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On May 1, 2016, the Centers for Medicaid and Medicare Services (CMS) approved a 15-month temporary extension for Texas’ Section 1115 Medicaid Transformation Waiver. This is the first extension and it will serve as an opportunity for the state to preserve the existing Delivery System Reform Incentive Program (DSRIP) as it continues to negotiate a […]

With the passage of the Affordable Care Act, millions of previously uninsured Americans have gained coverage and the ability to access a regular source of primary care. Payors and health care providers alike have had to scramble to accommodate the influx of new patients while adapting to new payment models. All of this comes at […]

Health systems across the nation serving the Medicaid population have recognized the dynamic interplay between an individual’s social needs and their health. Medicaid and uninsured patients have frequent unmet needs related to behavioral health, substance abuse, housing, access to food, unemployment and other core health-related social needs. Emerging research has shown that the lack of […]

Background: : Glendale Adventist Medical Center (GAMC) implemented the Health Scholar Program in March 2012. The program immerses aspiring pre-health professionals, including college students, career transitioners and veterans, into both clinical and administrative settings within health systems. The program provides structured experiential education and hands-on professional development. As stated in a previous article titled Community […]

As healthcare delivery in the US matures from a fee-for-service payment model to one that incentivizes quality and outcomes through value-based-payments, coordinated redesign of clinical processes is foundational on the pathway towards transformation. Siloed care delivery must become a vestige of the past, and highly-integrated, patient-centric care must become the new focus in order to […]

With data now available from the first three quarters of DSRIP, most Performing Provider Systems appear on track to collect the lion’s share of their first-year awards. Among the 25 PPSs, 12 were awarded all of their achievement values, or AVs. The worst-performing PPS, Advocate Community Providers, was on track to earn 93% of its AVs, according […]

Hear from Cindy Ehnes, our Executive Vice President about what’s next for Medi-Cal 2020 implementation and financing. California’s health care leaders are already deep into thinking about how $7 billion from CMS can drive system-level change. So, State of Reform invited some voices from the trenches to talk about what implementation strategies they see emerging, […]

The Letters of Intent for Next Generation Accountable Care Organization (NextGen ACO) model through the Center for Medicare and Medicaid Innovation (CMMI) are due May 2, 2016 for the program starting in 2017. Twenty-one participants nationwide will qualify for the NextGen ACO that builds upon the experience gained through the Medicare Shared Savings Program (MSSP) […]

The U.S. Health Care landscape is shifting at an unprecedented pace.  Since implementation of the Patient Protection and Affordable Care Act (ACA), reimbursement policies and methodologies have undergone significant changes alarming providers (i.e., hospitals, health systems, physicians, allied health and post-acute providers/professionals across the country). 2015 was especially remarkable due to significant policy changes in […]

Overview: California’s next Section 1115 Medicaid Waiver, Medi-Cal 2020, was approved on December 31, 2015. The Medi-Cal 2020 initiatives include a Global Payment Program, a Whole Person Care Pilot program, a Dental Transformation initiative and the introduction of the Public Hospital Redesign and Incentives in Medi-Cal program (PRIME). PRIME builds upon the successes of […]