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An influential nonprofit hospital critic, Republican Chairman of the Senate Finance Committee Chuck Grassley, asked the IRS in 2019 to probe whether the hospitals are living up to their charitable obligations.1 Senator Grassley helped enact requirements included in the Affordable Care Act and set standards for nonprofit hospitals and information they’re required to disclose. Nonprofit hospitals are […]

The survey commissioned by Change Healthcare and HealthCare Executive Group and conducted by InsightDynamo provides some excellent insights. It is interesting to see where payors and providers in the study align and where they differ. Here are the key takeaways:   “Alternative payment models” is a term that applies to a broad range of reimbursement […]

Introduction Social determinants of health (SDOH) can play a major role in ensuring better health outcomes at both the individual and population level. SDOH are responsible for over 80 percent of health outcomes while clinical interventions represent only 20 percent1. While the impacts of SDOH are well known, many providers and organizations still do not […]

This is part one of a series of articles focused on FQHCs and FQHC Look-Alikes. These community health centers can play a critical role in managing population health and achieving success in value-based contracts. Many communities struggle with access to high quality primary care services for their residents with lower incomes. Language and cultural barriers […]

The State of California is “carving out” the pharmacy benefit for Medi-Cal beneficiaries from managed-care plans and transitioning to a fee-for-service (FFS) program, moving 13 million Medi-Cal beneficiaries to a new pharmacy program by January 2021. Medi-Cal is taking responsibility from the managed care organizations (MCOs) for one of the key elements of care, the […]

The Affordable Care Act (ACA) has survived for a decade despite Congressional attempts to repeal it, executive orders to weaken it, and some Democratic Presidential candidates proposing to upend it in favor of a single-payer system. Despite the political rhetoric and executive actions, participating ACA individual insurers experienced a highly profitable 2019. This resulted in […]

The expiration of the Texas 1115 Waiver at the end of September 2022 is a call to action. With the uncertainty surrounding the Texas 1115 Medicaid Waiver renewal, the state’s Health and Human Services Commission may consider some of the policy and regulatory changes to the Medicaid program that the Centers for Medicare and Medicaid […]

In the calendar year (CY) 2020 for the “Value-based insurance design” (VBID) Model and has expanded opportunities for CY 2021 including a new hospice benefit. The VBID Model aims to increase health care quality and decrease costs for Medicare Advantage (MA) by leveraging financial incentives to promote cost efficient health care services and expand consumer […]

The new decade has barely begun, but already 2020 is shaping up to be another pivotal year in health care. With all the innovation taking place in payment models, service delivery, technology and other areas, it is easy to lose sight of the fundamental drivers of the emerging health care industry. This article outlines four […]

Academic Medical Centers (AMCs), for the large part, are late to the population health game and have been playing catch-up. Though uniquely innovative and focused on both clinical care and research, AMCs are challenged by systemic obstacles that make transformations difficult as change requires new levels of collaboration across the entire organization. Simply put, changing […]