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

Arizona Bricks & Mortar

Mayo Clinic Arizona Announces Another Expansion

The Phoenix campus will nearly double, adding 1.4 million square feet of medical space and employ 2000 more people. The giant non-profit, which is consistently ranked at the top of surveys and lists of hospitals and systems, will spend over $648...

Arizona News

Phoenix Business Journal Honors Kathy Bollinger with Healthcare Heroes Award

Emotional and inspirational were two words consistently used to describe the 17th annual healthcare heroes awards presented by The Phoenix Business Journal. Kathy Bollinger, longtime Banner Health executive, retired in June and spent a month on the beach. It must have agreed with her, as she was effervescent as ever when she...

Arizona News

Arizona HFMA Fall Conference to be held September 26-28 at San Marcos in Chandler

Registration is now open for sponsors, exhibitors and attendees. This large annual three-day event has been moved to the valley from Tucson after 20+ years in the old pueblo. This event is not to be missed and includes a golf outing, pre-conference workshops and special pricing available to providers that want to attend but are...

News

Arizona Hospital and Healthcare Association Releases May 2018 Financial Report

AzHHA releases financial information which includes improved overall operating income and continued stability in uncompensated care.The report focuses on the impact Medicaid expansion has had on lowering uncompensated care. Also included are stats about overall AHCCCS enrollment (falling), the hospital assessment and childless adults...

Arizona News

Health Systems and Plans Dominate Big Business List in Arizona

According to the latest list from the Phoenix Business Journal, Banner Health, HonorHealth and Dignity Health Arizona rank in the top ten of all employers by number of employees.With over 36,000 full-time employees in Arizona, Banner Health and its $7.8 billion in revenue has long been the top health system in Arizona when it comes to...

News

House GOP Proposed Budget for 2019 Cuts Medicare and Medicaid Spending

Largely symbolic budget calls for block grants for Medicaid and repeal of the Affordable Care Act (ACA) through reconciliation. In an effort to reduce the deficit by $302B over the next decade, the budget roadmap is called A Budget for a Brighter American Future. House budget chairman Steve Womack, the author of the budget document,...

Arizona Bricks & Mortar

Banner to Build a New Hospital in Chandler

Confirming its commitment to be the major hospital company in the east valley, Banner Health will build a new 120 bed facility adjacent to its existing Banner Health Center at Loop 202 San Tan Freeway and Alma School Road. Expecting an opening in the fall of 2020, Banner will spend more than $150 million on the project. “We want...

Arizona News

Governor Ducey Signs Credentialing Bill into Law

House Bill 2322 calls for a combined 100 day maximum for processing a credentialing application and "loading" the provider into the claims payment system. Arizona provider advocate organizations worked tirelessly with the healthplan lobby to work out the details of this important legislation. The bill includes details regarding...

Arizona News

Dignity Health and Blue Cross Blue Shield of AZ Renew Network Agreement

Agreement includes all Dignity Services and updates the patient centered medical home (PCMH) arrangement. From the jointly released press release: “Providing affordable quality care with compassion is what we stand for,” said Dignity Health Vice President of Managed Care Ethel Hoffman. “Being a part of BCBSAZ’s network...

News

Optum ACO Terminates Next Generation ACO Agreement

Optum Accountable Care, which has operated a Next Generation ACO Program since January 1, 2016, has notified network providers that it is out of the Medicare ACO business as of March 31, 2018. Optum Accountable Care or "Optum ACO" as they are known, recently reported to The Hertel Report that it has approximately 37,000 traditional...

News

CMS Issues Medicare Advantage and Part D Updates that Include a Payment Increase

Policy changes that include new supplemental benefits for services that improve health and quality of life also announced.CMS Administrator Seema Verma said the expansion is an example of addressing beneficiaries' needs, while creating more treatment flexibility and ensuring consumers have more choices. A CMS press release February 1,...

National News

Impact of Mandate Penalty Repeal, CSR's and High Risk Pools Still Not Determined

The uninsured rate and uncompensated care are expected to climb, impacting insurance rates for Americans and disproportional share hospitals (DSH). The Republican tax-reform bill clears penalties related to the individual and employer mandates. Senator Susan Collins (R-Maine) gets a promise from congressional leaders that bills...

News

CVS Buys Aetna for $69B

Both companies tout merger as integrating to further empower consumers. Aetna shareholders will get $145.00 per share in cash and .8378 CVS shares for each Aetna share. This values the Aetna shares at $207 per share and approximates that Aetna value at $69B. Aetna has about $8B in debt, making the entire transaction $77B. The...

National News

American Academy of Actuaries Comments on Elimination of the ACA Individual Mandate

AAA says repealing the mandate could raise premiums, cause insurers to become insolvent or leave the market altogether. The American Academy of Actuaries, whose tagline is Objective. Independent. Effective. wrote a letter to Mitch McConnell, Senate majority leader and Chuck Schumer, Senate minority leader, to share the potential adverse...

Arizona News

Banner Reports Improved Financial Position

In bondholder documents, Banner Health reports revenues of $5.84 billion for first nine months of 2017, up 2.7% from same period last year.Also reported were increased expenses of $5.65 billion, up 2.4%. Operating income was up 12.1% at $191.2 million, versus $170.5 from the same period in 2016. Net income went from $182.5 to $500.5...

Arizona News

Equality Health Network Deal with UnitedHealthcare Community Plan Uses Attribution Model

Approximately 18,000 UHC-Community Plan (UHC-C) members are attributed to Equality Health Network (EHN) primary care providers (PCPs). The PCPs will continue to receive payment based on their existing UHC-C agreements. EHN and UHC-C have an accountable care model agreement that tracks quality measures and per member, per month...

Arizona News

Ethel Hoffman Named New VP of Managed Care at Dignity Health

The longtime managed care executive replaces Carolyn Pace, who recently retired; Hoffman was previously the VP of managed care and business development for Phoenix Children's Hospital Both Carolyn Pace and Ethel Hoffman are Advisors to The Hertel Report. ...

News

Equality Health Network and UnitedHealthcare Community Plan Team up on a Quality Program

Focus is on delivering quality, culturally effective and coordinated physical, behavioral and community-based care. Equality Health Network, a Hertel Report Founding Sponsor, has announced its first arrangement with a healthplan. The deal is focused on improving quality for a diverse population of Medicaid recipients. “At...

News

Southwest Diagnostic Imaging Invests in Enterprise Master Patient Index

Leading radiology provider partners with NextGate in an effort to improve workflow efficiency, achieve cross-enterprise data sharing and decrease exam duplication.Shortly after announcing plans to merge with national radiology group Radiology Partners, SDI is in the news again. This time the story is about efficiency and accuracy. ...

Arizona News

Arizona's Southwest Diagnostic Imaging, Ltd. Joins Radiology Partners

Transaction represents national consolidation in the radiology market as the largest Arizona radiology firm joins the largest national firm. Southwest Diagnostic Imaging, Ltd. (SDI) began in 2004 with the merger of Scottsdale Medical Imaging and Valley Radiologists. In 2014, the physician owned and led practice expanded its market...

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