Author: Alex Yarijanian

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…

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…

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,…

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…

In an ambitious move to reshape healthcare access, Kentucky has enacted the 'Any Willing Provider' (AWP) statutes, challenging the traditional exclusivity of health maintenance organizations (HMOs) and their provider networks.…

Doulas, with their specialized training in providing emotional, physical, and educational support during childbirth, are becoming increasingly integral in modern maternity care. For hospitals navigating the intricacies of capitated contracts—where…

Advanced financial and statistical support relating to Capitation Rates, Risk Adjustment Models, and Payment Methodologies.

Various reports from the State of California regarding the quality of care provided by Medi-Cal managed care health plans. Plan-specific evaluation reports are also prepared for each individual health plan…

The Birth Count Query System is a highly useful online tool provided by the Florida Department of Health. It offers a plethora of data on birth counts in Florida, and…

Medicare Medicaid Alignment Initiative Value-based payment structures are gaining popularity for many reasons. The model can align incentives to encourage disparate providers to collaborate to achieve objectives. Cost savings can…

Business case for breast-feeding

Alzheimer’s care coordination payments are financial incentives or compensation provided to healthcare providers or organizations to coordinate the care and support for individuals with Alzheimer’s disease or related dementias. The…

This environmental scan was prepared at the request of the Office of the Assistant Secretary for Planning and Evaluation (ASPE) as background information to assist the Physician-Focused Payment Model Technical…

The Managed Care Legal Database is a resource identifying how state and federal statutes and regulations address many issues that may occur between private payers and physicians, such as prior…

As Medicare Advantage continues to grow, a gradual but significant reshaping of the Medicare program is taking place. A new KFF analysis finds that nearly half of eligible Medicare beneficiaries…

Healthcare Startups take too long to go to market hence innovations do not get to the American people in a form and fashion conducive to the aims of healthcare quality…

The United States is going through a fundamental shift in its demographics. By 2035, there will be more seniors than children under the age of 18.

CARES Act Telehealth Expansion: Trends in Post-Discharge Follow-Up and Association with 30-Day Readmissions for Hospital Readmissions Reduction Program Health Conditions

“The patient-centered medical home has served as a catalyst and organizing philosophy to refine our state care delivery system. It has brought stakeholders from both the public and private sector together to…

  Changing Demographics & Value Based Care The U.S. is stuck in a system of volume-based (fee-for-service) care that continues to drive up costs without providing better outcomes for patients.…