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What a wake-up call. On the heels of the Centers for Medicare & Medicaid Services (CMS) suspending Medicare Direct Contracting for most new applicants and sunsetting the Next Generation ACO model, the new director of the Center for Medicare and Medicaid Innovation (CMMI) last week signaled a likely move toward requiring providers to take financial […]

With the May 21 announcement that it was discontinuing the Next Generation ACO Model at the end of 2021, the Biden Administration continues to move decisively to put its stamp on The Centers for Medicare & Medicaid Services. While this decision has serious implications for NextGen ACOs participants, they are not alone.  The in-progress reassessment […]

If you’re like me, you remember the first round of capitated payments in the late 1980s and early 1990s. There were some good reasons why that grand experiment in managed care eventually collapsed, but one of the biggest culprits was lack of useful and actionable data as well as detailed analytics. Providers and payers did […]

Under the Biden administration, the Centers for Medicare & Medicaid Services has paused its 2021-22 contracting cycle for Medicare Direct Contracting and is assessing its other alternative payment programs. While many are busy trying to read the tea leaves as to which programs will survive and which will be cut, two patterns are clear: Programs […]

If you were shut out of Medicare Direct Contracting (MDC) when the Centers for Medicare and Medicaid Services (CMS) recently announced it would not accept new 2022 applicants, all is not lost. The pause on new MDC applicants is part of a broader examination of CMS’ various Medicare models to encourage value-based care and value-based […]

Network leakage is a priority for 96% of health system and hospital executives, and more than 79% have been working to decrease leakage for more than three years.1 For those searching for a solution to address this pressing issue, Montefiore Medical Center Bronx has cracked the code. The academic medical center in the Bronx is […]

In the recent Crain’s New York Business article “Pandemic will have little impact on future of hospital pay,” COPE Health Solutions CEO Allen Miller made two key points about health care executive pay.  : 1. Hospital CEOs and their senior executive teams face considerable challenges only made more difficult by the pandemic. : […]

It’s been more than 18 months since U.S. Health Resources & Services Administration (HRSA) added any new access point (NAP) grants to establish care clinics in underserved areas. Given the success of those grants and the fast-approaching August 31, 2021 end to the current two-year funding period, providers should begin preparing now to apply for […]

The COVID-19 pandemic has escalated already high levels of burnout, creating a tipping point for growing numbers of doctors, nurses, other providers and health care employees. 1 in every 4 (26%) U.S. health care workers has considered leaving their job since the start of the pandemic.1 14% are thinking of leaving the health care profession […]

Provider and payer success in Medicare Direct Contracting (MDC), a voluntary program for fee for service beneficiaries, hinges on earning member loyalty through a strong care infrastructure and provider referral network. The pace and path forward differs a bit depending on whether you are one of the 53 MDC Direct Contracting Entities (DCEs) that launched […]