Medication Adherence as a Path to Unlock Savings Opportunities

In a post COVID-19 world, it’s more critical than ever for health plans to gain market share as well as decrease costs associated with poor outcomes. By achieving the 5 star rating in the Star Rating Program, Medicare Advantage prescription drug plans and stand-alone prescription drug plans are able to enroll members throughout the calendar year compared to those plans who are only allowed to enroll members through open enrollment. [...]

2020-05-21T15:28:13-04:00

Integrating Medicaid Data: Understanding the Sociodemographic Metrics At Play

Last November, the Centers for Medicare & Medicaid Services (CMS) announced the release of Medicaid and Children Insurance Program (CHIP) data through its Transformed Medicaid Statistical Information System (T-MSIS) analytical files. This release marks a historic step in CMS's commitment towards increasing data transparency and enables healthcare professionals to identify waste, promote best practices, and optimize [...]

2020-05-26T12:44:46-04:00

Impact of COVID-19 on Accountable Care Organizations Short-Term and Long-Term

The ongoing COVID-19 pandemic has shaken the healthcare industry dramatically. We all have loved ones affected by COVID-19 whether they are on the front-line fighting for us or they are patients trying to fight off the virus themselves. A significant focus has deservedly gone towards disease prevention and progression, but little time has been devoted to discussions around what the outlook looks like [...]

2020-04-16T13:05:34-04:00

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), [...]

2020-04-16T14:22:05-04:00

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

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

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 reducing Medicare spending via prevention of acute hospital utilization, improving doctor-patient [...]

2020-03-10T16:09:52-04:00

We are working closely with our members & partners to assist in the response to COVID-19. View our special coverage here.