Primary care practices are facing a significant shift as the Centers for Medicare & Medicaid Services (CMS) continues to push toward its goal that all Medicare beneficiaries be under a value-based contract by 2030. Moreover, providers are faced with constant challenges in maintaining sustainable practices with ever-increasing administrative burdens, staff shortages and increasing operational costs….
In today’s complex healthcare system, the importance of accurate coding cannot be overstated, especially regarding Hierarchical Condition Categories (HCC) coding and Medicare risk adjustment. These components are vital in ensuring that healthcare providers are adequately reimbursed while complying with regulatory requirements. For organizations that handle Medicare Advantage patients, understanding and implementing accurate HCC coding practices…
Download Slides Join healthcare executive Rhonda Sanders, Chief Mission Access Officer at Empath Health and data expert Tom Martin, Senior Director of Data Insights at WellSky to explore how hospitals and Accountable Care Organizations (ACOs) can effectively leverage post-acute care (PAC) providers to drive success in value-based care. With more than 18 years of…
Download Slides This webinar addresses the critical role of professional caregivers in today’s healthcare system, particularly within Home and Community-Based Services (HCBS). With capacity challenges heightened post-COVID, the demand for caregiver support has never been more urgent. We’ll explore strategies to prioritize, support, and retain caregivers, recognizing them as the backbone of care. We’ll…
The Center for Medicare and Medicaid Innovation (CMMI) within CMS is tasked with fostering “healthcare transformation by finding new ways to pay for and deliver care that can lower costs and improve care.” An important component of CMMI’s agenda is the accountable care organization (ACO) model in fee-for-service (FFS) traditional Medicare (TM). CMS defines ACOs…
As we move through the second half of 2024, managed care organizations must prioritize member engagement, especially for individuals with chronic conditions. This period presents an opportunity to embrace strategies that encourage essential healthcare visits, such as annual wellness and primary care appointments. Read on for member engagement tactics that focus on precise member identification,…
Download Slides Join Our Exclusive Webinar: A Payer’s Pathway to an Integrated Fraud, Waste, and Abuse ProgramFraud, waste, and abuse (FWA) cost healthcare payers billions every year, negatively impacting operational efficiencies. Is your organization ready to detect, prevent, and effectively combat these issues? This webinar will provide actionable insights and tools to strengthen your…
The healthcare industry has been buffeted by a growing number of challenges over the past few years. This turbulence struck provider organizations in 2022, while payers were initially sheltered from the storm (Exhibit 1). But conditions became more difficult for payers in 2023, which has continued into this year, and there’s limited respite on the…
In this interview, Gordon Kuntz discusses the Delphi Method, a Predictable Cost of Care Model developed by the Predictable Cost of Care Working Group that enhances oncology market access strategies by standardizing and broadening the economic modeling of cancer treatment costs beyond just drug prices, while aiming to inform pathway developers, payers, and practices. Full…
Value-based care places additional emphasis on improved patient health outcomes, rather than solely on the volume of services provided. Looking ahead to 2025, it’s important to understand how current trends with value-based care could impact the health care industry as a whole. Pradeep Kumar Jain is the senior director of analytics and the senior client…