blog

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 […]

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 […]

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 […]

Is Incident to Bill Leading You to Long Term Revenue and GoalsIncident-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 […]

In late December 2022, CMS published the ACO REACH Health Equity Plan Templates, Guide and FAQ, outlining the standards and requirements REACH ACOs must meet in their efforts to address targeted health disparities in underserved communities in their service area. Health Equity is a hallmark ACO REACH initiative and a significant differentiator between the program […]

1. Continued transition to more value-based payment and risk for all lines of business.: Payers working to create more collaborative platforms and relationships with providers to improve outcomes and support strategies to mutually gain market share leveraging value-based payment arrangements. Providers realizing the need to develop a clear strategy and goals for their value-based […]

CMS has released the final ACO REACH Model Performance Period Participation Agreement (MPP PA) for PY2023 starters as well as a redlined version of the MPP PA compared to the GPDC Model Performance Period PA for PY2022 starters that highlights the updates made to the PA. Here are the key five considerations every ACO entity […]

As medical groups, health systems and health plans across the U.S. continue to feel the impact of COVID-19 and the Great Resignation, many are struggling to build sustainable pipelines of qualified staff and providers. Physician burnout, retirement and inflation are all factors leading individuals to leave the profession and/or retire. Recent studies have indicated that […]

With the heaviest burdens of the pandemic falling disproportionately on Californians who are low-income Black and Latino and on frontline workers, the need to implement targeted solutions to address long-standing Social Drivers of Health (SDoH) and health equity is at an all-time high. This is reinforced by the principles and goals of California’s newest Medicaid […]

Risk-bearing organization strategy and governance alignment Consider how ACO REACH plays into your overall strategy for growth and complements the capabilities necessary for greater risk across all lines of business Align and integrate the governance of your REACH ACO with your existing medical group, integrated delivery system, CIN or IPA; including boards and key committees […]