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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

Adeptus Health, Partner of Dignity Health in Arizona, Reports Big Earnings

It was a big year for Adeptus, which partnered with many organizations in 2015, including the opening of one hospital and four freestanding facilities in Arizona with Dignity Health Thomas S. Hall, Chairman and CEO, stated, "2015 was a year of...
News

Impact of Aetna - Humana Deal is Measured, Scrutinized

Provider and consumer advocate organizations are bringing attention to potential market shifts as a result of the $37 billion merger of health insurance giants The Center for American Progress (CAP) is reporting that Medicare Advantage (MA) premiums will rise if Aetna buys Humana. The $31 billion deal would give the combined...
Arizona News

CMS Suspends Cigna - Arizona's Only Five-Star MA Plan - From Marketing & Enrollment

In Arizona, Cigna enrolled nearly 50,000 Medicare-eligible seniors in its MA plan during the 2016 open enrollment Cigna received notice of intermediate sanctions that include suspension of marketing activities and enrollment effective January 21, 2016.  Sanctions are for  failure to comply with determinations, grievances and...
Arizona News

Arizona Bill Proposes Consolidation of 18 Health and Medical Regulatory Boards under ADHS

'Conceptual in Design' says Arizona Rep. Heather Carter, R-Cave Creek, sponsor of HB 2501 No specifics, no industry buy-in, but a broad expectation that housing multiple health profession regulatory boards under the Arizona Department of Health & Human Services provides gains in administrative efficiencies, reduces...
News

Congressional Budget Office Projections are Lower for HIM Enrollment, Higher for Medicaid Enrollment

Health Insurance Marketplace enrollment data from December 2015 reduces the CBO's 2016 projections from 21 million to 13 million, or  40 percent   The CBO report, "The Budget and Economic Outlook, 2016 to 2026' also projects: 11 of the 13 million covered in the HIM in 2016 will receive subsidized coverage Medicaid spending...
News

United Healthcare Stops Paying Commission for ACA Individual Plan Policies

This change applies to plans sold both “on and off” the Health Insurance Marketplace sold with 1-1-2016 effective dates. While some states are cited as exceptions, this is not good news for agents nationwide working in the individual market. Read more in International Finance Web News    ...
News

Health Insurance Marketplace (HIM) Consumers Given Extra 48 Hours to Sign up for January 1 Effective Date

Due to "unprecedented demand", CMS issues an FFM Alert communicating additional time to complete enrollment.  Enroll Today! Message from Kevin Counihan, CEO of the Health Insurance Marketplaces: Because of the unprecedented demand and volume of consumers contacting our call center or visiting www.HealthCare.gov, we are...
News

Dartmouth Hitchcock Medical Center Drops out of Pioneer ACO Program

Has received approval to join the Next Generation ACO model next year and may decide to participate after it learns its CMS dollar targets Dartmouth was one of three Pioneer ACO’s that owed CMS money for 2014 results. This leaves the original CMS ACO model with only 19 of the original 32 Pioneers.  The Next Generation program has...
News

Health Choice CEO Mike Uchrin Profiled in Phoenix Business Journal

Interview with Angela Gonzalez includes a video of Mike at The Henry on Camelback     Mike talks about what makes him tick, his wife, kids, golf and how important is to him that he gets to improve the lives of others through the healthcare provided by Health Choice.   Article with video video only  ...
News

CMS Releases MSSP ACO Performance Report for 2014

In Arizona, only two active MSSP ACOs beat their targets and only one earns a share of the savings. Scottsdale Health Partners saves $3.7 million and gets to share $1.8 million.  Commonwealth saves $2.2 million and gets $0 Nationally, 92 of 333 MSSPs held spending to $806 million below targets and earn $341 million in shared...
News

Scottsdale Healthcare Hospitals Gets Rating Upgrade

Moody's improves revenue bond rating from A3 to A2. Moody's reports solid operating margins and an improvement of balance sheet measures for  Scottsdale Healthcare Hospitals, which now includes assets from both Scottsdale Healthcare and John C. Lincoln Health Network, for its bond rating rise from A3 to A2. Scottsdale...
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