In this white paper from the Center for Healthcare Quality & Payment Reform, author Harold Miller outlines the strengths and weaknesses of FFS payment system, bundled payments and outlines numerous reasons why pay for performance, shared...
In this white paper, the third in a series, McKinsey's Center for US Health System Reform explores initiatives state Medicaid programs can initiate to improve care delivery efficiency.
This white paper discusses initiatves in:
Care Delivery & Payment Innovation
Changes to Enrollment, Benefits...
In this white paper, The National Association of ACOs (NAACOS) turns its focus on the challenges facing healthcare organizations participating in the Medicare Shared Savings Program (MSSP) program and solutions that better support the program's sustainability.
NAACOS incorporates its findings from a recent survey of MSSP ACOs and it...
The Network for Excellence in Health Innovation (NEHI) recommends experimentation of value-based arrangements, especially for new cancer drugs.
This white paper recommends a combination of strategies to address:
Innovation & Experimentation
Advance Policy Measures
A roundup of the 2018 Medicare Advantage (MA) plans offered during the Annual Enrollment Period (AEP in Arizona across all counties beginning October 15, 2017
Members Only 2018 Medicare Advantage Spotlight Report
The nationwide survey conducted in March 2017 by Schoen Consulting asked 1,500 Americans about their experience with insurers including their perceived access to medications, screenings and medical procedures.
Those surveyed were receiving health insurance through an employer, Medicare or Medicaid. The Doctor Patients Rights Project...
A September data brief from the Office of the National Coordinator for Health Information Technology provides insight into how America's skilled nursing facilities (SNFs) are adopting electronic health records (EHRs) as well as their ability to electronically send, receive, find, integrate or use patient health information with other...
In Arizona, oversight is delegated to the state’s Department of Insurance (DOI).
Arizona’s DOI provides little regulatory oversight and relies heavily upon consumer complaints as a basis for investigation. Most consumers do not understand how to file a DOI complaint.
On November 22, 2015, the National Association of Insurance...
Taking advantage of discharge planning functionality with an integrated and existing EMR plays a critical part in streamlining and standardizing patient transitions.
This white paper discusses patient handoffs and what a good discharge looks like.
In this white paper, Ensocare discusses several specific areas where technology can...
UnitedHealthcare began its transformation initiatives in 2007 with patient center medical homes, followed by its fist Medicaid ACO, Arizona Community Plan and later its Accountable Care Communities program in Yuma.
Focused on whole person care (integrating medical, behavioral and social support), UHC is an early adopter of coordinated...
Why Do Patients Opt Out of Home Healthcare Services?
Patients who choose to receive home healthcare services are less likely to have unnecesary hospital readmissions, but as many as 28 percent of eligible patients just say, "No" to available home healthcare services.
This May 2017 report recaps a United Hospital Fund and Alliance...
This recent white paper from Milliman provides members with insight into why shared risk arrangements deserve special scrutiny during the MA bid development process happening every summer
Providers Should do Annual Check-ups on Medicare Advantage Risk-Sharing Contracts
The MACRA 2018 proposed rule is under consideration. Two white papers provide readers with a bit of MACRA history along with recommendations for organizations navigating payment reform and strategies.
White Papers Produced By: EGG Management Consultants and Hooper, Lundy & Bookman, PC
In this two-part white paper series, Optima provides insight on the 2016 mandatory VBP initiative for home health agencies in nine states, the Conditions of Participation (CoP) for Medicare and Medicaid, the ACA mandated in-person encounters between physicians and beneficiaries and more.
...White Papers, E books, Reports and more
Learn why coverage of preexisting conditions is a key issue in health insurance with respect to affordability and sustainability, and to outline varying approaches to addressing it.
A White Paper by Milliman
Authored by Tom Snook, an Advisor to The Hertel Report
Preexisting conditions - how to cover them and how to pay for that...White Papers, E books, Reports and more
History and analysis from The Henry J. Kaiser Family Foundation
"In the debate over the future of the Affordable Care Act (ACA), proposals have emerged that would repeal or weaken rules prohibiting health insurance discrimination based on health status, instead offering high-risk pools as a source of coverage for people who would...White Papers, E books, Reports and more
This white paper is provided by Merritt Hawkins, a physician search and consulting firm
Physician and Hospital Reimbursement: From “Lodge Medicine” to MIPS
Published January 2016
In this white paper, Merritt Hawkins traces how compensation for physician and hospital services has evolved through...White Papers, E books, Reports and more
The first report in a series of five on health inequality in the U.S.
The report examines how America's healthcare system may intensify the disparity of health outcomes between wealthy and poor.
"The life expectancy of the wealthiest Americans now exceeds that of the poorest by 10-15 years," Samuel L Dickman MD, David U Himmelstein MD...White Papers, E books, Reports and more
Optima Healthcare Solutions white paper discusses the possible expansion of the MA program, and expected continuation of value-based care and the COP rule
Home health agencies are preparing to comply with new conditions of participation (COP) rules July 13, 2017. The new COP regs are the first comprehensive update from CMS since...White Papers, E books, Reports and more
Whitepaper from the insurance brokerage firm of Cottingham and Butler
This policy brief discusses what aspects of the current healthcare system, including employer plan rules, could be impacted by changes proposed in House Republican's approach to repealing the Affordable Care Act.
The approach this policy...