Tag Archives: Medicaid

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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Using data to move toward transparency: Six things health care providers can do

In our previous blog, “RISK now matters to health care providers”, we introduced the RISKMATTERS publication from Optum and touched on the latest conversation in the spring edition—health care providers managing financial risk becoming data-rich and insight-strong. And a new trend report in the spring edition, Transparency becoming health care’s new normal, kicks off the […]
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RISK now matters to health care providers

For the past several years, the U.S. health care industry has undergone a significant transformation in its payment structure, with many organizations evolving from supporting the current fee-for-service to a value-based payment model. A 2015 U.S. Department of Health & Human Services news release articulated its support for a new model when it set a […]
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5 reasons why Medicaid agencies should use cloud-based services

To what degree has your state made the move to cloud-based services? More and more states are successfully implementing data processing and hosting solutions in the cloud. These anything-as-a-service (XaaS) solutions can be more cost-effective and responsive to changing needs. When will your state Medicaid agency get on-board? To help you overcome any concerns, here […]
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Transparency provides competitive edge for health care providers

As high-deductible health plans become increasingly popular, cost may become a primary deciding factor for consumers seeking medical providers. But that doesn’t necessarily mean that consumers want the cheapest price. Instead, they want to spend their dollars wisely by understanding pricing and seeing clear accountability for outcomes. In a word, they want transparency. “The future […]
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The King vs. Burwell case: Implications for ACA and issuers

On March 4, the U.S. Supreme Court heard oral arguments on the case of King vs. Burwell. The Supreme Court’s decision, expected to be delivered in late June or early July, could have far-reaching effects on the Affordable Care Act (ACA) and the millions of Americans who depend on it. The suit maintains that the government […]
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Rethinking your MMIS: Change is good

“He who hesitates is lost.” “The early bird gets the worm.” And for those of you old enough to remember a popular Alka-Seltzer® commercial, “Try it, you’ll like it.” No matter how you say it, popular wisdom suggests that getting in on the ground floor of change is good. And nothing begs for change more […]
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Aligning network adequacy to meet greater expectations

With the passing of the Affordable Care Act (ACA) and the advent of the health insurance marketplace, network adequacy has come under greater scrutiny. Increased emphasis getting the right providers to consumers is leading health plans away from expansive networks to a narrow, more efficient network design that better serves member needs. Not lost in […]
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NCQA member engagement standards change accreditation paradigm for Medicaid plans

ACA mandates that plans offering insurance products on health benefit exchanges (HBE) maintain full accreditation with standards boards like NCQA or URAC. Generally considered the gold standard for accreditation, state Medicaid programs are increasingly adding NCQA compliance to their contracts with Medicaid MCOs. Traditionally exempt from NCQA’s Member Connections standards (MEM), Medicaid MCOs must now […]
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