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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

Subset of Arizona Primary Care Physicians Partners with Summit Medical Group (New Jersey)

Seven founding practices representing 51 providers will form new single Tax-ID multispecialty group and engage Summit Health Management for administrative support. For 2018, providers will remain in the Optum Next Generation ACO.  In 2019 and...
National News

Lindsey Graham Reinvigorates "Last-Ditch" Repeal and Replace Effort

Graham says that without repeal and replacement of the ACA, Bernie Sanders' (I-VT)  bid for a single payor system, "Medicare for All", is inevitable. Dubbed federalism of healthcare, the 141 page plan includes block grants for states to create their own insurance markets.  “We need people onboard now to stop what I believe is...
National News

Analysis Shows Mixed Results of ACA Risk Adjustment and Reinsurance Programs

CMS and Mark Farrah Associates looked at the impact of the different programs the ACA put in place to mitigate adverse selection and stabilize premiums. Risk corridors, reinsurance and risk adjustment were the "Three R's" of the ACA.  Only the risk adjustment program is permanent. It deters insurers from manipulating risk selection...
Arizona News

Linda Hunt and Dave Berg Among 25 Healthcare Heroes Honored by Phoenix Business Journal

The Hertel Report members honored last week include Linda Hunt, CEO of Dignity Health in Arizona, who was recognized with the lifetime achievement award; and Dave Berg, Founder and CEO of Redirect Health, who won for innovator of the year. The annual breakfast, hosted by PBJ Publisher Ray Schey and Editor-in-Chief Illona Lowery,...
News

Banner University Medical Center CEO Discusses New Structure of Academic Medical Center

Steve Narang, MD wants to collapse silo's and be more patient-centric. Academic medical centers are special organizations with their own struggles.  Traditional structure is focused on education, research and physician hierarchy.  Costs are high and patients are disconnected. Narang says Banner is embarking on a new structure based...
News

Dignity Health Opposed in Effort to Launch its own Non-Emergency Transportation Company

American Medical Response, Maricopa Ambulance and ABC Ambulance join effort to persuade Arizona Department of Health to not grant a license to Dignity's Community Ambulance.Dignity Health, which operates Community Ambulance in the Las Vegas market, filed its application in June of 2016, saying the market lacked competition. Current...
News

CAPG Proposes CMS Demonstration to Make Risk-Sharing with Medicare Advantage Plans an Advanced APM

IPA and value-based provider advocate organization sends 21 page letter to CMS Director Seema Verma in response to the MACRA Quality Payment Program proposed rule. CAPG, which uses the tagline: The Voice of Accountable Physician Groups, outlines the reasons groups that take risk from capitation should have that work qualify them for the...
Deadline Looming for MSSP and Next Generation ACOs Arizona News

Deadline Looming for MSSP and Next Generation ACOs

All of Arizona's Medicare ACOs have upcoming deadlines to submit their rosters of PCPs for 2018. Like the Cardinals shoring up its roster for the upcoming NFL season, Arizona's Medicare ACOs are prepping for the 2018 MSSP ACO enrollment deadline.  The MSSP deadline, which was set for August 30, 2017, has been delayed to September...
News

Centene and Dignity Health Extend Negotiations to May 19th

Local sources from both sides tell The Hertel Report that the parties are committed to working out their differences If the parties can reach agreement before the end of next week, Health Net's commercial, AHCCCS and exchange consumers can still receive in-network care at Dignity Health facilities and providers.  See The Hertel...
News

Dates Announced for Next State of the State Meetings

Mark your calendars now!  June 28 in Tucson, June 30 in Phoenix! Once again The Hertel Report will be providing leaders in the AZ healthcare industry the opportunity to network with their peers and get an update on the latest developments in our dynamic market.  Hear about Medicare Advantage, the Health Insurance Marketplace, MACRA...
News

Dates Announced for Next State of the State Meetings

Mark your calendars now!  June 28 in Tucson, June 30 in Phoenix! Once again The Hertel Report will be providing leaders in the AZ healthcare industry the opportunity to network with their peers and get an update on the latest developments in our dynamic market.  Hear about Medicare Advantage, the Health Insurance Marketplace, MACRA...
National News

Anthem Looks to Exit ACA Markets

Large national player has been supportive of Marketplace plans Aetna, Humana, United Healthcare and others have abandoned healthcare.gov.  Will Anthem join them? Anthem is talking with the administration “to emphasize the importance of regulatory and statutory changes in order to ensure sustainability and affordability of the...
National News

President Trump Addresses Congress, Calls for Replacing the ACA

Without getting into details, the new president sets some parameters for replacing the long-controversial law. Required health benefits are too rigid and expensive and sales across state lines will create competition, says Trump in his 5 minutes dedicated to healthcare.  He implores democrats to get on board and help the republicans...
National News

Republicans Scramble to Organize Efforts to Repeal and Replace

Senate Majority Leader Mitch McConnell, R-Ky., calls a special all-members caucus meeting Wednesday.  Speaker of the House Speaker Paul Ryan, R-Wis., is defending the Republican plan against attacks from the chamber's far-right Freedom Caucus. After Trump's address, republicans seem split on which direction they should take on...
Arizona News

Maricopa Medical Center Project Ready to Start

Construction firms awarded contracts. Nearly $1 Billion project awarded to Vanir Construction Management Inc. See Vanir for more info. Their fee will be $48.3 million over 6.5 years.  After voters passed Proposition 480 back in 2014, the replacement for MMC is finally getting underway. Three other companies are part of the group...
News

The Hertel Report and AZ HFMA to Host Accountable Care Seminar Next Week

Join us for: Provider & Health Plan Relationships on the Path to Accountable Care!  This one-day conference is a great value. What: Provider & Health Plan Relationships on the Path to Accountable Care When: 8 am to 4:30 pm, Friday, February 24 Where: Code Talker Meeting Room, Phoenix Plaza Conference Center....
Arizona News

An Afternoon with Arizona's ACO's Event a Huge Success

The Hertel Report and Vitalyst Health Foundation brought together more than 160 healthcare professionals curious about Arizona's accountable care organizations The event celebrated the release of a Spark Report titled Achieving the Promise of Accountable Care Organizations - Progress in Arizona.  The report was authored by Palmer...
Arizona News

BCBSAZ and Health Net Prepare for HIM Annual Enrollment Period 2017

Centene is opting to use the Health Net Community Care network and the Ambetter plan brand to offer individual products both off and on exchange During a Cover Arizona Coalition conference call/webinar on Wednesday October 12, Blue Cross Blue Shield Arizona (BCBSAZ) and Centene detailed the products they will offer on the Health...
Arizona News

Phoenix Health Plan to Leave Medicare Advantage Market

Tenet-owned health plan has not improved its 2.5 (out of 5) star rating for three consecutive years Sources tell The Hertel Report that the decision to no longer offer Medicare Advantage plans was reached by Phoenix Health Plan (PHP) leadership and CMS officials.  Questions remain about how this may affect current dual enrollees,...
Arizona News

Local News: One Network Termination Gets Resolved and Another Does Not

Southwest Diagnostic Imaging remains in-network with UnitedHealthcare with last minute deal.  Abrazo Community Health Network is parting ways with Humana. Southwest Diagnostic Imaging (SDI) and UnitedHealthcare (UHC) warned patients and other providers of the SDI termination effective October 1, 2016.  The impasse resolved on...
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