Blog

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 […]

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 […]

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, […]

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 […]

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 […]

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 […]

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 […]

Background: Our client is a large Academic Medical Center located in the Northeast with a direct-to-employer contract managing a commercial employee population. The health system uses Analytics for Risk Contracting (ARC) and the COPE Health Solutions (CHS) Data Analytics as a Service (DaaS) solution to identify specific opportunities and track performance in specific aspects […]

Background: Hawaii Health Network (HHN), based in O’ahu, HI, is a recently formed Clinically Integrated Network (CIN) composed of four partner medical groups/IPAs and is the state’s largest post-acute care provider. HHN’s mission is to be a clinically integrated network that systematically supports independent physicians and provides others in the transition from volume to […]

Background: Our MSO Co-Source client is a provider-led health system, physician governed clinically integrated network (CIN), and independent physician association (IPA) in the Northeast. The IPA is committed to enabling network providers to successfully perform in value-based payment (VBP) contracts with payers through strategic collaboration, powerful data & analytics, enhanced provider engagement strategies and […]