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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

Arizona News

Blue Cross Blue Shield of Arizona Will Not Offer Any Individual Products in Maricopa County in 2017

Phoenix Market abandoned by huge carrier, both on and off exchange Blue Cross Blue Shield of Arizona (BCBSAZ) recently sent letters to individual policy holders communicating that their plans will not be offered in Maricopa County in 2017. ...
News

AHCCCS Receives CMS Approval for Some of AHCCCS CARE Program

The latest version of Managed Medicaid includes premiums, co-pays and an "AHCCCS CARE Account" available for non-covered services including dental, vision and chiropractic care.   Changes only affect enrollees above the Federal Poverty Level (FPL). Of course, the waiver also allows the Arizona to continue to operate a...
Arizona News

Vitalyst Health Foundation and The Hertel Report to Host ACO Event

Event scheduled for 2pm October 13, 2016 at the Desert Willow Conference Center. Sign up today! Join Vitalyst Health Foundation and the Hertel Report for An Afternoon with Arizona's Accountable Care Organizations, an in-depth look at the development of Accountable Care Organizations (ACO) on October 13, 2016.  A number of ACOs are...
News

Now Cigna Backs Out of HIM, Leaves Centene as Sole Carrier in Maricopa County

Cigna Medical Group will be part of provider network for Centene product branded as Ambetter "We are pleased to work with state and federal regulators to help maintain quality coverage for over 120,000 residents in Maricopa County. Centene has served Arizona residents for the last decade and we look forward to extending our offering...
News

Centene Steps up in Arizona

Cigna will not be the sole carrier in Maricopa County and now three plans will be competing in Pima CountyCentene said it has filed applications with both the Arizona Department of Insurance and the Centers for Medicare and Medicaid Services (CMS) to sell Health Insurance Marketplace (HIM) plans in Pima and Maricopa Counties for coverage...
News

Blue Cross Blue Shield AZ Steps Up in Pinal County

After a few weeks of uncertainty, Arizona gets at least one carrier to cover each county on the HIM Blue Cross Blue Shield of AZ says concern for Pinal county residents drove them to reconsider the decision to leave the HIM there. Jeff Stelnik, senior vice president of sales, strategy and marketing for Blue Cross Blue Shield...
Arizona News

Cigna Left Standing Alone on the HIM in Maricopa County

Departure of Phoenix Health Plans hands over 125,000 potential enrollees to longtime Arizona commercial and Medicare Advantage insurer Last Friday was a big day for the Arizona healthcare community and TheHertel Report.  We actually broke the story that Phoenix Health Plans had officially withdrawn from the Health Insurance...
News

Phoenix Health Plan Latest to Quit the 2017 HIM

Phoenix Health Plans, Inc. has informed the Arizona Department of Insurance that it will be withdrawing from the federal Health Insurance Marketplace in Arizona for 2017. After asking for increases averaging 122 percent, the local Medicaid and Medicare Advantage player owned by Abrazo - Tenet Healthcare exits Maricopa County,...
News

CMS Proposes New Rules For ACA Marketplaces in 2018 in Effort to Help Insurers

294 page proposed rule touches on numerous topics, especially risk adjustment and estimating risk. The Obama administration is hoping to respond to insurers' fears that the marketplace dynamics make it unsustainable. Monday a new regulation was proposed. It is very technical and nearly 300 pages long. Experts are just beginning to...
News

Modern Healthcare Names 100 Most Influential

See who ranks tops from health systems, health plans, government, and various industry player and associationsLeaders with Arizona Connections include: Tenet Healthcare Chairman and CEO Trevor Fetter is number 14, Dignity Health President and CEO Lloyd Dean is ranked number 16, Community Health Systems CEO Wayne Smith is ranked 23,...
News

HFMA Fall Conference in Tucson September 11-13

Excellent programming for providers and health plan personnel on ACO's, MACRA preparation, post acute care, payment reform and more!  Don't miss it!  There are special rates and flexibility for members that are providers (includes health plan employees, too) so you can attend as much or as little as your schedule allows. This is...
News

HonorHealth Buys Out Scottsdale Physician Organization and Launches New ACO

Innovation Care Partners will provide management services for Scottsdale Health Partners and JCL ACOBefore the August 1 purchase, ownership of Scottsdale Health Partners (SHP) was split 50/50 between Scottsdale Physician Organization (SPO) and HonorHealth (formerly Scottsdale Healthcare). “We did an independent, fair market value...
News

MACRA Implementation May Be Delayed

Pressure from physician groups and associations creating concern over readiness of small physician practices Acting CMS Administrator Andy Slavitt testifies before the Senate Finance Committee on Wednesday, July 13 that the agency is concerned about the timing of implementing MACRA. After receiving significant feedback,...
News

KidsCare Bill Finally Passes Through Senate, Ducey Signs It

Five republican state senators come together with democrats to amend a disabled children voucher program to include KidsCare Senate President Andy Biggs, who opposes KidsCare,  does not attempt to block the bill, which passed the senate with a 16-12 vote after no debate and no comment from supporters.  The legislation should go...
National News

MACRA Details Emerge

The Medicare Access and CHIP Reconciliation Act of 2015 sets forth a new reimbursement system for physicians that includes quality reporting On April 27, 2016, the Department of Health and Human Services issued a proposed rule to implement parts of MACRA that replace the Sustainable Growth Rate formula for paying clinicians based on...
News

CMS Clarifies Quality Reporting and Reimbursement set forth in MACRA

Providers will need to determine if they will participate in the APM model with a qualifying ACO, or on their own in the MIPS programMost physicians will are expected to choose the Merit-based Incentive Payment System (MIPS) path in the first years of the program. In the MIPS program, physicians will select six outcomes-oriented...
News

Children's Action Alliance and the Cover Kids Coalition to Host an UnfreezeKidsCare News Conference and Rally Monday at the State Capitol

Event begins at 11:30 a.m. Monday, April 11, 2016 on the State Capitol House Lawn, 1700 W. Washington
News

AZ Legislature and Governor Ducey Regulate Abortion in Three New Laws and One Pending Senate Approval

Governor Ducey signs new laws that limit fetal research, prohibit state employees from donating to Planned Parenthood through the state payroll deduction program and requires doctors to use old FDA guidelines for abortion-inducing medications.  The latest bill to make its way through the legislature will potentially re-define...
News

Centene Purchase of Health Net Closes After Approval by California Department of Insurance

$6 billion purchase became final March 24 March 22, brought approval of Centene's merger with Health Net from the California Department of Managed Health Care (DMHC).  On March 23, the California Department of Insurance (CDI) made it official by approving the purchase, which closed on March 24. Read more about this merger in...
News

NPR Study Looks at Impact of ACA

Nearly half of respondents said their premiums had increased over the past two years In a study done in seven states and with over 1000 respondents, a majority of respondents, regardless of income considered their care as excellent or good.  However, low income  respondents were twice as likely to rank their care as fair or...
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