Jim Hammond

Jim Hammond has worked in the Arizona healthcare industry for 30 years. He has experience with payors and providers of all types, including medical management companies, Medicaid health plans, commercial health plans, physicians, IPA’s, hospitals and integrated delivery systems; including 10 years as Director of Payor Relations at Mayo Clinic. Jim currently operates his own consulting firm, Professional Healthcare Solutions, LLC. PHS offers consulting services in the fields of managed care contracting, network development, strategic planning and transitional care. He has extensive knowledge of the Affordable Care Act. Jim has been an active member of Arizona Healthcare Financial Management Association for many years. He served on the board for six years and as President in 2006-2007. He currently serves on the past-presidents council. He is a frequent speaker on managed care topics, as well as moderating the Arizona Managed Care Newsletter - Now The Hertel Report State-of-the-State meetings, which are attended by leaders of the Arizona healthcare industry.

Author's Posts

News

Centene Buys Magellan Health, Molina Closes on Magellan Medicaid Plans Deal

Back in April of 2020, Molina announced plans to buy Magellan Complete Care, Magellan's Medicaid managed care plan division.  That deal closed on December 31, 2020, see Market Watch for that story and the transition plan from AHCCCS.  On January 4, 2021, Centene announced plans to buy Magellan Health behavioral health and specialty...
Arizona News

Open Letter from Dr. Leonard Kirschner Regarding Vaccines

Leonard Kirschner MD, MPH, Colonel USAF (Retired), AHCCCS Director (1987-1993), Past President AARP Arizona, shares a history lesson and encourages vaccination. Letter to the Editor Get The Shot. Leonard Kirschner MD, MPH Colonel USAF (Retired) AHCCCS Director (1987-1993) Past President AARP Arizona    ...
Arizona News

Commonwealth Primary Care ACO Affiliates with Equality Health Network

Commonwealth Primary Care ACO (Commonwealth) joins with Equality Health Network (EHN) and its management services organization, Q-Point Health, to offer support  for independent primary care physicians. EHN has agreements with AHCCCS plans and Medicare Advantage (MA) plans. Commonwealth is a network of about 100 primary care...
CMS Rules

CMS Finalizes Models to Address Chronic Kidney Disease and Cancer

CMS makes move to drive value-based reimbursement for cancer and chronic kidney disease (CKD) and end stage renal disease (ESRD) with a new final rule. The End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model uses value-based care payments to encourage the usage of home dialysis and kidney transplants. The new model also benefits...
Arizona News

Arizona COVID-19 Weekly Update - Numbers Down, Bars Versus Restaurants

All COVID-19 metrics are trending down in Arizona. The Arizona Department of Health Services this week added a note to the ADHS Data Dashboard letting the public know it had enhanced its processes for identifying COVID-19 deaths and as a result, the number of new deaths reported on the dashboard may "increase more than expected". ...
National News

Biden-Sanders Unity Task Force Makes Healthcare Policy Recommendations

The 110-page document includes recommendations on climate change, criminal justice, the economy, education, immigration and healthcare. The task force was formed after Sanders left the race and represent a compromise from candidates positions during the Democratic primary campaigns. For example, in the healthcare section, there is no...
Arizona News

Northern Arizona Healthcare Announces Restructuring Plan

Staff and facility changes are announced via letters to the editor and online media briefings. Principle among these changes is the transition of the Sedona free-standing ED to a lower cost level of care.  The press release letter of May 22, 2020 notes that the vast majority of care delivered there is non-emergent and many patients are...
Arizona News

AHCCCS Submits Additional Waiver Request Letter to CMS

In a March 24th letter to CMS, the Arizona Heath Care Cost Containment System (AHCCCS) requested additional flexibility and authority to bolster Home and Community Based Services (HCBS), allow for more virtual visits, extend assessments and reassessments, and expand the provision of home delivered meals. AHCCCS also would like the...

Trump Administration Says "No" to COVID-19 Special Enrollment Period on HealthCare.gov

The Trump Administration announced  it would not open the federal marketplace for a special enrollment period (SEP) in response to the coronavirus pandemic. The Affordable Care Act does allow for enrollment outside of the annual enrollment period for Americans that have lost employer-sponsored health plans, however, a special enrollment...
National News

Supreme Court May Still Consider ACA Case This Spring

Controversy reigns supreme as the GOP argues that the case, Texas vs. US (formerly Texas vs. Azar) is not ready for SCOTUS' review, as the fifth district has sent the case back to Texas for reconsideration of the severability of the law.  The Democrats and ACA advocates argue that uncertainty about the law should be resolved before the...
Arizona News

Humana and Iora Plan Growth in Arizona

Iora Health, which specializes in primary care services for traditional Medicare beneficiaries and Humana Medicare Advantage members, announces that it will open 11 new centers in Texas, Georgia and Arizona. Iora invests in preventive care, using primary care teams to focus on outcomes.  Their relationship with Humana is built on...
Arizona News

AZ HFMA Fall Conference Open for Registration

With a great line-up of speakers and all kinds of fun planned, the annual conference September 11-13 at the Talking Stick Resort is a must-attend fall event for healthcare professionals. The event includes a choice of two opening sessions on Wednesday afternoon September 11, 2019 at 4pm, followed by an opening reception at 5:30pm in...
National News

CMS Releases CY 2020 Physician Fee Schedule Proposed Rule

New physician fee schedule represents an overall 0.14 percent increase, adds codes for telehealth, re-values some codes and addresses opioid treatment programs. In an effort to reduce administrative burdens, the new proposed rule allows for  physicians and practitioners to review and verify notes in the medical record made by...
News

New CMO at BCBSAZ Jim Napoli MD is Interviewed by Becker's Hospital Review

Local healthplan executive answers what the greatest challenges are that face health insurer leaders. James Napoli, MD was named interim CMO of BCBSAZ in March, when Woody Myers, MD retired.  He was named permanent CMO on June 12, 2019, after years of successive promotions within BCBSAZ.  Prior to joining BCBSAZ, Dr. Napoli was...
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