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GE Healthcare Camden Group Insights Blog

The Great Risk Shift: A Strategic Road Map for Providers

Posted by Matthew Smith on Apr 13, 2016 2:47:41 PM

By William Ringwood, Manager, GE Healthcare Camden Group

Customer-Roadmap.jpgWhen assuming financial risk for healthcare delivery, a provider has many options to choose from and a broad range of internal and market-based factors to consider to be able to choose the right option for its specific circumstances.

An unprecedented shift of financial risk from payers to providers is occurring within the healthcare delivery system as a result of reform efforts. Healthcare providers have many important strategic decisions to make in preparation for this shift that will have a profound impact on their future success. Foremost among these decisions is choosing from the broad range of risk options available to providers, including quality incentive and penalty programs, Medicare accountable care organization (ACO) models with various degrees of risk and requirements, commercial shared savings, bundled payments, cobranding, and partial/full capitation or percentage of-premium models. It is clear that government and private payers, as well as employers and the general public, are pushing to improve overall healthcare value by increasing providers’ degree of risk.

To continue reading this article in its entirety, please click the button below for immediate (no form) access.

Risk, Providers

Topics: ACO, Medicare, Risk-Based Contracting, Healthcare Delivery, Risk, William Ringwood

Are You Ready for Medicare’s Payment for Value? Do You Know Your Value Modifier Score?

Posted by Matthew Smith on Nov 16, 2015 2:58:18 PM

By Cami Hawkins, MHA, Manager, GE Healthcare Camden Group

Payment for ValueThe Affordable Care Act established the Value Based Payment Modifier (“VBPM”) to begin moving Medicare payments toward physician reimbursement that rewards value over volume. While it began with medical groups with more than 100 eligible providers (“EP”), all practices, regardless of practice size, are subject to payment adjustments in 2017 as a result of their performance in calendar year 2015. The Value Modifier (“VM”) adjusts the Medicare Physician Fee Schedule (“PFS”) payment based on the quality and cost of care provided(1).

Given the potential for future financial penalties, it is important to understand what your VM is and how you are performing as reported in the 2014 Annual Quality Resource Use Report (“QRUR”), which was released to all physicians by tax identifier numbers on September 9, 2015. The QRUR provides a snapshot of whether your practice is scoring in the acceptable range to avoid a penalty or exceeding the target and eligible for an incentive. Groups with ten or more EPs are subject to penalties in 2016 based on 2014 performance (those participating inMedicare Shared Savings Program ACOs, the Pioneer ACO Program, or the Comprehensive Primary Care Initiative are excluded) and should quickly review their QRUR report. 

If you are not performing within the acceptable range, there is still time to impact your VM and Medicare payments for 2017. Because the QRUR report provides a view into how a practice performs under a fee-for-value model, it is a valuable data source to use in identifying gaps in care and operations. You can use the data to facilitate your efforts to transform your practice to improve your quality of care, streamline resource use, optimize technology, and identify opportunities for care coordination.

Here are four ways your QRUR can help you on your path to success under fee-for-value:

  1. Use QRUR data to stratify your Medicare patients into the four chronic disease categories (diabetes, chronic obstructive pulmonary disease, coronary artery disease, and chronic heart failure) being measured to identify opportunities for care improvement. CMS is measuring this data to determine per capita costs(2). Perform an analysis of current workflows, physician and staff responsibilities, and practice resources to identify gaps in addressing care needs of these patients and develop an implementation plan to strengthen the practice’s care coordination capabilities. Implement a care management program using a team-based care model and use disease registries to track these patients to ensure they are receiving the care they need. Work with your hospitals to develop effective care transition planning.
  2. Review the last hospital admission data and date of last claim filed supplied in the QRUR to identify opportunities for follow-up visits after hospital admission and hospital admissions that could have been prevented. Develop and/or refine processes to ensure effective care transitions and follow-up of recently discharged patients. Create processes to stay in touch with your sickest patients who are at risk of hospitalization and implement interventions to prevent hospitalization.
  3. To ensure that your data accurately attributes the providers in your practice, review “Providers associated with TIN.” Check provider participation and specialty and confirm accuracy against Provider Enrollment, Chain, and Ownership System (“PECOS”).
  4. Non-participation in Physician Quality Reporting System (“PQRS”) will impact your score in VBPM because it relies on PQRS participation for the purposes of reporting quality. While closely connected to PQRS, the VBPM levies penalties separate from PQRS for non-participation. VBPM adjustments are made in addition to the PQRS penalties that EPs may receive for not successfully reporting in that program. Your PQRS scores as compared to benchmarks is another valuable tool in assisting practices in identifying gaps in care.

The move to fee-for-value has started, and your practice can’t afford to be left behind. Both the QRUR and PQRS reports provide practices and physicians with data to use in transforming their practices for success under value-based payment. It is time to start the journey to practice transformation now.

(1) Claims data is used to measure both quality and cost. Quality measures included in the QRUR report are the 30-day All Cause Hospital Readmission, Acute Ambulatory Care-Sensitive Condition (ACSC) Composite, and Chronic ACSC Composite measures. The cost measures included are Per Capita Costs for All Attributed Beneficiaries, Per Capita Costs for Beneficiaries with Diabetes, Per Capita Costs for Beneficiaries with Chronic Obstructive Pulmonary Disease (COPD), Per Capita Costs for Beneficiaries with Coronary Artery Disease (CAD), Per Capita Costs for Beneficiaries with Heart Failure, and Medicare Spending per Beneficiary (MSPB).
(2) For detailed CMS guidelines to evaluate and improve performance, refer to https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014-Understanding-Your-QRUR.pdf for more information.

Ms. Hawkins is a manager with GE Healthcare Camden Group and has more than 20 years of experience in the healthcare provider sector as a management consultant. She specializes in the areas of practice operations, contract negotiations, benefits administration, reimbursement management, and market development. Ms. Hawkins assists a wide range of provider organizations, healthcare systems, and independent and employed physician groups with addressing issues impacting their overall performance and competitive positioning. Her key areas of expertise include strategic planning, population health strategy, and hospital/physician integrations. She may be reached at chawkins@thecamdengroup.com or 512-792-5600.

Topics: Medicare, CMS, Payment Reform, Value Modifier, Cami Hawkins

Medicare Now Reimburses Physicians for Chronic Care Management

Posted by Matthew Smith on May 28, 2015 2:31:00 PM

By Lucy Zielinski, Vice President, The Camden Group

ccm.jpgCare coordination is a cornerstone of value-based healthcare. It is especially important for patients with chronic diseases, who require complex health services and careful tracking.

Under healthcare reform, physicians have increasingly been expected to provide better care coordination. The problem is that they have received no payment for coordination services not delivered face-to-face. That is now changing thanks to a recent Centers for Medicare and Medicaid ("CMS") decision.As of January 1, 2015, Medicare pays physicians separately for chronic care management ("CCM") services. This is a potential game-changer for provider organizations transitioning to value-based care. The new policy will help medical practices fund the resources needed to provide care coordination. It can also let organizations leverage quality to strengthen bottom-line income.

Implementing Care Management

In the 2015 Medicare Physician Fee Schedule, CCM services are billable under CPT code 99490. Reimbursement is approximately $43 per patient per month. To be eligible for the payment, services must meet several conditions:

  • Patients: Patients eligible for CCM services must have 2 or more chronic conditions expected to last at least 12 months. These conditions must place the patient at “significant risk of death, acute exacerbation/decompensation, or functional decline.” Patients must provide written consent for CCM services.
  • Parameters: Patient CCM services must take at least 20 minutes of clinical staff time per calendar month. Staff must establish, implement, revise, and monitor a comprehensive care plan. Patients must have 24/7 access to care management staff.
  • Providers: CCM services must be performed by a physician, a non-physician practitioner, or another clinical staff member supervised by a qualified health care professional (under Medicare’s “incident to” rules).

Significant Revenue Opportunity

According to the Centers for Disease Control, two-thirds of Medicare beneficiaries have two or more chronic conditions. As a result, healthcare organizations of every size stand to benefit from the new payment policy.

Consider a solo physician with 500 Medicare patients. Statistically, about 333 of these patients will have multiple chronic diseases. Depending on how many patients qualify for CCM and agree to receive these services, the physician could generate $100,000 or more in additional annual reimbursement.

To realize the full potential reimbursement, providers must meet several requirements. Patients must first agree in writing to receive CCM services. In addition, the practice must meet all documentation requirements, including documentation of staff time.

Care management can create additional costs, including staffing and IT costs and other general expenses. That is why this new payment policy is a great opportunity for organizations that have already built a care management program, such as many acountable care organizations, integrated delivery networks and even some larger medical groups.

For example, consider a health system that already provides care management services for select patient populations. The system has 100 employed physicians who manage patients with chronic conditions. With modest changes to comply with service and documentation requirements, the system could be eligible for several million dollars in new reimbursement for CCM services.

The opportunity for all healthcare organizations is to strengthen the bottom line while providing better care. CCM services can help lower complication and readmission rates, which will ultimately lower the cost of care for patients and payers. 

Careful Planning Needed

To successfully implement CCM, provider organizations need to focus on three priorities:

  • Hiring and organizing clinical staff to orchestrate patient care and manage patient populations.
  • Implementing technology that enables the sharing of patient data among providers, tracking clinical quality measures, and maintaining electronic care plans.
  • Developing effective processes for coordinating care, reconciling medications, managing care transitions, and attaining other CCM goals.

Achieving these goals requires careful planning. But qualifying for CCM reimbursement can help many healthcare organizations transition successfully to value-based care.


lucy_zielinski.pngMs. Zielinski is a vice president with The Camden Group, with over 20 years of experience in the healthcare industry. She specializes in helping private and hospital-owned medical practices achieve top financial performance by guiding physicians through practice development, strategic planning, coding and revenue cycle process optimization, and electronic health record system implementation. In her health system leadership roles, she has successfully managed the revenue cycle for over 2,000 physicians. Additionally, Lucy has led engagements with physician billing companies that involved restructuring operations and development of dashboard reports. She may be reached at lzielinski@thecamdengroup.com or 312-775-1700.

Topics: Medicare, Reimbursement, Lucy Zielinski, Chronic Care Management

Senate Passes SGR Fix, Embraces Value-Based Reimbursement

Posted by Matthew Smith on Apr 15, 2015 2:45:32 PM

senateThe fix for Medicare’s Sustainable Growth Rate (“SGR”) is finally in as the Senate approved the previously House-passed healthcare reform package (“H.R. 2”). The fix repeals Medicare’s SGR physician payment formula after previous passage of 17 short-term bills since 2003 to block cuts to physician payments. President Obama had previously pledged to sign the bill as soon as it passed the Senate.

Impact on Physicians

  • Stabilizes payment increases from 2015 to 2019 with 0.5 percent increase per year with 0.0 percent payment adjustment between 2020 to 2025
  • Moves to pay-for-value in 2019
    • Incentive bonuses (5 percent annually) to providers who “receive a significant portion (25 percent+) of their Medicare revenue” from an alternative payment model, including patient-centered medical homes and accountable care organizations (“ACOs”) between 2019 to 2024
  • Combines the various current incentive payments and streamlines the current Merit-Based Incentive System (“MIPS”) beginning in 2019 to reward physicians for quality, resource utilization, clinical practice improvement activities, and meaningful use of the electronic health record (“EHR”)

Medical Group Must Dos

The SGR fix doesn’t eliminate challenges for medical groups, whether they are independently or hospital/health system owned. To be successful, medical groups need to be taking action on a number of fronts, including the following:

  • Re-examine your physician compensation plan and add incentives for quality, patient satisfaction, and efficiency
  • Maximize operational efficiency
    • Assess work flows
    • Maximize patient throughput
    • Effectively use care team members to maximize physician effectiveness
    • Improve patient access so you can meet quality and efficiency standards
  • Participate in Medicare’s current value-based payment initiatives
    • Participate in Medicare’s Physician Quality Reporting System (“PQRS”)
    • Attest for EHR meaningful use
    • Analyze your performance on quality and cost and develop a performance improvement action plan now

Other Key Provisions

H.R.2 also extends the Children’s Health Insurance program through September 30, 2017 and includes provisions on hospitals and post-acute providers. Other provisions include:

  • Delays disproportionate share payment cuts to safety net hospitals until 2018 and extends the DSH policy through 2025
  • Delays until September 30 changes in the two midnight rule on inpatient billing that were set to take effect at the end of this month
  • Increases Medicare payments to post-acute facilities by no more than 1 percent in 2018
  • $7.2 billion in additional funding for community health centers
  • Permanently extends Medicare’s Qualifying Individual program for low income seniors and the Transitional Medical Assistance program that helps families with Medicaid keep their coverage as they transition from welfare to work

Only about one-third of the $200 billion-plus package was offset by spending cuts. To help offset new spending, H.R. 2 provides for means testing for Medicare recipients. Higher-income beneficiaries will pay higher premiums for physician services and prescription drugs; some Medi-Gap plans will see limits on first-dollar coverage.

Although the bill’s passage was welcomed, some expressed caution and suggested that the legislation should not be considered a permanent solution. Additional payment updates and bonuses are currently set to expire in 2025 so there will be a need to re-examine the physician payment methodology again in the future.

Topics: Value-Based Reimbursement, Medicare, Physician Compensation, Operational Efficiency, Physician Group Practices, Sustainable Growth Rate, SGR

Calling All Oncology Practices: CMS Extends Oncology Care Model Letter of Intent Deadline

Posted by Matthew Smith on Apr 14, 2015 3:39:32 PM

By Mary Witt, MSW, Senior Vice President, The Camden Group

oncology-salaryIn February, the Centers for Medicare and Medicaid Services (“CMS”) announced the Oncology Care Model (“OCM”) Initiative to improve care coordination, appropriateness of care, and access to care for Medicare beneficiaries undergoing chemotherapy by using appropriately aligned financial incentives. The deadline for submitting a non-binding letter of intent (“LOI”) has been extended from April 23 to May 7, 2015If your oncology practice has not yet considered participating in the OCM initiative, time still remains to consider participation and to submit your LOI.

Participation in the initiative may benefit your practice in the following ways: 

  • Improves how you deliver care
    • Care coordination
    • Quality
    • Efficiency
  • Provides financial resources to strengthen your care delivery model
  • Enhances your competitive position in the marketplace by increasing quality and efficiency (cost), (i.e., assist in the creation of a market differentiator)

The OCM Initiative is episode-based, which is defined as chemotherapy and related care during a 6-month period following the initiation of chemotherapy treatment. The goal of the OCM Initiative is to improve quality through transforming how oncology care is delivered in the medical practice setting. Fee-for-service Medicare beneficiaries are automatically enrolled if they receive chemotherapy at a participating practice.

Under the OCM Initiative, participating practices will continue to be paid Medicare fee-for-service payments. Additionally, CMS is implementing a two-part payment approach:

  • Per beneficiary per month (“PBPM”)
  • Performance-based payment
    • Performance on specific quality measures
    • Total cost of care as compared to established targets

Eligible practices include:

  • Physician group practices and solo physicians providing chemotherapies and currently enrolled in Medicare (multispecialty practices may apply and include only those physicians who furnish cancer chemotherapy).
  • Hospital-owned practices may apply as long as the hospital is paid by Medicare under the inpatient and outpatient prospective payment systems.
  • Practices that partner with a hospital outpatient department for chemotherapy infusion services may participate as well as those that are owned or affiliated with hospitals that participate in the 340B Drug Pricing Program.
  • Practices may participate in other CMS programs including shared savings models such as accountable care organizations. Practitioners participating in the Transforming Clinical Practices Initiative are not eligible to participate.
  • Those owned or affiliated with PPS-exempt cancer hospitals, critical access hospitals, Federally Qualified Health Centers, and Rural Health Clinics can’t apply.

For additional information, please download The Camden Group’s new CMS Oncology Care Model Initiative Overview by clicking the button below. This new overview provides the following details of the initiative:

  • Eligible Practices
  • OCM Practice Requirements
  • Financial Incentives
  • Risk Factors
  • Beneficiary Enrollment and Attribution
  • OCM Initiative Benefit to Physician Practices
  • Sample Payment Projection
  • Timeline for LOI Through Implementation

  Oncology Care Model Initiative Overview


 

witt_headshotMs. Witt is a senior vice president with The Camden Group and has over 25 years of healthcare experience. She has held management positions in hospitals, health systems, and management services organizations (MSOs). She has extensive experience in medical group and integrated delivery system development and management. This includes developing patient-centered medical homes, practice management, performance improvement, physician compensation, managed care, strategic planning, healthcare marketing, and physician recruitment. Ms. Witt leads medical group development, performance improvement, and turnaround projects for integrated delivery systems, medical groups, and academic residency programs throughout the country. She may be reached at mwitt@thecamdengroup.com or 424-201-3971.

Topics: Medicare, CMS, Mary Witt, Oncology Care Model Initiative

New Download: The Next Generation ACO Model

Posted by Matthew Smith on Mar 16, 2015 11:53:00 AM

download_1MobileThe Centers for Medicare and Medicaid Services (“CMS”) recently announced a new Accountable Care Organization (“ACO”) model through its Center for Medicare and Medicaid Innovation ("CMMI"). The new model, called "Next Generation ACO," builds upon the experience gained with the Medicare Shared Savings Program ("MSSP") and Pioneer ACO Models. As with the two existing programs, the Next Generation ACO is a model for traditional fee-for-service ("FFS") Medicare, otherwise known as "Original Medicare."

This new PDF download from The Camden Group presents a concise overview of the new program, including:

  • Next Generation ACO Model Highlights
  • Risk Arrangements
  • Payment Mechanisms
  • Beneficiary Engagement
  • Next Steps

For more information about the CMMI's Next Generation ACO model, please read our previous blog post, CMMI Announces Next Generation ACO Model.

To access and download this PDF, simply click the button below.

Next Generation ACO, ACO, Accountable Care Organization, The Camden Group

Topics: ACO, Medicare, CMS, Pioneer ACO, Next Generation ACO Model, CMMI, Original Medicare

The Latest Thought Leadership from The Camden Group

Posted by Matthew Smith on Feb 11, 2015 3:57:00 PM

The Camden Group, Thought Leadership, Population Health, Clinical IntegrationEach month, thought leaders from The Camden Group share their expertise through original posts, articles, speaking engagements, and interviews.

Below are links to the top thought leadership shared recently by The Camden Group. 

 

Email Newsletters

►“Top 10 Trends and Implications for Medical Groups in 2015” by Mary Witt

►“Prevent 2017 Medicare Penalties Now” by Lucy Zielinski

►“Improving the Financial Performance of Your Newly Acquired Medical Group” by       Tawnya Bosko

Bylined Articles

In the News

Upcoming Speaking Engagements

To request more information about scheduling a thought leader from The Camden Group to speak at your organization's next event, please click the button below.

The Camden Group, Speaking Opportunity

Topics: Value-Based Care, Medicare, Medical Group, Deirdre Baggot, Daniel J. Marino, The Camden Group, Steve Valentine, Physician Services.

Value-Based Purchasing in 2015: Bonuses Up / Penalties Down

Posted by Matthew Smith on Dec 19, 2014 10:03:00 AM

Value-Based Purchasing, More hospitals will see a payment bump than a penalty in the coming year under Medicare's value-based purchasing program, according to newly released federal data for more than 3,000 U.S. facilities.

A total of 1,698 hospitals will have their Medicare payments boosted in 2015, 467 more than in 2014, according to a Modern Healthcare analysis of data the CMS posted Wednesday. The posted adjustments, however, range between 0.01% and 2.09%, which suggests there could be some anomalies in the data. Under the structure of the program, payments should adjust up or down as much as 1.5% for fiscal 2015. Modern Healthcare has reached out to CMS about why bonuses for more than 40 hospitals in the CMS data surpass that maximum. 

A total of 1,360 U.S. hospitals will have their Medicare payments docked next year. The cuts will range from 0.01% to 1.24%. The number of hospitals facing cuts represents only a slight improvement over last year, when 1,400 hospitals were penalized under the program. The average penalty for 2015 is negative 0.30%. That's higher than the minus 0.26% in 2014 and minus 0.21% adjustments in 2013.

The CMS launched the value-based purchasing program in October 2012 in a major effort under the Patient Protection and Affordable Care Act to reimburse hospitals for quality that marked a shift from pay-for-reporting initiatives such as the Hospital Inpatient Quality Reporting Program. 

The program is budget-neutral because it draws its funds from an across-the-board reduction in base operating DRG payments. For 2015, that cut increased to 1.5% from 1.25% in 2014 and it will grow incrementally each year until reaching 2% in 2017. The 1.5% reduction produced a pool of $1.4 billion. 

The current adjustments are based on hospitals' performance across 26 measures of clinical processes; patient satisfaction; and outcomes, including use of preoperative antibiotics, doctor-patient communication and mortality rates. They include 12 clinical process-of-care measures; eight patient-experience dimensions; five outcome measures; and one efficiency measure on spending per beneficiary.

Health policy leaders at the American Hospital Association are reviewing the data but say upon initial review the findings are positive. “There's nothing surprising here,” said Nancy Foster, the AHA's vice president for quality and patient safety policy. “We see that hospitals continue to improve on their performance on these measures, and some measures are getting to the point where we've achieved such high levels that there's very little room for additional improvement.”

Topics: Medicare, CMS, Value-Based Purchasing

New EHR Attestation Deadline for Eligible Hospitals: 12/31/14

Posted by Matthew Smith on Nov 24, 2014 3:01:00 PM
Courtesy of Centers for Medicare & Medicaid Services 

CMS, EHR, Meaningful UseCMS is extending the deadline for eligible hospitals and Critical Access Hospitals (CAHs) to attest to meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program 2014 reporting year from 11:59 pm EST on November 30, 2014 to 11:59 pm EST on December 31, 2014.

This extension will allow more time for hospitals to submit their meaningful use data and receive an incentive payment for the 2014 program year, as well as avoid the 2016 Medicare payment adjustment.

CMS is also extending the deadline for eligible hospitals and CAHs that are electronically submitting clinical quality measures (CQMs) to meet that requirement of meaningful use and the Hospital Inpatient Quality Reporting (IQR) program. Hospitals now have until December 31, 2014 to submit their eCQM data via Quality Net.

Note: This extension does not impact the deadlines for the Medicaid EHR Incentive Program.

How to attest?
Medicare eligible hospitals and CAHs will use the Registration and Attestation System to submit their attestation for meaningful use for the 2014 reporting year. The system is open and fully operational, and includes the 2014 Certified EHR Technology (CEHRT) Flexibility Rule options. Medicare eligible hospitals and CAHs can attest any time to 2014 data until 11:59 pm EST on December 31, 2014 to meet the new 2014 program deadline.

Attestation Tips
Here are some steps to help make the attestation process easier:

  • Consider logging on to use the attestation system during non-peak hours, such as evenings and weekends
  • Log on to the registration and attestation system now and ensure that your information is up to date and begin entering your 2014 data  
  • If you experience attestation problems, call the EHR Incentive Program Help Desk and report the problem

Reminder: Medicare eligible hospitals must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment.

2016 Payment Adjustments
Payment adjustments will be applied at the beginning of FY 2016 (October 1, 2015) for Medicare eligible hospitals that have not successfully demonstrated meaningful use in 2014. Read the eligible hospital payment adjustment tipsheet to learn more.

Note:  CAHs have a different payment adjustment schedule than Medicare eligible hospitals. Review the CAH Payment Adjustment and Hardship Exception Tipsheet.

Resources
The EHR Information Center is open to assist you with all of your registration and attestation system inquiries. Please call, 1-888-734-6433 (primary number) or 888-734-6563 (TTY number). The EHR Information Center is open Monday through Friday from 7:30 a.m. – 6:30 p.m. (Central Time), except federal holidays.

Attestation resources are available on the Educational Resources webpage of the EHR Incentives Programs website.

Topics: EHR, EMR, Meaningful Use, Medicare, CMS, Medicaid, Attestation

Medicaid Reform: Are You Ready?

Posted by Matthew Smith on Nov 19, 2014 1:11:00 PM
By Gregory Shufelt, Adam Medlin, Patricia A. Hines
The Camden Group

The Camden Group, ACA, Affordable Care Act, Medicaid, Healthcare Reform, In an article for HFMA's HFM Magazine, our colleagues at The Camden Group urge health system leaders to view any steps they take to prepare for their state's Medicaid reform initiatives as integral to their organization's evolution toward value-based care and population health.

Hospitals and health systems should follow a four-step process to evaluate their state’s Medicaid initiatives and to develop new care models to better manage the Medicaid patient populations they serve:

  • Perform an initial assessment
  • Identify opportunities and risks
  • Develop a business plan
  • Implement the plan

More than 72 million Americans receive healthcare coverage from Medicaid, including children, nondisabled adults, pregnant women, individuals with disabilities, and seniors with both Medicare and Medicaid coverage (known as dual eligibles). This number is expected to grow to 93 million by 2024.a New reports are showing that even in states where Medicaid expansion under the Affordable Care Act (ACA) was rejected or put on hold, Medicaid enrollment is still expanding due to the “woodwork effect,” whereby people previously eligible for Medicaid are just now signing up, due in large part to the outreach and educational efforts associated with the ACA. Regardless of their state’s decision to expand Medicaid, healthcare leaders should prepare for potentially drastic changes in how states manage their Medicaid programs.

To read the full version of this article, please click the button, below:

Medicaid Reform, Affordable Care Act, ACA, Population Health

Topics: Medicare, ACA, Affordable Care Act

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