Press Case Study
Clinical Continuity Improvement
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 […]
Payer/Provider Partnership
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 […]
CIN/IPA MSO Co-Source
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 […]
US Family Health Plan Cuts Readmission Rate for High-Risk Members to 11% By Upgrading Medical Management Programs
Challenge: Frequent regulatory and plan requirement changes, coupled with the need to adapt to pandemic challenges, prompted Uniformed Services Family Health Plan to find a partner to undertake a thorough review and restructuring of its medical management program. US Family Health Plan, a TRICARE Prime® military health care option serving military families in New […]
Building a Medicare Advantage Network
Background The Health Plan is a not-for-profit health plan in the Northeast that services more than 280,000 members, offering Medicaid, Medicare and Children’s Health Insurance Program (CHIP) plans. The plan has consistently ranked high on the National Committee for Quality Assurance’s (NCQA) quality metrics but had a relatively small footprint in its target markets, despite […]
Leveraging Care Navigators to Deliver Impact Medicare Compliance
Background Starting in 2011, the Center of Medicare and Medicaid Services (CMS) has required health care systems to deliver the Important Message from Medicare (IM) to all Medicare beneficiaries who are hospital inpatients. This admission notice provides beneficiaries and representatives a written notice about their hospital discharge appeal rights. CMS regulation dictates that IM delivery […]
Leveraging DSRIP to Improve Clinical Outcomes and Shift Toward Value-Based Payment
Background In 2013, the Texas Legislature created The University of Texas Rio Grande Valley (UTRGV) to increase educational opportunities in the surrounding Rio Grande Valley area, located at the state’s southernmost point along the Mexican border.1 The Rio Grande Valley has an estimated population of about 1.5 million residents.2 In conjunction with the school’s founding, […]
Improving Access and Quality in Post-Acute Care: Building a System-Wide Network of Skilled Nursing Facilities at One of the Nation’s Largest Public Hospital Systems
Introduction Hospital and health systems that strive toward value-based payment as their primary payor engagement strategy become more accountable for costs and health outcomes after a patient leaves an acute care facility. Medicare has already made this accountability a fact of life for all hospitals serving Medicare members through the value-based payment and re-admissions penalties […]
Improving Post-Discharge Phone Call Rates Using Health Scholars
Background: Benefits of a Post-Discharge Phone Program Hospitals have improved patient outcomes and patient satisfaction scores via implementation of a successful post-discharge phone call program to achieve: Improved patient outcomes: Patients receiving a post-discharge call were 23.1% less likely to be readmitted compared to patients who did not receive a call1. Early detection of adverse […]
Related Services : Health Care Talent InnovationsImplementing Medicaid’s 1115 Waiver for Texas’ JPS Health Network
The Problem: John Peter Smith (JPS) Health Network is a major public health care delivery system in Fort Worth, Texas and is the anchor entity for Region 10’s Regional Healthcare Partnership (RHP), part of Texas’ 1115 Medicaid waiver. The Delivery System Reform Incentive Payment (DSRIP) funding pool of the waiver allows providers that participate […]
Related Services : Policy Analysis