Payers and Providers California Edition
Call to Leadership: The California Delegated Model at Risk
Libertarians, and others frustrated with the costs and strictures of regulation, may express the view that regulation of the insurance industry is often burdensome and unnecessary. Without addressing the global topic, there is a solid argument that good regulation serves the public interest through supporting ongoing confidence in the insurance market in which the public […]
Population Health 360 Key Takeaways
On October 18, 2018, COPE Health Solutions and Montefiore Health System hosted the West Coast regional Population Health 360 Conference in Los Angeles, California. More than 50 health care leaders from provider and payor organizations gathered for this invite-only event to discuss current trends, challenges and the future vision of the value-based payment landscape. Attendees […]
Learning From Kaiser and Optum
A recent headline, “With 8k more physicians than Kaiser, Optum is ‘scaring the crap out of hospitals’1 is resonating within the hospital sector, as it reinforces what many hospital system executives are facing: either becoming a partner – or fearing becoming a “cost center.” The article’s premise – that two behemoths are battling it out for […]
The Who, Where, Why and What You Should Do Next with the California DMHC’s Expanded Licensing and Exemption Requirements
Effective July 1, 2019, the California Department of Managed Health Care (“Department” or “DMHC”) is requiring organizations under certain conditions to file their risk contracts with DMHC. California managed care organizations, medical groups, risk bearing organizations (RBOs), clinically integrated networks (CINs) and any entities looking to enter into upside or downside financial risk agreements will […]
Redesigning Specialty Care in Community Clinics: A California Case Study
Interim Evaluation Report on California’s Health Care Coverage Initiative
Golden State Guidepost: A Preview of Operational, Financial, and Regulatory Dilemmas
The Role of Medicaid Waiver Transformation Projects in Transforming the Core Strategic and business planning framework of health care organizations
Overview Across the United States over the last 10 years, 1115 Medicaid Waiver projects — initially known as Delivery System Reform Incentive Payments (DSRIP) projects — are driving health care transformation on a large scale in California, Texas and New York with other states such as Washington preparing to launch. These waiver-funded projects represent an […]