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Despite Threats to the ACA, It is Time to Plan Long-Term

February 14, 2020

The Affordable Care Act (ACA) has survived for a decade despite Congressional attempts to repeal it, executive orders to weaken it, and some Democratic Presidential candidates proposing to upend it in favor of a single-payer system. Despite the political rhetoric and executive actions, participating ACA individual insurers experienced a highly profitable 2019. This resulted in […]

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Considerations for Extension and/or Renewal of the Texas 1115 Waiver: A Look at Other States

February 5, 2020

The expiration of the Texas 1115 Waiver at the end of September 2022 is a call to action. With the uncertainty surrounding the Texas 1115 Medicaid Waiver renewal, the state’s Health and Human Services Commission may consider some of the policy and regulatory changes to the Medicaid program that the Centers for Medicare and Medicaid […]

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Medicare Advantage Value-based Insurance Design Model: Should You Apply?

January 29, 2020

In the calendar year (CY) 2020 for the “Value-based insurance design” (VBID) Model and has expanded opportunities for CY 2021 including a new hospice benefit. The VBID Model aims to increase health care quality and decrease costs for Medicare Advantage (MA) by leveraging financial incentives to promote cost efficient health care services and expand consumer […]

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2020 Healthcare Forecast: 4 Key Trends and 10 Essential Strategies

January 29, 2020

The new decade has barely begun, but already 2020 is shaping up to be another pivotal year in health care. With all the innovation taking place in payment models, service delivery, technology and other areas, it is easy to lose sight of the fundamental drivers of the emerging health care industry. This article outlines four […]

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Population Health and the Academic Medical Center (AMC) Chase – Five Hurdles to Value-Based Care

January 29, 2020

Academic Medical Centers (AMCs), for the large part, are late to the population health game and have been playing catch-up. Though uniquely innovative and focused on both clinical care and research, AMCs are challenged by systemic obstacles that make transformations difficult as change requires new levels of collaboration across the entire organization. Simply put, changing […]

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The Value of Federally Qualified Health Centers and Community-based Organizations to IPA Networks – Options and Keys to Success

January 21, 2020

Independent Physician/Provider Associations (IPAs) are key mechanisms for physicians, health systems and federally qualified health centers (FQHCs) to align and engage in value-based payment arrangements that add value to payors and attributed members. This paper provides insights into the benefits to IPAs for engaging FQHCs and community-based organizations (CBOs) into their network, care model and […]

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Do you have the right analytics to help you succeed with Medicare Direct Contracting and model projected financial performance?

January 21, 2020

Analytics for Risk Contracting (ARC) helps organizations manage and succeed in risk-bearing payment arrangements such as Medicare Direct Contracting (MDC). The ARC platform can help prospective Medicare Direct Contracting applicants address key business decisions related to MDC-specific requirements and operational parameters required to become a Direct Contracting Entity (DCE). Medicare Direct Contracting applicants can leverage […]

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New York Medicaid Waiver’s DSRIP Extension Considerations

January 14, 2020

The New York State Department of Health (NYSDOH) recently released a draft proposal to extend its Delivery System Reform Incentive Payment (DSRIP) program as part of the state’s 1115 Medicaid waiver, currently set to expire at the end of March 2020. Asking the Centers for Medicaid and Medicare Services (CMS) for $8 billion over four […]

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Top Considerations to Assess Readiness for CMS Medicare Direct Contracting

December 19, 2019

Medicare Direct Contracting (MDC) is a unique opportunity for providers and payors to align financial incentives and redesign care for Medicare fee-for-service beneficiaries. To succeed under this model, risk bearing organizations need to be able to reduce total cost of care and improve performance against key quality metrics. To maximize success in Medicare Direct Contracting […]

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Preparing for Your DSRIP 2.0 Audit

December 18, 2019

On December 16, 2019, Texas Health and Human Services Commission (HHSC) announced that Myers & Stauffer has been selected as the compliance monitor for the Delivery System Reform Incentive Payment (DSRIP) program in Texas for current reporting years – Demonstration Year (DY) 7-9. Myers & Stauffer previously held the role as the compliance monitor under […]

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