Blog

The National Committee for Quality Assurance was founded in 1990. For almost four decades, practices have been required to maintain, and regularly submit to carriers, credentialing data for their clinicians. So how is it, nearly forty years later, practices still treat this process as an afterthought? The reality of “the re-cred firedrill” is not limited […]

In today’s rapidly evolving healthcare landscape, the integration of data analytics and care management tools is proving to be a game-changer. With healthcare systems moving toward value-based care models, the demand for efficient, data-driven decision-making has never been higher. Integrated analytics and care management tools are bridging the gap between patient outcomes and operational efficiency, […]

Value-based contracting between payers and healthcare organizations and/or providers has seen steady growth in recent years. The basic idea is to incentivize healthcare and provider organizations for better performance on the targets set up by these agreements, with the ultimate goat to achieve the Quintuple Aim. While they offer the potential to align financial incentives […]

1. Evaluate your practice’s capacity to meet the three domains of MCP’s care delivery approach*: care management, care integration, and community connection: Care management: focus on designing and developing care management and chronic condition self-management services, with an emphasis on chronic disease prevention and management Care integration: strengthen connections with specialty care (Track 2 […]

New York State has revealed the nine organizations awarded with Social Care Network (SCN) status under the 1115 Medicaid Waiver Amendment. One of the state’s main goals under the 1115 Waiver is to invest in the screening and delivery of Health-Related Social Needs (HRSN) services to reduce health disparities and improve quality outcomes. SCNs will […]

Healthcare delivery has traditionally reimbursed providers on a fee-for-service (FFS) basis. This reimbursement system incentivizes volume over quality and leads to unsustainable growth in healthcare costs. In an effort to contain costs and reform the healthcare delivery system to prioritize value over volume, CMMI and commercial payers have introduced a multitude of value-based payment (VBP) […]

Expanded access to claims, EMR, ADT (Admission, Discharge and Transfer information), health related social need and other health care data sources through maturing health information exchanges, integration solutions and other avenues is creating new opportunities for both providers and payers. At the same time the volume of data available and diversity of data sources can […]

Over the course of the past decade, as more practices have entered the arena of Value-Based Care, practice operational functions have increasingly become an after-thought. The promise of big bonus checks (real or imagined) has created an environment in which small and mid-sized practices have shifted their focus toward RAF, gap closure activity, quality indicator […]

As we write to you in May 2024, the first cohort application dates have passed and the third in August remains. Our team highlights key considerations for hospitals below: 1. Hospitals Should Monitor Whether Their State Applied for Cohorts 1 & 2 or Intend to Apply for Cohort 3: Applications for the first two […]

As CalAIM continues through year three of implementation, Enhanced Care Management (ECM), Community Health Workers (CHWs) and Community Supports (CS) continue to scale. These services are increasing integration with primary care provider organizations, whether an in-house service, contracted or a referral partner, who are ultimately accountable to managed care plans (MCPs) and the State for […]