Tag Archives: Medicaid

The way from here: The collaborative future of MMIS procurement

As states move forward with plans to overhaul aging Medicaid Enterprise Systems (MES), collaboration is only going to increase in importance. That’s why organizations like the National Association of State Procurement Officers (NASPO) are working to streamline Medicaid Management Information System (MMIS) procurement. In NASPO’s case, they’re harnessing resources from multiple states to create cooperative […]
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IT procurement cycle stuck on spin? Here are 3 ways to get it sorted.

No matter the size of the state nor the type of system being developed, large government technology projects seem to share the same time frame: long, convoluted and often very different from the end users’ initial goals. To learn why, we studied a number of Medicaid Managed Information System (MMIS) development projects from across the […]
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High-tech guided meditation eases burn pain

Parkland Hospital in Dallas County, Texas, is one of America’s “most wired,” as recognized by Hospitals & Health Networks® Magazine. Its careful integration of user-friendly tech extends from handy kiosks in the lobby to patient rooms with an array of digital devices that help both patients and staff. While much of the technology is focused […]
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Analytics provides “one report card” for physicians

In today’s health care, there are a lot of players – and a lot of payers, each with their own standards for evaluating physicians and the care they provide. As Greg Kile, CEO of the analytics firm Populytics, explains in an Optum® video, his company’s top 10 payers have 176 different metrics. Being washed over […]
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Modernizing Medicaid: Mega-Reg implications health plans should know

Payers manage a multitude of responsibilities as it relates to their Medicaid membership. From regulatory adherence, and payment integrity optimization to enrollment management, the current, and sometimes, complex canvas of Medicaid oversight is now growing.   The Department of Health and Human Services (HHS) issued a new ruling earlier this year with the intention to […]
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Preventive care: Gauge potential to drive revenue

Say your patient population is the size of Cincinnati and Toledo combined, you might be able to fill up my beloved Buckeyes’ Ohio Stadium with patients who’ve skipped two years of well visits. I’m talking about 18 percent of your patients missing out on preventive care. What would closing that gap in care mean to […]
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A healthy partnership: Medicaid managed care organizations and federally qualified health centers

“Triple Aim” has become recognized as the methods designed to put our health care system on the path to long-term sustainability. Stakeholders recognize the triple aim as simultaneously lowering population health costs, increasing quality and improving the health care experience for patients. Critical to improving the patient experience is measuring the performance of health providers, […]
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Engaging in risk-based contracts? Get an actuary’s opinion

Health care providers across the country are looking at ways they can increase their clinical and financial risk exposure under value-based contracts. But if they’re not experienced with risk, they may enter into contracts that put them in difficult situations. The consequences of bad risk contracts could include poor cash flows, non-competitive rates resulting in […]
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Provider executives share insights on the evolution of population health

How can you adapt to population health? If you’re a health care provider, such a question can’t be answered in a sentence or a paragraph—or even an entire article. But providers who are undergoing a fee-for-service to fee-for-value transformation have offered some insight into how and why they’re evolving to become excellent at managing the […]
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King v. Burwell: How should payers move forward after the ruling?

With the U.S. Supreme Court handing down its decision today in the Affordable Care Act case King v. Burwell, health insurers can turn their full attention to preparing for their continued participation in the health insurance exchanges. Ruling to retain policies in accordance with the current PPACA law as written allows the tax subsidies to […]
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