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Resources to Drive Performance and Profitability:

Study estimates a total annual value opportunity of $31 billion in the Medicare market through integration of Mental Health/substance use and medical treatments. “Literature suggests that an estimated 5%-10% of these total health expenditures for those with behavioral conditions may be...
The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, the primary enforcer of fraud and abuse prohibitions, posted Advisory Opinion No. 15-12 on August 13, 2015, which makes it clear that agencies may provide “introductory” or coordination visits to patients in...
Community paramedicine (CP) is a new and evolving model of community-based health care in which paramedics function outside their customary emergency response and transport roles in ways that facilitate more appropriate use of emergency care resources and/or enhance access to primary care for...
Colorado The longest-standing Medicaid program is in Colorado, where the statewide Accountable Care Collaborative launched in 2011. The Colorado program’s Regional Care Collaborative Organizations (RCCOs) are not at financial risk for improving quality and lowering costs (they only share in...
The ACO Investment Model is an initiative developed by the Center for Medicare & Medicaid Innovation (Innovation Center) for organizations participating as ACOs in the Medicare Shared Savings Program (Shared Savings Program). The ACO Investment Model is a new model of pre-paid shared savings...
Fragmentation of the care delivery system is widely recognized as a cause of missed opportunities to treat both acute and chronic conditions. Coordination of care among physicians and other practitioners is seen as an essential part of improved quality. Anthem is partnering with well-established...
Several factors are driving merger and acquisitions in the payor’s national market. First, they appear to be diversifying their product mix to create synergies and mitigate risk by expanding their offerings across market segments and experimenting with new distribution channels in public and...
A panel of eldercare experts, organized by the American Geriatrics Society, released its definition for person-centered care. The updated definition stresses the importance of individuals’ values, and a collaboration between the patient, their family and the provider. A panel of eldercare experts...
Section 2(a) of the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act) requires post-acute providers to submit standardized patient assessment data, as well as standardized data on quality measures and resource use and other measures. A standard acute care instrument...
The Comprehensive Care for Joint Replacement (CJR) Model – set to begin on April 1, 2016 – will test bundled payment and quality measurement for hip and knee replacements and/or major leg procedures to encourage hospitals, physicians, and post-acute care (PAC) providers to work together to improve...
HHAs, Skilled Nursing Facilities (SNFs), Inpatient Rehabilitation Facilities (IRFs), and Long-Term Care Hospitals (LTCHs) have different quality measure domains. All four settings must report standardized data using the assessment instruments  on at least five of the following eight quality...

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