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The Washington State 1115 Waiver application and concept paper is a system transformation initiative that will significantly change the way care is delivered to low-income patients. Medicaid patients are entitled to accessible, coordinated and quality health care that is supported by robust community support services. This multi-faceted approach to patient care and wellness lays the […]

Overview: Delivery System Reform Incentive Payment (DSRIP) providers in Texas have been closely following the proposed extension to the Texas State Section 1115 Waiver as HHSC prepares to submit an extension application to the Centers for Medicaid and Medicare Services (CMS). A main goal of the extension is to align the waiver with Medicaid […]

The Centers for Medicare and Medicaid Services (CMS) recently released its proposed Medicaid and CHIP Managed Care Proposed Rule—the first major update to regulations in more than a decade—with public comments due on July 27, 2015. As the former Director of the California Department of Managed Health Care (DMHC) with oversight of the state’s health […]

COPE Health Solutions has enjoyed success with some of our health system partners in deploying Care Navigators to better link high-cost patients to care within the system to enhance success under at-risk contracts, readmission penalties and value-based payments.  Such compassionate touch and high quality patient care has become a critical success factor for today’s hospitals […]

New York State (NYS) has one of the nation’s largest populations of Medicaid and Medicare beneficiaries, each around 3 million members. As health care reform continues to lead states away from volume-based payments to value-based reimbursements, NYS has proposed a unique alignment strategy between the two largest federal health care coverage programs. The “Draft Medicare […]

The state of Texas has published a draft extension application requesting an additional five years of its 1115 Medicaid Waiver, which began in 2012 and will expire in September 2016 without an extension.  Providers implementing projects under the current waiver will need to understand how programmatic changes in this extension may impact their operations and […]

Nationally, the drive to improve health outcomes, enhance patient/member satisfaction and reduce total annual cost per member is requiring both providers and health plans to re-evaluate their contracts and the structure of their financial relationships.  The health care industry and its payers, both government and commercial, are rapidly shifting from fee-for-service to a value-based payment […]

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 a lack […]

The Centers for Medicare and Medicaid Services (CMS) awards incentive payments to eligible health professionals and hospitals that demonstrate meaningful use of certified electronic health record technology.  Compliance with the meaningful use (MU) guidelines established by CMS is intended to improve efficiency and quality through the use of these patient-centered tools. In order to receive […]

It is well understood that a small percentage of patients account for the largest proportion of health care expenditures. Systems have achieved remarkable success in keeping patients healthier and out of the hospital by employing case managers to identify opportunities, make connections, close gaps and troubleshoot problems. In a fee-for-service payment world however, hospitals and physicians […]