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December 31, 2018

Top 10 Healthcare Headlines from 2018

From mergers and vertical integrations to changes in quality reporting and technology, Healthcare in America continues to evolve with an eye on access, quality, and efficiency. Here is a look back at some of the major headlines of 2018.  …

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December 21, 2018

Medicare Advantage: In-Network vs. Out-of-Network

Medicare Advantage plans continue their unabated growth; in 2019, plan options across the United States have grown by 20% from 3,100 plans in 2018 to 3,700 plans in 2019.  By 2025, it is expected that Medicare Advantage market saturation will…

Attracting Patients via Narrow Networks

Narrow networks have surged in attempts for health plans and employers to tame rising healthcare costs. In many ways, patients negatively associate the phrase, “out-of-network” with arbitrary limitations of their choice. Frustrating, we’ve all felt it. How then can provider…

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December 13, 2018

Continuity of Care QPP Measures

Introducing continuity of care measures to the Quality Payment Program (QPP) may be the best route to lower healthcare costs and reduce hospitalizations according to a study recently published in the Annals of Family Medicine. Provider-level measures that support value-based…

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December 7, 2018

Common CIN Pitfalls to Avoid

Mistaking Inaction for Action Hesitant leaders can easily raise the red flag at any one of the many unclear pathways to success, that Clinically Integrated Network (CIN) conversationalists claim when discussing the ability to cultivate true innovation capable of both…

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November 15, 2018

2019 CMS Quality Payment Program (QPP) Changes

In 2019 the Centers for Medicare and Medicaid (CMS) are making changes to the Quality Payment Program (QPP). Below are the most impactful changes we think you need to know about. For additional information, click one of the links at…

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October 26, 2018

Why All Roads Lead to Network Adequacy

In recent years, the uneven playing field between the large carriers in Georgia and the rank and file physician practices across the state has become even more skewed toward these payers. More aggressive tactics have littered the physician landscape recently,…

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October 2, 2018

CMS Proposes to Completely Overhaul Accountable Care

CMS announced a major proposed adjustment to the vast majority of Accountable Care Organizations on Thursday, August 9 by re-branding the Medicare Shared Savings Program (MSSP) as the “Pathways to Success Initiative.” In essence, CMS Administrator Seema Verma intends to shorten…

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October 1, 2018

2019 Quality Payment Program Overview: APMs

Although Advanced Alternative Payment Models (APMs) haven’t spread like wildfire across the industry, the incentive to earn a 5% lump sum of yearly Medicare Part B payments and the ability to sidestep the MIPS program deserves attention. Although only ≈200,000…

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