Our Latest Thinking

We are constantly scanning the health care market for new and interesting developments; then we write about them here. Check out our latest thinking.

Medicaid

The Medicare-Medicaid ACO Model: Addressing Dual Eligibles’ Costs

July 17th, 2017

Dual eligibles, individuals enrolled in both Medicare and Medicaid, are among the highest-need, highest cost patients in the United States. Although it is difficult to determine the exact number of dual eligibles, a 2012 Kaiser Family Foundation report estimates that dual eligibles comprise 21 percent of the Medicare population and 15 percent of the Medicaid […]

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The MACRA All-Payer Advanced APM Pathway: System-Wide Implications

May 3rd, 2017

Background The Quality Payment Program (QPP) under MACRA is now more than three months underway into the first payment year. However, there are still many nuances of the program, specifically under the multi-payer Advanced APM option, that payers —including commercial, Medicare Advantage, and Medicaid — and clinicians need to understand before they can begin collaborating, […]

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The Future of Medicaid

May 1st, 2017

The Affordable Care Act turned Medicaid into America’s largest public health care coverage program. While the volume associated with this growing program created increasing opportunities for providers, health systems, health plans, and vendors, these same stakeholders shouldn’t write off opportunities in Medicaid now simply because of the change in direction at the federal level. Instead, […]

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State Innovation Waivers, the Next Wave of Health Care Reform?

November 17th, 2016

One potential ACA replacement strategy could include punting health care reform to the states. The incoming administration could accomplish this is by significantly relaxing the 1332 innovation waiver requirements.

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CMS Proposes New Mandatory Bundled Payment Models: 4 Observations

July 29th, 2016

On July 25, 2016, CMS announced a proposed rule to provide additional incentives for hospitals to provide higher quality care at a lower cost. The proposed rule seeks to increase coordination of care and decrease costs for heart attack and bypass surgery patients, creates a new Surgical Hip/Femur Fracture Treatment model (SHFFT), and outlines a […]

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Federal Flexibility Under Section 1115 Medicaid Demonstrations

October 7th, 2015

Many states have been forcefully arguing for the Department of Health and Human Services (HHS) to grant extensive flexibility in the state administration of the Medicaid program.

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The Rise and Future of Medicaid ACOs

September 10th, 2015

No two models nor markets are alike, and the pace and prevalence of Medicaid accountable care growth will largely depend on states’ ability to generate savings and successfully overcome common and unique challenges over the long run. This paper contains a state-by-state landscape analysis.

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