Opioid Epidemic, Part 2: The Pharmacy Impact

The US Opioid Crisis Continues to Grow. In our previous blog Opioid Epidemic, Part 1: The Prevalence of Opioid Use Disorder and Impact of Distressed Communities, we utilized Medicare Part D data (over 40 million enrolled beneficiaries) to highlight the growing prevalence rates across the board in the U.S. In short, the key findings were [...]

2020-08-05T10:41:50-04:00

The Future of Value-Based Oncology: Oncology Care First (OCF)

The Centers for Medicare and Medicaid Services’ (CMS) recent COVID-19 changes to it’s Alternative Payment Models (APMs) present an opportunity for the oncology community. With the changes, CMS has given Oncology Care Model (OCM) practices the opportunity to “forgo upside and downside risk for performance periods” during the pandemic, to remove COVID-19 related episodes, and to elect into aggregate quality measures. [...]

2020-06-25T17:04:49-04:00

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 […]

2020-06-25T10:36:40-04:00

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

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 [...]

2020-06-12T16:02:57-04:00

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
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