CareJourney Blog2019-12-20T10:11:52-05:00

Blog

A Pulse on Healthcare Insights, Trends, and Hot Topics

21Feb, 2020

Measuring the Success of Medicare Advantage Open Enrollment 2019

While much of the healthcare market hypes Open Enrollment (OE), for CareJourney, the months to follow are an equally exciting time. During OE, the Centers for Medicare and Medicaid (CMS) and health plans are able to recruit new (and retain existing) Medicare Advantage (MA) insurance plan beneficiaries as individuals select their choices for the year. [...]

31Jan, 2020

Understanding the Direct Contracting (DC) Payment Model

Earlier this year, the Center for Medicare and Medicaid (CMS) announced five new payment models designed to transform primary care by paying providers for outcomes rather than services. Direct Contracting and Primary Care First are two of these models announced by CMS to help encourage providers […]

27Jan, 2020

Investigating the Medicare Diabetes Prevention Program (MDPP)

By Zach Bredl

What is MDPP?
Diabetes is a condition that affects more than 1 in 4 Americans age 65 and older.1 Centers for Medicare and Medicaid Services (CMS) estimated that Medicare spent $42 billion more on beneficiaries that have diabetes than it would have spent if those beneficiaries did not have diabetes. Let’s take a look at PMPY (Per Member Per Year) spend breakouts in 2018 [...]

20Dec, 2019

Medicare Advantage 101

By Chris Freyder

Medicare is the federal health insurance program started in 1965 that is provided for individuals who meet certain criteria. Those who are over the age of 65, younger people who have certain disabilities, or anyone who has End-Stage Renal Disease (ESRD) qualify for Medicare insurance. In 1997 Medicare Advantage […]

10Dec, 2019

An Exploration of the Primary Care First (PCF) Payment Model

Earlier this year, the Center for Medicare and Medicaid (CMS) announced five new payment models designed to transform primary care by paying providers for outcomes rather than services. One of the payment models is the Primary Care First (PCF) Model which is a voluntary, five-year alternative payment model (APM) aimed at […]

26Nov, 2019

Opioid Epidemic, Part 1: The Prevalence of Opioid Use Disorder and Impact of Distressed Communities

By: Zach Bredl and Cody Elias

The Growing Opioid Epidemic
The opioid epidemic is a serious public health crisis that is affecting the nation’s social and economic welfare. In 2017, opioids were responsible for about 130 deaths per day, more than 47,000 yearly. Opioid prescribing rates are three times higher than they were in 1999 while opioid overdoses are an astounding five times higher. How did this happen? [...]

19Nov, 2019

Rethinking Referrals to Post-Acute Care

By Ivy Xiwen Deng Data Visualization by Sanat Malhotra

In the wake of the Affordable Care Act (ACA), hospitals have drawn attention from policymakers as key partners in reducing the overall cost of care. Consequently, the effort has led to an enhanced focus on preventing readmissions and reducing unnecessary care. The ACA implemented several policy measures to hold hospitals accountable for what happens to patients post-discharge. [...]

16Oct, 2019

UHS Case Study Webinar Recap: Improve Network Design and Management with Claims Data

Listen in as Mallory Cary, ACO Operations Director of Universal Health Services (UHS), one of the nation’s largest hospital management companies, and Abbas Bader, Director of Product Development at CareJourney discuss their collaboration on building better and more optimized networks using claims data and insights from CareJourney’s Network Advantage platform.

You […]

27Sep, 2019

Member Spotlight: How a CareJourney Member Leverages Network Advantage and Population Insights for Market Expansion, Network Optimization & Integrity

The past decade has seen a remarkable increase in the number of lives covered in risk-based contracts. According to a recent article by Leavitt Partners published in Health Affairs, “At the end of the first quarter of 2018, we were tracking a total of 1,011 ACOs representing 1,477 distinct active accountable care payment contracts with public and private payers. [...]

27Aug, 2019

Tracking Unnecessary Care Through Claims-Derived Measures

By Timmy Del Vecchio

As organizations continue the transition to value-based care, the need to (1) identify, (2) assess, and (3) eliminate wasteful spending continues to be a priority. From the identification perspective, initiatives like Choosing Wisely, started by the American Board of Internal Medicine, help both providers […]

26Aug, 2019

Recap of the Blue Button Developer Conference 2019

By Edward Yurcisin

The Centers for Medicare & Medicaid Services (CMS) recently held the second annual Blue Button 2.0 Developer Conference on the 54th anniversary of Medicare. There were several key takeaways from the conference [...]

01Mar, 2019

CareJourney HIMSS Debrief

By Deepika Kumar

Listen in as Aneesh shares with CareJourney members and partners the key highlights from HIMSS 2019; covering topics such as Consumer-Directed Exchange, Bulk APIs regulations, FHIR Accelerators, and more. […]

10Jan, 2019

ACO Open Data Report

By Ben Bigelow

The ecosystem of healthcare data is vast. There are electronic health records (EHRs), medical claims, lab results, biometrics, and a whole slew of other data sources, including open data published by organizations like the Center for Medicare and Medicaid Services (CMS). […]

29Oct, 2018

Turning Quality Score Insights into Actionable Opportunities

By Timmy Del Vecchio, graphic by Ben Bigelow

As CMS recently made unembargoed Performance Year (PY) 2017 results available to ACOs in late August, ACOs were able to view not only PY 2017 financial expenditures relative to benchmarks, but also the ACO’s overall quality score for the performance year. For an ACO […]

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