Responding to a (Digital) “Call to Action” on COVID-19

We greatly appreciate our heroic frontline healthcare workers who are delivering much needed care during this public health emergency. To assist in the national response to the current pandemic, CareJourney is responding to a “call to action” issued by our nation’s Chief Technology Officer (a role held by our President, Aneesh Chopra), [...]

2020-04-07T11:45:32-04:00

Benchmarking ACO Network Utilization: Lessons Learned in Network Design and Performance

For organizations across the healthcare sector concerned with network building and management, utilization of the network among the attributed population is often a major area of focus. Whether from a provider or payer perspective, maintaining a high-performing network with high utilization allows organizations to more effectively manage the quality and cost of patient care. [...]

2020-03-26T11:12:51-04:00

Entering the “Consumer-First” Delivery Reform Era

Today, ONC & CMS finalized landmark rules to ensure safe, secure, standardized access to health information. Having spent some time on these issues, I’m pleased to read this White House post that puts these rules in historical context, and celebrates the bipartisan nature of this important endeavor. [...]

2020-03-10T15:56:36-04:00

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. [...]

2020-03-26T11:13:46-04:00

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 […]

2020-03-09T18:02:18-04:00

Investigating the Medicare Diabetes Prevention Program (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 [...]

2020-03-10T15:57:52-04:00

2018 MSSP ACO Results: Optimistic Savings Trends Encourage New CMS Risk Sharing Program

The Centers for Medicare and Medicaid Services (CMS) released the 2018 Financial Performance results on all Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). CMS shared this data for the last six years, contributing to a more transparent, open evaluation of the program, and demonstrating how ACOs are not only increasing overall savings, but striving towards value-based care. [...]

2020-03-10T16:01:55-04:00

Medicare Advantage 101

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 (at that time called Medicare+Choice) was signed into law which gave Medicare eligible beneficiaries more [...]

2020-03-10T16:07:25-04:00
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