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5 Key Considerations of the New CMS AHEAD Model

September 6, 2023

Yesterday, September 5, 2023, the CMS Innovation Center released the AHEAD Model focused on improving overall population health of a specific state or region, advancing health equity by reducing disparities in health outcomes and curbing the growth of health care costs. Key aspects of the model: State accountability and alignment with Medicaid Waivers: States will […]

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Webinar – The Role of Data Analytics in Population Health Management

July 24, 2023

This webinar will delve into the transformative impact of data analytics in the context of value-based care, bringing together providers and payers to explore strategies for leveraging disparate data sources and enhancing performance. Speakers will address key topics, including how we can use data to improve health and patient outcomes in relation to value-based care, […]

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Strategies to Establish Strong Provider Engagement for Health Plans

May 2, 2023

Understanding Drivers of Performance: Engaging providers at a higher rate and with the right data and insights early on leads to improved clinical, quality and financial outcomes, improved provider and health plan performance, provider and member retention, and overall efficiency.  Nationally, health plans and their contracted provider networks are actively working to improve performance […]

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Medicare Advantage Rule Changes for 2024

May 2, 2023

On March 31st U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), released the Calendar Year (CY) 2024 Medicare Advantage (MA) and Part D Rate Announcement that finalized payment policies for these programs. CMS will phase-in certain updates, and on average, CMS anticipates a payment increase for […]

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Is Incident to Bill Leading You to Long Term Revenue and Quality Goals?

March 23, 2023

Incident-to billing is a billing practice in which a non-physician health care provider, such as a nurse practitioner, physician assistant, or clinical nurse specialist, can bill for services provided at the full rate of the supervising physician. In this billing practice, the physician supervises the non-physician provider’s services and is responsible for initiating and managing […]

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Webinar: Designing for Dignity: Disrupt Workforce

February 22, 2023

The speakers at the “Designing for Dignity: Disrupt Workforce” webinar will take juicy, creative, human-centered innovation and make novel solutions succeed out there in the real world. This webinar will help us learn how provider systems and consultants are tackling strategy, analysis, and financial modeling as generative design tools, and help organizations turn their biggest, […]

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What Payers and Providers Should Know About Proposed Changes to Medicare Advantage

February 13, 2023

On February 1st, CMS released the 2024 Medicare Advantage and Part D Advance Notice to inform Medicare Advantage organizations of proposed changes to the program. The changes that were proposed in that notice stretch far beyond just Medicare Advantage organizations (MAOs). Providers serving Medicare Advantage members in value-based arrangements will also be impacted and in […]

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5 Key Considerations for Your REACH ACO’s Health Equity Plan

January 12, 2023

In late December 2022, CMS published the ACO REACH Health Equity Plan Templates, Guide and FAQ, outlining the standards and requirements REACH ACOs must meet in their efforts to address targeted health disparities in underserved communities in their service area. Health Equity is a hallmark ACO REACH initiative and a significant differentiator between the program […]

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2023 Health Care Forecast, Trends and Key Issues

January 6, 2023

1. Continued transition to more value-based payment and risk for all lines of business: Payers partnering to create more collaborative platforms and relationships with providers Focus on improving outcomes and support strategies to mutually gain market share while leveraging value-based payment arrangements Providers realizing the need to develop a clear strategy and goals for […]

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5 Considerations of the ACO REACH Model Performance Period Participation Agreement

December 13, 2022

CMS has released the final ACO REACH Model Performance Period Participation Agreement (MPP PA) for PY2023 starters as well as a redlined version of the MPP PA compared to the GPDC Model Performance Period PA for PY2022 starters that highlights the updates made to the PA. Here are the key five considerations every ACO entity […]

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