Blog

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 […]

As medical groups, health systems and health plans across the U.S. continue to feel the impact of COVID-19 and the Great Resignation, many are struggling to build sustainable pipelines of qualified staff and providers. Physician burnout, retirement and inflation are all factors leading individuals to leave the profession and/or retire. Recent studies have indicated that […]

With the heaviest burdens of the pandemic falling disproportionately on Californians who are low-income Black and Latino and on frontline workers, the need to implement targeted solutions to address long-standing Social Drivers of Health (SDoH) and health equity is at an all-time high. This is reinforced by the principles and goals of California’s newest Medicaid […]

Risk-bearing organization strategy and governance alignment Consider how ACO REACH plays into your overall strategy for growth and complements the capabilities necessary for greater risk across all lines of business Align and integrate the governance of your REACH ACO with your existing medical group, integrated delivery system, CIN or IPA; including boards and key committees […]

The 1115 Medicaid Waiver Program was developed to enable innovation and access to services by waiving the Medicaid rules or law and allow for a programs, benefits or expansion of coverage that would not normally be covered within the state’s Medicaid plan. This allows the states to better tailor the benefits provided by Medicaid to […]

Over the last couple of years, the COVID-19 Public Health Emergency (PHE) laid bare the disparities in health care in disadvantaged communities with preventive and routine care for chronic conditions was delayed in many cases. The California Department of Health Care Services (DHCS) has proposed a one-time investment for Equity and Practice Transformation of $700 […]

Over the past few years, we have continued to see an increase in provider clients interested in pursuing not only global risk but specifically capitation. This interest has accelerated with the COVID impacts on fee-for-service (FFS) visit revenue as well as the former Medicare Direct Contracting and current REACH ACO programs from CMMI which include […]

As the market continues its transition nationally towards value-based care, risk shifts from health plans to providers.  A big part of this shift means providers own and operate functions and services traditionally handled by health plans, such as utilization and care management, credentialing, claims processing, network development, technology support and more. Faced with the need […]