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…
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…
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…
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…
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…
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,…
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…
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…
Is accountable care more than just a buzzword? Even if it is, what can today’s healthcare provider even do about it? Although everyone from the private sector to CMS to the U.S. taxpayer agrees we are spending too much and…
As healthcare benefit costs continue to worry employers, health systems and employer groups are becoming more sophisticated in their approach to contracting directly. Direct-to-employer contracting deals from health systems allows both entities to both understand and gain more control…