Health plan-owned PCP clinics steer members to lower-cost sites-of-service
Hospitals and health systems need to be able to deliver high-quality outcomes in a cost-efficient manner to ensure they are not implicitly tiered out of a health plan's network.
What to expect from Medicaid block grant waivers
HFMA's Chad Mulvany says the macro design choice that matters to most to providers in any state that adopts the block grant program will be whether the state chooses the true block grant financing option, or if it selects a per capita cap based on the prior year’s enrollment.
The yin-yang of Medicaid: Expected federal regulations will increase number of uninsured despite increase in states taking expansion dollars
Despite more states considering taking Medicaid expansion dollars, federal regulatory efforts may drive an acceleration in the number of uninsured.
Limited BPCI savings seen with joint replacement bundles
CMS’s new BPCI-A model incorporates patient complexity into the risk-adjustment mechanism, but it remains to be seen if it will solve all issues with the previous model.
Analysis: Aspire Health Founder Brad Smith chosen as new CMMI director
The change in CMMI leadership could mean long-anticipated models are released, and may signal more emphasis on palliative care in future models based on Brad Smith’s background.
Atrius Health: Experience with global-risk contracts paves way to success in new arrangement
Previous success in risk-based contracts will allow Atrius Health to thrive in its new global-risk arrangement with Blue Cross Blue Shield of Massachusetts, two of the provider’s leaders write.
Analysis: FY20 appropriations bills passed – lessons for potential future healthcare legislation
A review of the FY20 appropriations package to fund the federal government and a couple of ideas on lessons that might be applied to future efforts to expand coverage.
‘Medicare for All’: What would it really mean for healthcare stakeholders?
“Medicare for All” would have varying impacts on hospitals, physicians and health plans but would be expected to cause financial hardship in the majority of cases.
Why initiate health plan contract testing?
Various circumstances require providers to prepare for the impact of payment changes.
How to use contract testing and analysis to prepare for payment change
Whether a contract is new or up for renewal, a thorough understanding of the financial implications of changes to provider-payment terms is vital for continued operations.