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Independent Physician/Provider Associations (IPAs) are key mechanisms for physicians, health systems and federally qualified health centers (FQHCs) to align and engage in value-based payment arrangements that add value to payors and attributed members. This paper provides insights into the benefits to IPAs for engaging FQHCs and community-based organizations (CBOs) into their network, care model and […]

Analytics for Risk Contracting (ARC) helps organizations manage and succeed in risk-bearing payment arrangements such as Medicare Direct Contracting (MDC). The ARC platform can help prospective Medicare Direct Contracting applicants address key business decisions related to MDC-specific requirements and operational parameters required to become a Direct Contracting Entity (DCE). Medicare Direct Contracting applicants can leverage […]

The New York State Department of Health (NYSDOH) recently released a draft proposal to extend its Delivery System Reform Incentive Payment (DSRIP) program as part of the state’s 1115 Medicaid waiver, currently set to expire at the end of March 2020. Asking the Centers for Medicaid and Medicare Services (CMS) for $8 billion over four […]

Medicare Direct Contracting (MDC) is a unique opportunity for providers and payors to align financial incentives and redesign care for Medicare fee-for-service beneficiaries. To succeed under this model, risk bearing organizations need to be able to reduce total cost of care and improve performance against key quality metrics. To maximize success in Medicare Direct Contracting […]

On December 16, 2019, Texas Health and Human Services Commission (HHSC) announced that Myers & Stauffer has been selected as the compliance monitor for the Delivery System Reform Incentive Payment (DSRIP) program in Texas for current reporting years – Demonstration Year (DY) 7-9. Myers & Stauffer previously held the role as the compliance monitor under […]

The State of New York has submitted a request to the Centers for Medicare and Medicaid Services (CMS) for a four-year extension and renewal of its Delivery System Reform Incentive Payment (DSRIP) program as part of the state’s 1115 Medicaid waiver. The current waiver is set to expire at the end of March 2020. In […]

Medicare Direct Contracting program is an unique opportunity for existing Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs), NextGen ACOs, organizations that have experience serving Medicare fee-for-service (FFS) patients and organizations with limited Medicare FFS experience that wish to grow their market share. Some of the opportunities that Medicare Direct Contracting presents include: Providing […]

Traditional management service organization (MSO) models have shifted away from purely administrative and management services in support of physician practices to more population health services organization (PHSO) models for independent provider associations (IPAs), accountable care organizations (ACOs), health systems or other provider entities taking premium risk from payors. MSOs are now focused on helping organizations […]

Part II: Leveraging Financial Incentives and Contracting Strategy In Part I of this series, we introduced various models in establishing care management organizations within risk bearing entities (RBE), ranging from fully decentralized to fully centralized model. Within these models, three levers influence care management tactics to varying degrees: financial incentives and contract design, organizational and […]

As the nation continues to move away from traditional fee-for-service payments, providers are seeking ways to maximize their revenue and maintain a healthy profit. The transition to value-based payment (VBP) has been slower with Federally Qualified Health Centers (FQHCs) as they often run on razor thin margins and traditionally on a volume based revenue model. […]