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

Oncologists Face Risky Bundled Payment Models

The CMS Oncology Care Model, which begins in July, moves practices to two-sided risk, where the practices may be responsible for costs over target. According to Avalere Health, about 70% of oncology practices participating would owe the CMS money...

Arizona News

Ducey's Budget Proposal Does Not Include Funding for Graduate Medical Education - Updated - GME in Budget

Public health groups and stakeholders are concerned that many healthcare related priorities are being left out of the budget in Arizona. This includes funding of Graduate Medical Education (GME) which, in a nail biter, was included in the final budget. POST UPDATED: Reporting from Arizona Central confirmed that...

Arizona News

Governor Ducey Signs Association Health Plan Bill Into Law

Arizona passes a law that mirrors the rule published by the Department of Labor in June of 2018. With the individual mandate being ineffective due to a zero-dollar penalty, Americans can choose not to buy an ACA compliant plan. Association health plans (AHP) are an example of options available to consumers that are contrary to ACA...

Arizona News

High Rate of Vaccination Exemptions Makes Arizona Public Health Officials Fearful of a Measles Outbreak

Arizona non-medical exemption rates have increased across all age categories three years in a row. Arizona Department of Health Services Director Cara Christ, MD sees more parents submitting vaccine exemption forms for childcare, pre-school age and K-12 age groups. Dr. Christ called the trend alarming and is concerned about a measles...

National News

Department of Justice Settles with Three Pharmaceutical Companies Over Unlawful Payment of Patient Co-pays

The practice of funding co-pays so members don’t feel the impact of price increases was alleged against Jazz Pharmaceuticals, Lundbeck LLC and Alexion Pharmaceuticals. The so-called “patient assistance programs” were set up to funnel money to patient for co-pays. Quote from U.S. Attorney Andrew Lelling’s...

National News

CMS Gives Medicare Advantage Raise in 2020

Payment rates will increase an average of 2.53 percent for 2020. This new rate is 1.53 percent higher than originally projected due to new estimates of medical cost growth, but less than the 3.4 percent raise MA plans were given in 2019. Also included in the proposal is a loosening of the non-health related supplemental benefits...

National News

Study Says Federal Reinsurance Program Could Work: 2020 Price Tag $9.5B

The volatility of the individual market is no surprise to insurance insiders. Insurers need certainty to set low premiums. Reinsurance can create a level of certainty. This study looks at the cost of a national reinsurance program. Federal support for reinsurance programs has been consistent. The Affordable Care Act (ACA) set forth...

National News

Value-based Insurance Design - Matching Benefit Value to Patient Cost-Sharing

Designing benefits packages so that members pay less for high-value services and pay more for unnecessary, low-value services should result in lower overall costs and improved satisfaction. The VBID for Medicare Advantage has been expanded to all 50 states. Others are taking VBID to the exchanges. At the University of Michigan VBID...

News

Pushing 65? Medicare Has a Benefit Plan to Keep You Well

Medicare offers preventive services that can keep you healthy. Author Greg Dill, Medicare’s regional administrator for Arizona, California, Nevada, Hawaii and the Pacific Territories, spells out some of the preventive benefits offered through Medicare. Read this informative piece from the Arizona Daily Star You can always get...

National News

Democrats and BCBS Association Call For Changes Supporting Affordable Care Act

Reinsurance and cost sharing reductions (CSRs) are among the top recommendations to stabilize individual markets and lower premiums. The New Democrat Coalition, a caucus of 101 centrists, wants to work with Republicans to bring down Affordable Care Act (ACA) premiums and reverse the impact of what they consider the Trump...

Arizona News

Governor Ducey Makes Commitment Veto Any Anti-Vaccine Legislation

Saying Arizona is a "Pro-Vaccine State", Ducey said he would not sign any bills that could decrease vaccinations. In a rare statement on pending legislation, Arizona Governor Doug Ducey told reporters that because it involves public health, he is letting the people of Arizona that Arizona is "pro-vaccination". This comes after three...

National News

Drug Companies Face Pressure on Prices, Formularies and Transparency

HHS released proposed rules for Medicare Advantage and Part D plans in November. On Tuesday February 26th, the Senate took testimony from seven drug company executives. The pharmaceutical companies placed blame on the Pharmacy Benefit Management companies (PBMs) and warned that if they were to face outrageous solutions to lower...

Arizona News

Vaccines in the News and in Bills on the Legislative Chopping Block

After recent news of a measles outbreak in the U.S., including Arizona, two vaccine-related bills have seen some time in committee. One has not. The bills that have been proposed and discussed include one that will require a physician or administrating provider to inform parents of the risks and benefits of each vaccine, and one...

Arizona News

Arizona Legislature Looking Favorably Toward Telemedicine Coverage Parity

All eyes are on the Arizona Legislature as a bill encouraging parity of coverage (not rates) between in-person care and telemedicine makes its way through the lawmaking process. Publisher's note: Bill 1089 ultimately passed and was signed by Gov. Ducey, effective January 1,2021Senate bill 1089, sponsored by now Senator Heather Carter...

News

United Healthcare Supports Codes for Social Determinants of Care

The nation's largest insurer wants the codes to help identify key barriers to care and wants CMS to adopt standards for effective targeting of at-risk populations.Sheila Shapiro, senior vice president for national strategic partnerships in UnitedHealthcare's clinical services team, told Fierce Healthcare that one of the key barriers...

News

American Group Management Association CEO calls for End to Exclusions to MIPS

With nearly 60% of providers allowed to exclude themselves from the Quality Payment Program, the groups that have invested in technology and improved systems have not been able to reap the rewards originally promised in the MIPS program under MACRA. Under MACRA, providers were promised that their Medicare multiplier would go up if they...

News

CMS Releases Part II of the CY2020 Advance Notice and Proposes More Changes to Risk Adjustment, Supplemental Benefits and Opioid Policy

CMS wants to give Medicare Advantage (MA) plans more flexibility to offer previously non-covered supplemental benefits that will help chronic patients, adjust risk adjustment scores to reflect costs of beneficiaries with multiple conditions, and effectively raise the MA Revenue by 1.59 percent. Last year the revenue bump for plans...

National News

Mayo Clinic and US Youth Soccer Collaborate to Collect Brain Injury Data

Athletic Incident Management System (AIMS) was developed by Mayo Clinic Arizona sports neurology and concussion program co-director Jennifer Wethe, PhD. The program collects data on brain injuries, educates parents and young athletes on concussions and can help keep children safe and improve recovery after injuries. US Soccer...

News

Arizona MGMA Conference This Week Features AHCCCS Director Tom Betlach on Thursday

It is not too late to sign up and attend the annual Arizona Medical Group Management Fall Conference at the Sheraton Wild Horse Pass Resort. The event kicks off with a networking happy hour on Wednesday evening, October 17th. Of course, I will be in attendance again this year and look forward to seeing everyone. The agenda...

Arizona News

Different Perspectives on Impact of Arizona's Medicaid Expansion

Hospitals say getting paid for previously uninsured folks has saved them from potential closure. The Goldwater Institute says hospitals are raking in the dough by also raising rates on the commercial side.The Arizona Hospital and Healthcare Association (AzHHA) publishes a report that tracks uncompensated care trends for Arizona...

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