MedPAC’s Updated View on the ACO MSSP Program

The MedPAC June 2019 report is out and Chapter 6 of the report to Congress shares MedPac’s review on the MSSP program.  As always, we invite you to read the full report and share your thoughts.  Let’s all remember that in 2018 there were 561 ACOs. The goal of ACOs

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What is Electronic Visit Verification (EVV)?

Electronic Visit Verification (EVV) is a technology that verifies where and when a caregiver begins services for a client and when they clock-out. This creates a breadcrumb trail that provides the basis for billing, staff safety, and service efficiency. The need for EVV arose from some providers inflating their time

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Managing Risk in Healthcare: The 4 Cs

In the late 1990s, I was part of an extraordinary team that managed the percentage of premium risk for over 450,000 lives in Arizona. We did it all from credentialing to care management to claims payment. We had our physicians in aggressive incentive programs which offered engagement and care plan

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Medicare Advantage Bids are Nearly Completed: What are your vendor’s results telling you?

What is going on at DataLink during Medicare Advantage bid season? Our Evoke360 platform integrates total costs, quality, risk adjustment, and provider network metrics, in addition to tracking value-based transformation. Evoke360 shows the wellness of the population, the engagement of the provider community, and the financial performance of the communities,

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College Commencement and Healthcare: Your First Steps

Last Friday night, I was privileged to attend the Indiana University Kelley School of Business graduation ceremony. There were a lot of well dressed, intelligent students walking across the stage about to take on the first stage in their careers. Kelley Business School speakers talked a great deal about being

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Looking Deeper at the CBOs Key Design Components and Considerations for Establishing a Single-Payer Health Care System

The Congressional Budget Office’s (CBO) Key Design Components and Considerations for Establishing a Single-Payer Health Care System is a long read and deserves discussion, digestion, analysis, and critical thinking. As someone who has worked on the health plan and the provider side, a public single-payer health care system makes me

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CMS Final Notice: A Rocky Path for Risk Adjustment

Let’s talk about the 2020 Part C Risk Adjustment Model The 21st Century Cures Act of 2016 required CMS to augment the risk adjustment model to reflect the number of clinical conditions an individual member may have and to make additional adjustments as the number of conditions increases. For 2020,

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