Tennessee is now the fourth state to introduce a work requirement proposal for Medicaid enrollees, joined by Alabama, Michigan, and Virginia who also posted their proposals this month.
The waiver would require enrollees to seek or maintain...Arizona News
The National Committee for Quality Assurance ranked over 1,000 health plans on measures of quality, member satisfaction and the committee's survey accreditation results. The ratings aim to highlight patient care outcomes and how patients feel toward those outcomes and the care they are receiving.
The highest performing plans...Arizona News
Arizona's Medicaid agency identified significant concerns regarding the data submitted by HCA as well as, "HCA's lack of attention to, and focus on," the audit, which was used to evaluate immunizations to members before age 2 in compliance with childhood immunization reporting requirements.
It's not the first time AHCCCS has penalized...Arizona News
An Avalere analysis of accountable care organizations (ACOs) found that ACOs in the Medicare Shared Savings Program (MSSP) accumulate more savings as their experience grows. ACOs in the program for four years or more accounted for nearly all of the $317 in savings reported in 2017.
As of 2018, over 10.5 million Medicare...Arizona News
The pharmaceutical companies on Capitol Hill rarely get the short-end of the stick, so it shouldn't come as a surprise that the industry is lobbying for a provision to block the increase of the percentage of drug costs they must cover under Medicare.
Lawmakers are now considering to add measures that would ease the burden of drug...Arizona News
The Arizona Alliance for Community Health Centers begin providing weekly talking points on the ACA marketplace.
With just $10 million for marketing and outreach available from the federal government for this year's open enrollment on HealthCare.gov (90 percent below the fed's 2017 investment) spreading the word locally and ensuring a...
The film by the legendary documentarian Ken Burns features interviews with patients including John McCain and the Dalai Lama.
From the PBS press release:
The two-hour documentary examines how the Mayo Clinic meets the changing demands of healthcare.
The film tells the story of William Worrall Mayo, an English immigrant who...
Members only September Newsletter from The Hertel Report.
Members click here to access the edition.
Non-members, see below for what you're missing.
ACOs Push Back on CMS Proposals to Remix MSSP
Arkansas' Medicaid Work Requirement Experiment
Putting Medicaid Expansion in the Hands of Voters
Filed on September 12, the lawsuit alleges the state hospital impeded the ACDL's ability to monitor the conditions of facilities housing individuals with mental illness, and investigate incidents of abuse and neglect in those facilities.
Under the Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act, ACDL is...Arizona News
On Monday the Justice department gave the $52 billion merger between Cigna and Express Scripts a green light. The health insurance giant and massive pharmacy benefits manager aim to cut costs of care.
The deal passed a shareholder vote toward the end of August but the DOJ's vote was the last major obstacle to clear, all that...Arizona News
The healthcare cost increases Americans have seen in the past few years in the Affordable Care Act’s (ACA) individual marketplace are coming to a halt as insurers get to know their risk pool.
Studies reveal premiums on the individual ACA exchange will experience less than a five percent increase, a slowdown considering in 2018...Arizona News
The demographics of the medical field are changing as more and more women are entering the field and filling power positions, pushing the industry in the direction of equal-opportunity.
An Association of American Medical Colleges study revealed in 2017 more women than men were enrolled in U.S. medical schools. Of the new...Arizona News
The Phoenix-based non-profit and the valley’s largest health system is seeking to fill 1,500 positions at a time when nursing shortages are of national concern. Throughout the month of September, Banner Health will host various career open houses to fill out its nursing staff, leadership and entry-level positions as well as...Arizona News
Grant funding provided by the Department of Health and Human Services (DHS), Substance Abuse and Mental Health Services Administration (SAMHSA).
AHCCCS will administer the grant and work with other state agencies, health plans, and community partners to address specific initiatives. This is the first installment of a two-year grant...
The Jesuit, Catholic University plans to construct a new, nearly $100 million health sciences campus at Park Central in midtown Phoenix.
The university will share the neighborhood with other healthcare organizations including Dignity's St. Joseph's Hospital and Medical Center.
Park Central mall, one of our city's first major...
A discussion with The Hertel Report Publisher Jim Hammond on the most important stories we covered the week ending September 13, 2018.
Click on the microphone below to listen to the conversation moderated by Veronica Graff, a contributor to The Hertel Report.
MA insurers are auditing patient's medical charts to find more diagnosis codes in effort to get larger reimbursements from the Medicare program. The business of insurance encourages the documentation of all possible diagnoses to generate billions in profits. Modern Healthcare cites an Anthem lawsuit as an example of the returns...Arizona News
The Parson v. Ryan saga continues to drag on for nearly five years. Before retirement in June, U.S. Magistrate Judge David Duncan issued a series of orders in response to a lack of progress from the Department of Corrections (DOC) and Corizon.
In a statement, CEO of Corizon Health Stephen Rector said the court failed to recognize...Arizona News
The Department of Veterans Affairs Office of Inspector General (OIG) released an audit on Thursday, Sept. 6 revealing over $101 million in overpayments during a one-year period to two contracted third party administrators under the Veterans Choice Program: Health Net Federal Services and TriWest Healthcare Alliance Corporation.
As an alternative Medicare payment model, bundled payment for care improvement (BPCI) programs aim to reduce spending by creating incentives for providers to remove expendable costs.
Bundled payments are “episode-based,” relevant to specific conditions or treatments in which providers are expected to absorb service costs and...