Blog

On January 9, 2024, CMS approved a just under $7 billion amendment to New York’s Medicaid 1115 Waiver, allowing the state to make investments in Medicaid initiatives that expand access to primary and behavioral health, address health-related social needs (HRSN) to reduce disparities and promote health equity, and strengthen the healthcare workforce. The term of […]

5 Things for Health Systems in Participating States to Know About the AHEAD ProgramOn September 5, 2023, CMS released a new, voluntary state total cost of care model called the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. CMS plans to collaborate with states to increase investment in primary care, improve overall population […]

In the first part of this series on Utilization Management (UM), we discussed the basics and some of the newer rules and regulations on entities conducting (UM) required by CMS beginning January 2024.  In this section, we will dive deeper into the process of UM and start to examine some of the best practices used […]

As in any relationship, strategic relationships require time and commitment to develop a partnership with mutual benefits. It all begins with an introduction which will test the chemistry and the objectives between the two parties. At times, even when all the strategies are aligned, the interactions may not be comfortable. It’s an indication that the […]

In this webinar, industry experts discuss how the pending New York State Medicaid Waiver and aligned CMS value based payment programs will present new opportunities for healthcare organizations in both upstate and downstate New York. We’ll cover how the NY Waiver aligns with specific CMS models in upstate and downstate New York, lessons learned from […]

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. Both CMS and the State of New York have said that the program will be aligned with the upcoming New York 1115 Medicaid Waiver amendment which […]

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. CMS has indicated that the program may be aligned with the upcoming Washington 1115 Medicaid Waiver amendment which will have its own primary care enhancement program […]

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. The eight states selected for the MCP model are: Colorado, North Carolina, New Jersey, New Mexico, upstate New York, Minnesota, Massachusetts, and Washington. MCP’s payment, quality […]

In this virtual panel, we discussed the benefits of D-SNPs, cost sharing protections covered under D-SNPs, how D-SNPs affect healthcare utilization, and the opportunities and challenges of integrating care through D-SNPs. Provide your information to access the webinar. 

On October 3rd, 2023, CMS published an ACO REACH Newsletter providing PY23 HEDR submission procedure and timeframe updates. Health Equity advancement is a fundamental component of the ACO REACH model and a key differentiator from its predecessor, the Global and Professional Direct Contracting Model (GPDC). CMS established HEDR requirements for REACH ACOs as part of […]