Change Healthcare and ACO Partner reported a 26 percent lower 30-day readmission rate for participating providers and a 28 percent reduction in all cause readmission rates than a non-participant cohort in its first year. ACO partner is operated by...Data Resources
AHCCCS Complete Care (ACC) began October 1, 2018. The new integrated system allows managed care organizations to provide both physical and behavioral health services to better treat the needs of 1.6 million Arizona Medicaid members.
A quick read of the insurers, their October membership totals and overall membership losses with...National News
The bill includes support for research to find new, non-addictive pain relieving drugs and expanding access to substance abuse treatment for Medicaid patients.
According to CNN, the White House on Wednesday also announced public-private partnerships with Amazon, Belden Industries, Blue Cross Blue Shield, Cigna, CVS Health, Dispose...Arizona News
Hundreds of nurses at St. Joseph's and St. Mary's hospital in Tucson voted to unionize and join the largest registered nurses' union in the country--the National Nurses Organizing Committee (NNOC).
The votes were cast via secret ballot and officials from Carondelet Health Network, owner of the hospitals, told the Arizona Daily Star...National News
A proposal to lift a prohibition on allowing companies to take advantage of health reimbursement arrangements (HRA) dating back to the Obama administration is slated to reshape employee-based healthcare.
Announced Tuesday, the expansion of HRAs would enable employers to use them to pay for health insurance premiums, allowing...National News
The America's Physician Group (APG) recently launched a new initiative aimed at developing advanced alternative payment models (APMs). Dubbed "the Risk Evaluation Task Force," its inception was a result of a learning collaborative looking to move volume to value.
There is no lack of interest in APMs in the physician world, but...National News
On Monday, the Centers for Medicare and Medicaid Services (CMS) along with the Department of the Treasury released revised guidance giving states more regulatory power with innovation waivers under the Affordable Care Act (ACA).
The way CMS evaluates and accepts waivers regarding innovation for each state's individual market is...Arizona News
The personal information of approximately 75,000 people was breached last month after a government run healthcare sign-up system was hacked. The Centers for Medicare and Medicaid Services (CMS) announced the news on Friday, Oct. 19 just a few weeks before the Affordable Care Act exchange opens up for open enrollment.
CMS administrator...Arizona News
In 2019, after a 140-year tradition serving as Maricopa County's public teaching hospital and safety net healthcare system, Maricopa Integrated Health System will be known as Valleywise Health.
Although still under the oversight of the Maricopa County Special Health Care District Board of Directors and governed by the same mission,...Arizona News
Care1st Health Plan Arizona is a WellCare company which currently serves 184,000 of the state's Medicaid members in eight counties under a new AHCCCS Complete Care (ACC) contract.
The company said the regional hub in Phoenix will better serve Medicaid members in Arizona, augment the company's clinical and operational functions...Arizona News
Last week, the Centers for Medicare and Medicaid Services (CMS) announced the average premium for benchmark silver plans in the Affordable Care Act (ACA) exchanges dropped by 1.5 percent for the 2019 benefit year - the first premium drop since HealthCare.gov opened for business in 2013.
In Arizona, consumers will have more plans...Arizona News
An Alternative Payment Model (APM) is one way of delivering value-based care, as the shift from traditional fee-for-service to a value-based payment model continues, programs are continuously looking to serve as a catalyst in offering cost-effective, higher-quality care. APMs incentivize this goal and can apply to an episode, condition,...Arizona News
Medicare Advantage has been dominating healthcare headlines, especially with the start of the annual enrollment period; it is no secret the Medicare alternative pulls monstrous profits, but their means are in question. A study conducted by the Health and Human Services' (HHS) Office of the Inspector General (OIG) found that MA...Arizona News
Last week on Oct. 12, 33-year-old Nicholas White and 60-year-old Jeffrey White, father and son duo pleaded guilty to defrauding Affordable Care Act (ACA) programs out of $27 million across at least 12 states--including Arizona. Both were healthcare professionals out of Twin Peaks, California.
According to the Department of Justice...
On Monday, the Centers of Medicare and Medicaid Services (CMS) proposed a rule that would require drug companies to list drug costs in their direct-to-consumer advertisements. In an initiative to inform beneficiaries of drug costs, the agency anticipates it will help minimize their out-of-pocket costs along with Medicare and Medicaid...
Last week the Department of Justice gave CVS and Aetna approval for their $69 billion merger on the condition that Aetna sells off its Medicare Part D prescription drug business. Insurers cozying up with the pharmaceutical industry is a growing trend, think: OptumRx and UnitedHealth, or the recent Cigna-Express Scripts...
In Arizona, Medicare beneficiaries have more options than ever - MA plan growth is nearly 30 percent in the state and MA special needs plans grew by about 12 percent, year over year.
Across the country, more MA plans are available in 2019 than in any year since 2009, said the Kaiser Family Foundation, reporting that nationwide,...
Find out which insurers are participating in Arizona's 2019 MA market including plan type, premium, prescription drug deductibles, MOOP and YOY star rating comparison.
In Arizona, Medicare beneficiaries have more options than ever - MA plan growth is nearly 30 percent in the state and MA special needs plans grew by about 12 percent,...Arizona News
Michael Groeger joins BCBSAZ from Banner-Aetna, where he led the national employer solutions team. Groeger will lead the local insurer's sales team on his home turf, with more than 20 years of experience, Groeger has spent his entire career working in the Arizona health insurance industry.
He also previously served as chief...News
It is not too late to sign up and attend the annual Arizona Medical Group Management Fall Conference at the Sheraton Wild Horse Pass Resort. The event kicks off with a networking happy hour on Wednesday evening, October 17th. Of course, I will be in attendance again this year and look forward to seeing everyone. The agenda...
A discussion with The Hertel Report Publisher Jim Hammond on the most important stories we covered the week ending October 11, 2018.
Click on the microphone below to listen to the conversation moderated by Veronica Graff, a contributor to The Hertel Report.
Hospitals say getting paid for previously uninsured folks has saved them from potential closure. The Goldwater Institute says hospitals are raking in the dough by also raising rates on the commercial side.The Arizona Hospital and Healthcare Association (AzHHA) publishes a report that tracks uncompensated care trends for Arizona...National News
The Centers for Medicare and Medicaid Services (CMS) announced on Tuesday, almost 1,300 providers have signed themselves up to test-drive the Bundled Payment for Care Improvements (BPCI) advanced model.
Among the Arizona participants are:
Desert Institute Spine Care
Desert Orthopedic Specialists
Flagstaff Medical...Arizona News
Speaker of the House Paul Ryan, on Monday said "Medicare for all" initiative shows that the Democratic party "has gone off the rails," despite many congressional Democrats not quite so gung-ho about the idea. The "Medicare for all" bill is Sen. Bernie Sanders' crown jewel of healthcare policies, a program that would essentially shift the...National News
The National Association of ACOs (NAACOS) Fall 2018 conference kicked off with a discussion about MSSP ACOs relationships with private payers.
The strategy is payer-neutral - take care of patients regardless of the payer.
According to NAACOS more than 20 million lives are covered under commercial Medicare and Medicaid, and a...