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As providers and payers grapple with the best ways to address social determinants of health (SDOH), they are neglecting an important and readily available tool to improve outcomes and costs. That tool is Z codes, which include a subset of ICD-10-CM codes created to report social, economic and environmental determinants in patients’ electronic records and […]

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The national trend across all lines of business toward more risk arrangements means most health systems and physician groups are operating in pluralistic payment environments. They earn some of their revenue through traditional fee-for-service and other portions come from shared savings, bundled payments, capitation and other value-based payments. Figure 1: Payment System Spectrum: While […]

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If you’re thinking about starting a new health plan or expanding your offerings, you are not alone. Take Medicare Advantage. In response to the fast growth in the Medicare-eligible population and strong interest in Medicare Advantage, both new and established insurers have seized this opportunity. In the past five years, the number of MA plans […]

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It’s the time of year when Joe Namath and other personalities are taking to the airwaves to tell seniors about the benefits of Medicare Advantage (MA) plans. For seniors, choosing between traditional Medicare and MA plans during the annual enrollment period can have a significant financial impact. The same holds true for health care providers […]

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The shift to value-based payments and value-based care is the most complex and far-reaching transformation being undertaken by U.S. health care in our lifetimes. One proven way to increase the chance of success in any project, let alone one the size and scope of the wholesale move to population health management and risk contracting, is […]

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In the recent Modern Healthcare article “Addressing healthcare worker burnout as another COVID-19 fall nears,” COPE Health Solutions Principal and Workforce Development Expert Elizabeth DuBois offers immediate actions providers can take to address some of the healthcare workforce’s acute pain while putting in place procedures and programs that take a strategic, longer-term approach to managing burnout. Two […]

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Only 62% of projects complete within budget and 56% finish on time, according to the Project Management Institute’s 2021 Pulse of the Profession. Worse, 25% of all projects fail completely. Value-based health care projects are highly complex, particularly due to the significant cultural shift required. Whether you are a health system, health plan, IPA or […]

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The New York State Medicaid Redesign team this week released a concept paper for a new 1115 Waiver, including a request for $17 billion over 5 years from the Centers for Medicare & Medicaid Services to build an enhanced health care delivery system as part of New York’s overall efforts to “reimagine, rebuild, and renew” […]

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Everyone in health care fervently supports the goals of value-based care—better quality and better outcomes at lower costs. But transitioning from the traditional fee-for-service system to population health management and payments based on capitation or global risk with reconciliation raises legitimate concerns and obstacles for physicians, hospitals, health plans and consumers. True, many payers and […]

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If a financial advisor promised 25% of your investments would never produce returns, you probably would not trust that advisor with your financial future. Many businesses, though, do exactly that with their project investments. U.S. organizations have a 75% success rate for projects that achieve their planned goals or benefits, according to the Project Management […]

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