Blog
4 Things to Know About the CMS MCP Request for Application
December 13, 2023On 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 […]
Webinar – Integrating Care Through Dual Eligible Special Needs Plans
November 21, 2023In 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.
5 Things to Know About ACO REACH Health Equity Data Reporting Submissions
November 2, 2023On 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 […]
Webinar – Redefining Whole Person Care: The Importance of DxF in Advancing Equity & Healthcare Transformation
October 26, 2023In this webinar, our speakers from COPE Health Solutions, Health Tech 4 Medicaid, Transform Health and LTIMindtree discuss how California and other states are working toward streamlining the way agencies share data to improve care for members. Changes to policy will have real impacts to data sharing and how payers and providers use data to […]
Understanding Utilization Management, Part I: The Basics
October 26, 2023Utilization Management (UM) has been employed by organizations to ensure that patients get the right care at the right time in the right place in a cost-effective manner while maintaining high quality patient care and services. Many programs have recently come under fire because of the administrative impact the process has on health care providers […]
5 Things to Know about Medicaid Redetermination
October 26, 2023As of August 2022, preliminary federal estimates showed that Medicaid enrollment stood at more than 90.9 million people, or more than one in four Americans, following the impact of the Families First Coronavirus Response ACT, which enabled continuous enrollment for Medicaid beneficiaries through the COVID-19 pandemic. As of March 31, 2023, Congress has stopped continuous coverage […]
Data-Driven Care for Medicaid: Tailored Solutions for Diverse Needs
October 26, 2023The Medicaid population is a mosaic of individuals, each with unique needs and challenges. For clinicians and caregivers navigating this complexity, the integration of longitudinal patient data, outcome data, and financial data offers a beacon of clarity. The following represent some potential real-world applications for this integrated approach: Elderly and Dual-Eligible Beneficiaries: :: […]
HLTH 2023 Panel: Accelerating Success in Advanced Value Based Payment
October 9, 2023During the HLTH 2023 Conference, on Monday, October 9, speakers emphasized the urgent need to advance and accelerate Value-Based Care, highlighting key challenges in qualifying, rate setting, data accuracy, and goal alignment. They additionally emphasized the importance of evidence-based models, community engagement, and comprehensive programs to foster warm handoffs and collaborative, patient-centered care within a […]
Success Through Value Based Care: Focus on Primary Care, Scalable Infrastructure, and Health Plan Partnerships
September 28, 2023In the rapidly evolving landscape of healthcare, the shift towards value-based care is gaining momentum. This paradigm shift, which emphasizes patient outcomes over volume of services, presents a unique opportunity for primary care providers to redefine their role and create a more sustainable and effective healthcare system. The key to success in this new era […]
Webinar – CalAIM Technical Assistance: Access New Funding, Increase Managed Care Revenue and Performance
September 19, 2023While we are well into the second year of implementation, there remains a significant portion of the eligible population and provider community who have yet to realize the benefits of this waiver. We will discuss key pain points, as well as the resources and infrastructure development opportunities CalAIM offers to providers, community-based organizations, counties, and […]