Background In 2013, the Texas Legislature created The University of Texas Rio Grande Valley (UTRGV) to increase educational opportunities in the surrounding Rio Grande Valley area, located at the state’s southernmost point along the Mexican border.1 The Rio Grande Valley has an estimated population of about 1.5 million residents.2 In conjunction with the school’s founding, […]

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The Centers for Medicare and Medicaid Services’ (CMS) Direct Contracting (DC) Model Options, a new set of voluntary payment models announced this week by the U.S. Department of Health and Human Services (HHS) for Medicare fee-for-service patients and their health care providers, represent a major step forward for population health management and value-based care. Based […]

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As health systems seek or are forced into risk-based contracts, aligning stakeholders and developing a comprehensive strategy to create a culture ready for change is key. Regardless of your system’s current level of maturity with risk contracts or its ability to manage care for a population, moving from fee-for-service payments to global risk or capitated […]

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As 2019 begins, health care plans and provider systems are rightfully perplexed by the clamor of continued Trump Administration efforts to erode the Affordable Care Act (ACA), as well as the broad, and somewhat conflicting, policy assertions of other transformation initiatives. Examples of conflicting policy assertions are found in the Centers for Medicare and Medicaid […]

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Introduction Hospital and health systems that strive toward value-based payment as their primary payor engagement strategy become more accountable for costs and health outcomes after a patient leaves an acute care facility. Medicare has already made this accountability a fact of life for all hospitals serving Medicare members through the value-based payment and re-admissions penalties […]

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Libertarians, and others frustrated with the costs and strictures of regulation, may express the view that regulation of the insurance industry is often burdensome and unnecessary. Without addressing the global topic, there is a solid argument that good regulation serves the public interest through supporting ongoing confidence in the insurance market in which the public […]

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