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Value-based contracts offer provider organizations an opportunity to govern themselves in order to provide high-quality, cost-efficient care to their attributed members and take responsibility for determining the most efficient and effective use of healthcare resources. Much has been written on what a value-based contract is, what is included in a value-based contract, how to negotiate […]

At the end of February, the Millbank Memorial Fund released their 2024 primary care scorecard entitled ‘No One Can See You Now’. A bleak assessment of primary care in the United States, the scorecard identifies five key contributors to the ever-worsening patient access crisis, the top two of which cite the need for workforce expansion1: […]

Recently we shared key considerations for organizations considering or planning to apply to the Medicare Shared Savings Program (MSSP), a progressive risk sharing program created as part of the Affordable Care Act in 2010 that enables physician networks to take risk against a budget and share in potential savings by creating Accountable Care Organizations (ACOs). […]

The Medicare Shared Savings Program (MSSP) is a progressive risk sharing program created as part of the Affordable Care Act in 2010 that enables physician networks to take risk against a budget and share in potential savings. Within the program, physicians create Accountable Care Organizations (ACOs) to cover a Medicare Fee for Service (FFS) population […]

As Medicaid populations are increasing and Medicaid managed care contracting requirements are trending to more rigorous quality requirements, health systems must develop strategies to improve quality while managing losses that clinics serving mostly Medicaid typically experience. Speakers: • Steven Carson, MHA, BSN, RN, Senior Vice President, Population Health, Temple University Health • Stephanie King, Assistant […]

Background: In September 2023, the CMS released the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. At that time, we shared with you five key initial considerations. With the recent release of Version 1.0 of CMS’ Medicare Fee-for-Service (FFS) global budget methodology our team has put together some updated considerations for health […]

One of the main initiatives in New York’s just under $7.5 billion 1115 Medicaid waiver amendment is the formation of 13 regionally based Social Care Networks (SCN) that will be responsible for building, maintaining and strengthening networks of Community-Based Organizations (CBO) to deliver health-related social needs (HRSN) services. The Request for Application (RFA) window to […]

Medicaid membership has grown dramatically over the past decade, even with the recent dips due to fall-off from post Public Health Emergency redetermination, however Medicaid reimbursement has not kept up with inflation. Health systems and other providers are in a very tight spot with increasing costs driven by staffing, supply chain, the need to transform […]

A year ago, we explored the first results of the Global & Professional Direct Contracting (GPDC) program¹ (renamed to ACO REACH for performance year 2023) and found four themes:  Most participants could have earned greater savings by selecting a different risk arrangement (Professional or Global); “New Entrant” REACH ACOs tended to earn larger savings than […]

Community Health Workers (CHWs), also known as Promotores, are community-based professionals who provide culturally competent, person-centered support. CHWs provide a range of services for vulnerable populations to close gaps in care and navigate resources to help members better self-manage their health and social needs. In September 2022, the Biden Administration announced it was awarding $225 […]