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Provider and payer success in Medicare Direct Contracting (MDC), a voluntary program for fee for service beneficiaries, hinges on earning member loyalty through a strong care infrastructure and provider referral network. The pace and path forward differs a bit depending on whether you are one of the 53 MDC Direct Contracting Entities (DCEs) that launched […]

The Centers for Medicare & Medicaid Services’ latest model for risk-based payments and care offers the potential to significantly advance clinical transformation and value for payers, providers and their patients. As we noted in the recent webinar “Medicare Direct Contracting: What Payers and Providers Need to Succeed,” Medicare Direct Contracting Entities (DCE) have a unique […]

Ready or not, the Centers for Medicare and Medicaid Services is moving more strongly to downside risk. That’s especially true with Medicare fee-for-service as CMS continues to expand the Medicare Direct Contracting (MDC) program even as it delays the geographic option. Attendees will learn: The differences between global and professional MDC models Possible next steps […]

Background Dr. Mary Carol Jennings, MD, MPH, is the Chief Medical Officer of Sendero Health Plans, a local non-profit health plan based in Austin, Texas. Sendero offers individual insurance coverage on the Affordable Care Act’s (ACA) Marketplace and is unique among other payers in the focus it places on ensuring access to affordable, quality healthcare […]

This new feature in ARC allows the user to filter for specific diseases across the population. Meaning, the user can now see data on the page specific to a population of members with that chronic disease. Below is an example of the drop down and the available chronic disease options.   The filter is available […]

Necessity really is the mother of invention. During the pandemic, providers quickly scaled alternative care options, including telemedicine and hospital at home. Now, payment structures need to catch up. The reliance on fee-for-service (FFS) and traditional patient care models during the pandemic hurt both providers and members. Non-COVID-19 patient care plummeted—even for people with chronic […]

An innovative workforce development and training partnership with COPE Health Solutions’ COPE Health Scholars enabled Kaiser Permanente to quickly fill critical staffing gaps at several medical centers during the pandemic. Kaiser Permanente Irvine Medical Center, Kaiser Permanente Anaheim Medical Center and Kaiser Permanente Orange County hospitals tapped this unique solution to supplement depleted staff in […]

Given the impact of COVID-19, health systems are rethinking how to align with and assist physicians. It’s an integral part of the opportunity to reimagine their future with respect to their market, their medical staff and the community they serve. They should look no further than clinically integrated networks (CINs). CINs have already proven, in […]

In the recent Health Payer Specialist article “The Biggest Challenges Facing Payers in 2021,” COPE Health Solutions CEO Allen Miller called out two areas. Rising Demand: Enrollment on the ACA-mandated health insurance exchanges is expected to grow. Indeed, a proposal to increase subsidies and expand ACA insurance eligibility is part of the Biden $1.9 […]

Maybe you’ve seen this quip floating around Facebook: It’s funny and may even end up containing an element of truth. Amazon recently offered up its infrastructure, operations and tech to the Biden administration to improve the COVID-19 vaccine rollout. An even better (and more realistic) idea? Leverage health plans, their provider networks, member engagement and […]