Blog

Utilization Management (UM) is employed by payers and by providers in global risk with UM delegation to ensure that patients get the right care at the right time in the right place in a cost-effective manner while maintaining high quality patient care and services. Many UM programs have recently come under fire because of the […]

As of August 2022, preliminary federal estimates showed that Medicaid enrollment stood at more than 90.9 million people, or more than one in four Americans, following the impact of the Families First Coronavirus Response ACT, which enabled continuous enrollment for Medicaid beneficiaries through the COVID-19 pandemic. As of March 31, 2023, Congress has stopped continuous coverage […]

The Medicaid population is a mosaic of individuals, each with unique needs and challenges. For clinicians and caregivers navigating this complexity, the integration of longitudinal patient data, outcome data, and financial data offers a beacon of clarity. The following represent some potential real-world applications for this integrated approach:   Elderly and Dual-Eligible Beneficiaries: :: […]

In the rapidly evolving landscape of healthcare, the shift towards value-based care is gaining momentum. This paradigm shift, which emphasizes patient outcomes over volume of services, presents a unique opportunity for primary care providers to redefine their role and create a more sustainable and effective healthcare system. The key to success in this new era […]

Deadline 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. The eight states selected for the MCP model are: Colorado, North Carolina, New Jersey, New Mexico, upstate New York, Minnesota, […]

On June 8, 2023, CMS announced a new CMMI primary care model, Making Care Primary (MCP), covering traditional Medicare beneficiaries, that aims to strengthen primary care infrastructure through service delivery and care integration enhancements designed to improve an MCP entity’s care management programming, specialty care integration and community supports connections closing social determinant of health […]

This webinar will delve into the transformative impact of data analytics in the context of value-based care, bringing together providers and payers to explore strategies for leveraging disparate data sources and enhancing performance. Speakers will address key topics, including how we can use data to improve health and patient outcomes in relation to value-based care, […]

Understanding Drivers of Performance: Engaging providers at a higher rate and with the right data and insights early on leads to improved clinical, quality and financial outcomes, improved provider and health plan performance, provider and member retention, and overall efficiency.  Nationally, health plans and their contracted provider networks are actively working to improve performance […]

On March 31st U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), released the Calendar Year (CY) 2024 Medicare Advantage (MA) and Part D Rate Announcement that finalized payment policies for these programs. CMS will phase-in certain updates, and on average, CMS anticipates a payment increase for […]

Incident-to billing is a billing practice in which a non-physician health care provider, such as a nurse practitioner, physician assistant, or clinical nurse specialist, can bill for services provided at the full rate of the supervising physician. In this billing practice, the physician supervises the non-physician provider’s services and is responsible for initiating and managing […]