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Background: The period following discharge as a patient transitions from hospital to home can be a vulnerable time for patients, especially those who are at high risk for hospital readmission. Preventable hospital readmissions often stem from a discontinuity in a patient’s care plan due to confusion surrounding discharge instructions, changes to medication regimen, or […]

The initial failed launch of CMS’s HealthCare.gov website is cautionary tale of what can go wrong when leadership teams do not have actionable intelligence delivered from a problem solver’s perspective. Plagued by glitches and performance issues, HealthCare.gov was so unreliable during its debut in October 2013 that the government considered scrapping the entire $300 million […]

  Tom Dougherty, FACHE, Principal, has extensive expertise in risk-based coordinated health care delivery models, health plan network management and administration of hospitals, nursing homes, and home health. COPE Health Solutions draws on Tom’s experience and knowledge for its health system clients that are developing or enhancing their risk-based care and capitation models.  : […]

Background: In 2010, the Affordable Care Act provided states the option to implement a “health home” (HH) care management model, with the goal of improving care coordination, reducing costs and improving health outcomes for high-need Medicaid members with chronic conditions. In an attempt to bridge resource gaps for a particularly complex segment of the […]

Overview: On January 9, 2017, Washington State Health Care Authority (HCA) released highly anticipated Special Terms and Conditions (STC) outlining the provisions of the Section 1115 Medicaid demonstration waiver. The five-year waiver is active now through December 31, 2021. Under this demonstration, a delivery system reform incentive payment (DSRIP) program aims to increase access, […]

:   Abstract: : Health care reform has evolved over the past few decades, but one constant in this transformation has been Section 1115 waivers. These waivers broadly permit states to conduct “Medicaid research and development” programs to better meet the health care needs of their unique populations. Thus, the onus of health care reform […]

On January 9, 2017 the Washington Healthcare Authority (HCA) reached a pivotal milestone in their partnership with the Centers for Medicare and Medicaid (CMS) to transform the delivery and quality of care served to their Medicaid population. The two parties finalized the Standard Terms and Conditions (STCs) of the 1115 Medicaid waiver, making the waiver […]

Carla D’Angelo, Vice President, leads the Health+Hospital/OneCity Health account in New York City. As the account lead, she directs the work of 15 consultants in the internal account team and manages the relationship with the client. She has spent most of her career in managed care and most recently helped lead the transition of an […]

  The year 2017 is upon us, and that means that the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 is in effect for eligible clinicians who participate in Medicare Part B. MACRA is a bipartisan approach to physician payment reform attempting to repair the patient-provider relationship, as the Centers for Medicare and Medicaid […]

Introduction & MSO Background: A management services organization (MSO) is a health care specific administrative and management engine that provides a host of administrative and management functions necessary to be successful in the ever changing healthcare environment. As risk begins to shift from health plans to providers as part of managed care arrangements, many […]