Payment Reimbursement and Managed Care

The yin-yang of Medicaid: Expected federal regulations will increase number of uninsured despite increase in states taking expansion dollars

Despite more states considering taking Medicaid expansion dollars, federal regulatory efforts may drive an acceleration in the number of uninsured.

Chad Mulvany, FHFMA January 23, 2020

Limited BPCI savings seen with joint replacement bundles

CMS’s new BPCI-A model incorporates patient complexity into the risk-adjustment mechanism, but it remains to be seen if it will solve all issues with the previous model.

Chad Mulvany, FHFMA January 15, 2020

Analysis: Aspire Health Founder Brad Smith chosen as new CMMI director

The change in CMMI leadership could mean long-anticipated models are released, and may signal more emphasis on palliative care in future models based on Brad Smith’s background.

Chad Mulvany, FHFMA January 14, 2020

Atrius Health: Experience with global-risk contracts paves way to success in new arrangement

Previous success in risk-based contracts will allow Atrius Health to thrive in its new global-risk arrangement with Blue Cross Blue Shield of Massachusetts, two of the provider’s leaders write.

Patrick Holland January 13, 2020

Analysis: FY20 appropriations bills passed – lessons for potential future healthcare legislation

A review of the FY20 appropriations package to fund the federal government and a couple of ideas on lessons that might be applied to future efforts to expand coverage.

Chad Mulvany, FHFMA December 30, 2019

‘Medicare for All’: What would it really mean for healthcare stakeholders?

“Medicare for All” would have varying impacts on hospitals, physicians and health plans but would be expected to cause financial hardship in the majority of cases.

Richard Rollo December 19, 2019

Why initiate health plan contract testing?

Various circumstances require providers to prepare for the impact of payment changes.

Lauree E. Handlon, FHFMA, RHIA, CRCR December 13, 2019

How to use contract testing and analysis to prepare for payment change

Whether a contract is new or up for renewal, a thorough understanding of the financial implications of changes to provider-payment terms is vital for continued operations.

Lauree E. Handlon, FHFMA, RHIA, CRCR December 13, 2019

Analysis: Timeline for CMS’s mandatory radiation oncology model appears to slip

It’s not surprising CMMI has slowed its pace on finalizing the proposed mandatory radiation oncology payment model given the complexity of the model and stakeholder opposition.

Chad Mulvany, FHFMA December 11, 2019

Analysis: More options for providers looking to directly contract with employers for episodes of care

Platforms like Carrum Health’s are meeting the demands of employers for higher-value care and the providers who want to meet these demands.

Chad Mulvany, FHFMA December 10, 2019
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