Blog

In the rapidly evolving landscape of healthcare, the shift towards value-based care is gaining momentum. This paradigm shift, which emphasizes patient outcomes over volume of services, presents a unique opportunity for primary care providers to redefine their role and create a more sustainable and effective healthcare system. The key to success in this new era […]

While we are well into the second year of implementation, there remains a significant portion of the eligible population and provider community who have yet to realize the benefits of this waiver. We will discuss key pain points, as well as the resources and infrastructure development opportunities CalAIM offers to providers, community-based organizations, counties, and […]

On August 14, CMS published the Request For Application (RFA) for Making Care Primary (MCP), a progressive roadmap to value-based payment for primary care providers with little-to-no VBP experience, including providers that may have been in or are currently in MSSP or ACO REACH models. MCP’s payment, quality and care delivery design are meant to […]

Yesterday, September 5, 2023, the CMS Innovation Center released the AHEAD Model focused on improving overall population health of a specific state or region, advancing health equity by reducing disparities in health outcomes and curbing the growth of health care costs. Key aspects of the model: State accountability and alignment with Medicaid Waivers: States will […]

On June 8, 2023, CMS announced a new CMMI primary care model, Making Care Primary (MCP), covering traditional Medicare beneficiaries, that aims to strengthen primary care infrastructure through service delivery and care integration enhancements designed to improve an MCP entity’s care management programming, specialty care integration and community supports connections closing social determinant of health […]

This webinar will delve into the transformative impact of data analytics in the context of value-based care, bringing together providers and payers to explore strategies for leveraging disparate data sources and enhancing performance. Speakers will address key topics, including how we can use data to improve health and patient outcomes in relation to value-based care, […]

Understanding Drivers of Performance: Engaging providers at a higher rate and with the right data and insights early on leads to improved clinical, quality and financial outcomes, improved provider and health plan performance, provider and member retention, and overall efficiency.  Nationally, health plans and their contracted provider networks are actively working to improve performance […]

On March 31st U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), released the Calendar Year (CY) 2024 Medicare Advantage (MA) and Part D Rate Announcement that finalized payment policies for these programs. CMS will phase-in certain updates, and on average, CMS anticipates a payment increase for […]

Incident-to billing is a billing practice in which a non-physician health care provider, such as a nurse practitioner, physician assistant, or clinical nurse specialist, can bill for services provided at the full rate of the supervising physician. In this billing practice, the physician supervises the non-physician provider’s services and is responsible for initiating and managing […]

The speakers at the “Designing for Dignity: Disrupt Workforce” webinar will take juicy, creative, human-centered innovation and make novel solutions succeed out there in the real world. This webinar will help us learn how provider systems and consultants are tackling strategy, analysis, and financial modeling as generative design tools, and help organizations turn their biggest, […]