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Effective July 1, 2019, the California Department of Managed Health Care (“Department” or “DMHC”) is requiring organizations under certain conditions to file their risk contracts with DMHC.1 California managed care organizations, medical groups, risk bearing organizations (RBOs), clinically integrated networks (CINs) and any entities looking to enter into upside or downside financial risk agreements will […]

Public hospitals and health systems have a commitment to provide access to care for the most vulnerable populations, including the uninsured and underinsured. They also have a unique opportunity to become leaders of a network of choice for the care of Medicaid, Medicare Advantage, dual-eligible, subsidized exchange, and other populations by overcoming the traditional siloes […]

Background Starting in 2011, the Center of Medicare and Medicaid Services (CMS) has required health care systems to deliver the Important Message from Medicare (IM) to all Medicare beneficiaries who are hospital inpatients. This admission notice provides beneficiaries and representatives a written notice about their hospital discharge appeal rights. CMS regulation dictates that IM delivery […]

Background Starting in 2011, the Center of Medicare and Medicaid Services (CMS) has required health care systems to deliver the Important Message from Medicare (IM) to all Medicare beneficiaries who are hospital inpatients. This admission notice provides beneficiaries and representatives a written notice about their hospital discharge appeal rights. CMS regulation dictates that IM delivery […]

Thank you all for joining our Las Vegas Population Health 360 Conference. More than 100 health care leaders gathered for this invite-only event to discuss current trends, challenges and the future vision of the value-based payment landscape. Attendees engaged in a series of panels and round table discussions throughout the two days to learn best […]

Background In 2013, the Texas Legislature created The University of Texas Rio Grande Valley (UTRGV) to increase educational opportunities in the surrounding Rio Grande Valley area, located at the state’s southernmost point along the Mexican border.1 The Rio Grande Valley has an estimated population of about 1.5 million residents.2 In conjunction with the school’s founding, […]

Background In 2013, the Texas Legislature created The University of Texas Rio Grande Valley (UTRGV) to increase educational opportunities in the surrounding Rio Grande Valley area, located at the state’s southernmost point along the Mexican border.1 The Rio Grande Valley has an estimated population of about 1.5 million residents.2 In conjunction with the school’s founding, […]

The Centers for Medicare and Medicaid Services’ (CMS) Direct Contracting (DC) Model Options, a new set of voluntary payment models announced this week by the U.S. Department of Health and Human Services (HHS) for Medicare fee-for-service patients and their health care providers, represent a major step forward for population health management and value-based care. Based […]

As health systems seek or are forced into risk-based contracts, aligning stakeholders and developing a comprehensive strategy to create a culture ready for change is key. Regardless of your system’s current level of maturity with risk contracts or its ability to manage care for a population, moving from fee-for-service payments to global risk or capitated […]

It is no trade secret that physicians drive quality and medical spend in the health care industry. Across the nation, health systems, independent physician associations (IPAs), and accountable care organizations (ACOs) are challenged to effectively partner with their physicians to achieve high-quality outcomes and reduce the total cost of care. Those organizations most successful in […]