In the News

Stories and trends changing the healthcare landscape

Navigating COVID-19 in the Healthcare Industry

We can all agree COVID-19 brought about a seismic shift in the delivery of healthcare in 2020. This article reflects on services shifts, challenges those shifts create and approaches for providers and payers to anticipate and navigate the initiatives.

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CMS cancels two mandatory pay models and scales back a third

CMS is planning to reduce mandatory bundles based on results, provider feedback and “minimum” utilization considerations. Some programs will be cancelled, some will not launch in 2018 and one is being scaled back.

At the same time, we are helping our clients achieve great success building population health risk based management solutions. Let us help you identify your opportunities to improve outcomes and reduce the cost of healthcare.…/170819935

Reducing Post Acute Costs for Mandatory CMS Joint Replacement Bundle

Knee“Looking for ways to reduce your post acute costs for the Mandatory CMS Joint replacement bundle? New products are entering the market that allow providers to gauge progress without onsite visits…in surprising ways. Microsoft Kinect shifts from gauging your dance moves to measuring your gait and recovery from hip or knee replacement. In addition, tracking and providing on demand rehabilitation therapy programs with instant feedback. Tell us what you think!Read More.

CMS Final Rule on Overpayments

gavel and law bookMedicare Advantage Plans, need to update your strategy? Provider responsibilities and look back periods are reduced in the CMS final rule for overpayments. See more information:

The Centers for Medicare & Medicaid Services has issued a final rule regarding the legal requirements providers most follow if they are overpaid.

New Ideas for Population Health Analytics Using Persona-Based Model

crowdSome Health Plans are charting new territory in population health management: Member centric clinical persona. In the traditional disease/condition categorization, many members were in separate and unconnected programs. The nine clinical personas are: healthy kids, healthy adults, acute kids and adults, ADD High-Cost/Rx, Serious Mental Illness/Substance Abuse/Other At-Risk, Uncoordinated Care, Chronic Coordinated, Complex Managed and Extreme Complex. We find the approach compelling. Read More.

Medicaid Health Plans Face Quality And Performance Ratings

best-quality-graphicProposed Medicaid Managed Care Organization regulations include quality ratings for private plans providing benefits, in addition to provider network certification and member education. These changes are aligned with Medicare plan requirements, although well behind the rest of the CMS programs focused on quality of care while reducing overall costs. However, Medicaid reimbursement levels are lower posing larger challenges. Will quality measures be less robust? Read More.

How Data and DNA Are Making Cancer Treatment a Personal Issue

TData and Medicinehe power of data to help personalize optimal treatment for cancer is exciting; yet even more exciting is the ability to prevent it. Even though the health care industry recognizes the risks to quality of life as well costs associated with a disease event, innovation and pro-active care will need to address proven/necessary treatment and the timing of the costs when health plan benefits are annual. Not only providers of care, but also employer groups, individuals, and multi-year government innovation will likely need to play the role of change agents.Read the story.