Distributed Healthcare Intelligence
Physician practice acquisitions are often justified by the payer contracts that come with them. Assignment and change-in-control provisions can take those contracts away, sometimes retroactively. Here is what to audit,…
Under fee-for-service, hospital maternity programs are run on volume, payment per birth, efficiency, and clean billing. Here are the metrics that matter most, why C-section rates matter even without financial…
HMO, PPO, EPO, capitation, value-based care — see how these managed care basics play out in real life through California's CYBHI Fee Schedule program and its Evaluation Hub results.
Most revenue cycle management challenges are treated as billing problems. In reality, many are contract problems — upstream issues that billing teams cannot resolve at the claims stage. Learn how…
From Ancient Wisdom to Modern Economics: The Case for Doulas in Healthcare Throughout human history, childbirth has been more than a medical procedure—it was a community event deeply rooted in…
The blog post examines the health insurance industry's challenges in 2025, highlighting rising healthcare costs, increased patient demand, and heightened government scrutiny. Insurers, particularly those focused on Medicare Advantage, must…
In the latest episode of the VBCA Podcast, we explore the complexities, frustrations, and sometimes absurd realities of today’s healthcare landscape. This episode isn’t just about theory; it’s a hard-hitting…
The new Population Needs Assessment requirements in California's Population Health Management program aim to improve health outcomes while impacting healthcare costs. Initially, increased expenses from community engagement and data collection…
As of 2024, California healthcare plans must submit a Population Needs Assessment every three years to enhance community engagement and address diverse health needs. This shift aims to improve health…
Introduction In the intricate dance of healthcare negotiations, achieving a win-win outcome can seem like a daunting task. Whether it’s negotiating agreements between health plans and providers, determining reimbursement rates,…
The CalAIM Budget Estimator Tool helps CBOs navigate the financial complexities of contracting under CalAIM. It offers an Excel-based template with built-in assumptions, cost input fields, revenue customization, and a…
The Continuum of Care for children in out-of-home settings can be enhanced by leveraging existing data sources. California's CDSS, DDS, DHCS, and CDE provide crucial data on community care facilities,…
The latest HHS rule targets information blocking practices in healthcare, imposing penalties for non-compliance. Healthcare providers face increased scrutiny, financial impact, and reputational risk. To comply, they must strengthen compliance…
Understanding State-Level Variation in Supplemental Maternity Kick Payments in Medicaid Managed Care Introduction Today, we’re exploring an intriguing study on the state-level variation in supplemental maternity kick payments in Medicaid…
The Center for Children and Families (CCF) at Georgetown University’s McCourt School of Public Policy offers extensive insights into health policy issues affecting children and families. The CCF blog, “Say…
Expanding Medicaid Coverage for Doulas: A Crucial Step for Maternal and Infant Health As the maternal and infant health crises continue to challenge the healthcare system, there is growing recognition…
What is the Justice-Involved Initiative? The Justice-Involved Initiative is a pioneering program under California’s Medicaid reforms, specifically designed to extend Medicaid coverage to incarcerated individuals. Historically, under the Medicaid Inmate…
Business Brief: Addressing Critical Needs in Population Health Partnership’s membership remained relatively stable in 2023. The member redetermination process, resulting from the winding down of the COVID-19 Public Health emergency,…
Monitoring chronic absence data is essential for ensuring educators are equipped to support their students effectively. Amidst the busy school year, it can be easy to lose track of how…
by Ali Modaressi, California Health Report California’s ambitious journey to reshape health care through the multiyear Medi-Cal reform effort known as California Advancing and Innovating Medi-Cal (CalAIM) represents a profound…
Introducing the Care MAP Tool, designed to support healthcare providers in managing complex care needs. This user-friendly, Excel-based tool offers a structured framework for effective care coordination, resource allocation, and…
The Breastfeeding Intention and Duration Indicators are key measures used to track breastfeeding practices and intentions among new mothers. These indicators include plans to breastfeed exclusively or in combination with…
The video titled "Managed Care Business Models 101 - Digital Therapeutics & Health Technology" on the channel Carenodes provides an in-depth discussion on healthcare business models, focusing on managed care,…