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As CalAIM continues through year three of implementation, Enhanced Care Management (ECM), Community Health Workers (CHWs) and Community Supports (CS) continue to scale. These services are increasing integration with primary care provider organizations, whether an in-house service, contracted or a referral partner, who are ultimately accountable to managed care plans (MCPs) and the State for […]

Background: Federally Qualified Health Centers (FQHCs) are designated entities in the national Health Center Program that are instrumental in providing healthcare services to underserved communities and increasing access to high quality, affordable healthcare. The fee for service model does not reimburse most providers at an adequate level to be sustainable with the growing Medicaid […]

Community Health Workers (CHWs), also referred to as Promotores, are community-based frontline health workers experienced in providing linguistic and culturally sensitive, individualized whole person care in both clinical and non-clinical environments. CHWs can enhance access to and quality of primary care and are often underutilized due to a lack of understanding of their capabilities and […]

Value-based contracts offer provider organizations an opportunity to govern themselves in order to provide high-quality, cost-efficient care to their attributed members and take responsibility for determining the most efficient and effective use of healthcare resources. Much has been written on what a value-based contract is, what is included in a value-based contract, how to negotiate […]

At the end of February, the Millbank Memorial Fund released their 2024 primary care scorecard entitled ‘No One Can See You Now’. A bleak assessment of primary care in the United States, the scorecard identifies five key contributors to the ever-worsening patient access crisis, the top two of which cite the need for workforce expansion1: […]

Recently we shared key considerations for organizations considering or planning to apply to the Medicare Shared Savings Program (MSSP), a progressive risk sharing program created as part of the Affordable Care Act in 2010 that enables physician networks to take risk against a budget and share in potential savings by creating Accountable Care Organizations (ACOs). […]

The Medicare Shared Savings Program (MSSP) is a progressive risk sharing program created as part of the Affordable Care Act in 2010 that enables physician networks to take risk against a budget and share in potential savings. Within the program, physicians create Accountable Care Organizations (ACOs) to cover a Medicare Fee for Service (FFS) population […]

As Medicaid populations are increasing and Medicaid managed care contracting requirements are trending to more rigorous quality requirements, health systems must develop strategies to improve quality while managing losses that clinics serving mostly Medicaid typically experience. Speakers: • Steven Carson, MHA, BSN, RN, Senior Vice President, Population Health, Temple University Health • Stephanie King, Assistant […]

Background: In September 2023, the CMS released the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. At that time, we shared with you five key initial considerations. With the recent release of Version 1.0 of CMS’ Medicare Fee-for-Service (FFS) global budget methodology our team has put together some updated considerations for health […]

One of the main initiatives in New York’s just under $7.5 billion 1115 Medicaid waiver amendment is the formation of 13 regionally based Social Care Networks (SCN) that will be responsible for building, maintaining and strengthening networks of Community-Based Organizations (CBO) to deliver health-related social needs (HRSN) services. The Request for Application (RFA) window to […]