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:   Abstract: : Health care reform has evolved over the past few decades, but one constant in this transformation has been Section 1115 waivers. These waivers broadly permit states to conduct “Medicaid research and development” programs to better meet the health care needs of their unique populations. Thus, the onus of health care reform […]

On January 9, 2017 the Washington Healthcare Authority (HCA) reached a pivotal milestone in their partnership with the Centers for Medicare and Medicaid (CMS) to transform the delivery and quality of care served to their Medicaid population. The two parties finalized the Standard Terms and Conditions (STCs) of the 1115 Medicaid waiver, making the waiver […]

Carla D’Angelo, Vice President, leads the Health+Hospital/OneCity Health account in New York City. As the account lead, she directs the work of 15 consultants in the internal account team and manages the relationship with the client. She has spent most of her career in managed care and most recently helped lead the transition of an […]

  The year 2017 is upon us, and that means that the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 is in effect for eligible clinicians who participate in Medicare Part B. MACRA is a bipartisan approach to physician payment reform attempting to repair the patient-provider relationship, as the Centers for Medicare and Medicaid […]

Introduction & MSO Background: A management services organization (MSO) is a health care specific administrative and management engine that provides a host of administrative and management functions necessary to be successful in the ever changing healthcare environment. As risk begins to shift from health plans to providers as part of managed care arrangements, many […]

  New York State announced the approval of an extension for the Section 1115 Medicaid Waiver and released updated Standard Terms and Conditions (STCs) this week. The STCs is the contract between the state and CMS that lays out the terms of the waiver and how waiver programs will be operated. The current waiver was […]

On Thursday, CMS announced the creation of a new ACO model geared toward patients who qualify for both Medicare and Medicaid, also known as dual eligible. Dual eligible patients typically have more complex health needs, chronic conditions and social issues than the general Medicare population.  Consequently, they account for a disproportionate share of spending in […]

In today’s changing health care environment, one constant is the role of technology in optimizing clinical care delivery. Today more than ever, organizations face increasing pressure from regulatory bodies to increase quality and reduce cost, while doctors are encouraged to see more patients during the same 8-hour work day, and patients grow frustrated with the […]

Value-Based Payments Require a Value-Based Business Model: Many providers today find themselves amid shifting tides. Though local markets are at different stages in this process, the trajectory away from fee-for-service and toward value-based payment (VBP) is well under way, with strong policy tailwinds and buy-in from commercial payers. Prudent health care enterprises are embracing […]

In summer 2015, four of the five biggest insurance companies shook the health care industry when they announced two mega-mergers: Aetna to buy Humana for $37 billion, and Anthem to acquire Cigna in a $54 billion deal. Since the announcements, many have wondered about the potential ramifications of leaving a trillion-dollar industry in the hands […]