Blog

Capacity and Infrastructure Transition, Expansion and Development (CITED) is an incentive payment model available to Enhanced Care Management (ECM) and Community Supports (CS) providers which includes Federally Qualified Health Centers (FQHC), county and social services agencies, community clinics, and other community-based entities. CITED is one component of the Providing Access and Transforming Health (PATH) Initiative […]

As Medicare open enrollment begins for 2025, major reductions in Medicare Advantage (MA) plan offerings are expected to lead to major shifts in patient enrollment in plans. Existing enrollees will need to decide whether to explore alternative plans or switch to traditional Medicare. It’s imperative that providers keep a close track on enrollment trends for […]

For the last 10+ years, most providers participating in Medicare Accountable Care Organizations (ACOs) have done so under the umbrella of an ACO aggregator. These aggregator organizations form risk-bearing entities, contract with CMS, and then recruit physician groups to participate in their ACO. While this “I’ll drive, you can ride in the back seat” type […]

On October 28, CMS announced that Rhode Island and Downstate New York were accepted to participate into Cohort 3 of the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. Cohort 3’s first Performance Year is 2027. Downstate NY will consist of the following five counties: Bronx, Kings, Queens, Richmond, and Westchester. AHEAD is […]

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) […]