Blog
Strategies to Optimize Medicaid Quality and Revenue
February 28, 2024Medicaid membership has grown dramatically over the past decade, even with the recent dips due to fall-off from post Public Health Emergency redetermination, however Medicaid reimbursement has not kept up with inflation. Health systems and other providers are in a very tight spot with increasing costs driven by staffing, supply chain, the need to transform […]
ACO REACH: Selecting the Right Track and Risk Profile is Not Easy
January 30, 2024A year ago, we explored the first results of the Global & Professional Direct Contracting (GPDC) program¹ (renamed to ACO REACH for performance year 2023) and found four themes: Most participants could have earned greater savings by selecting a different risk arrangement (Professional or Global); “New Entrant” REACH ACOs tended to earn larger savings than […]
5 Things to Know About Community Health Workers
January 30, 2024Community Health Workers (CHWs), also known as Promotores, are community-based professionals who provide culturally competent, person-centered support. CHWs provide a range of services for vulnerable populations to close gaps in care and navigate resources to help members better self-manage their health and social needs. In September 2022, the Biden Administration announced it was awarding $225 […]
Medicaid Global Budgets for Downstate New York Safety Net Hospitals
January 24, 2024On January 9, 2024, CMS approved an amendment to New York’s Medicaid 1115 Waiver, allowing the state to make investments in Medicaid initiatives that expand access to primary and behavioral health, address health-related social needs (HRSN) to reduce disparities and promote health equity, and strengthen the healthcare workforce. The term of the demonstration amendment will […]
What to Expect in 2024 for Healthcare
January 16, 2024Greetings health care colleagues: Well, we’re through the Yuletide season and most folks are back from holiday travels or hibernations. It’s 2024 and an election year. What can we expect to see this year and for those of us updating strategic plans and reviewing our priority initiatives what should we be considering? 1.• Significant ongoing […]
New York State 1115 Waiver: An Overview of Its Contents
January 10, 2024On January 9, 2024, CMS approved a just under $7 billion amendment to New York’s Medicaid 1115 Waiver, allowing the state to make investments in Medicaid initiatives that expand access to primary and behavioral health, address health-related social needs (HRSN) to reduce disparities and promote health equity, and strengthen the healthcare workforce. The term of […]
5 Things for Health Systems in Potential Participating States to Know About the AHEAD Program
December 29, 2023On September 5, 2023, CMS released a new, voluntary state total cost of care model called the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. CMS plans to collaborate with states to increase investment in primary care, improve overall population health, advance health equity, and curb the growth of health care costs. States […]
Strategic Relationships in Partnerships
December 22, 2023As in any relationship, strategic relationships require time and commitment to develop a partnership with mutual benefits. It all begins with an introduction which will test the chemistry and the objectives between the two parties. At times, even when all the strategies are aligned, the interactions may not be comfortable. It’s an indication that the […]
Understanding Utilization Management, Part II: Best Practices
December 21, 2023In the first part of this series on Utilization Management (UM), we discussed the basics and some of the newer rules and regulations on entities conducting (UM) required by CMS beginning January 2024. In this section, we will dive deeper into the process of UM and start to examine some of the best practices used […]
4 Things for Washington Providers to Know About the CMS MCP Request for Application
December 5, 2023Deadline Approaching on December 14th: On August 14, CMS published the Request For Application (RFA) for Making Care Primary (MCP), a progressive roadmap to value-based payment for primary care providers with little-to-no VBP experience. CMS has indicated that the program may be aligned with the upcoming Washington 1115 Medicaid Waiver amendment which will have […]