Health Insurance Providers’ Actions Concerning Mental Health

New Jersey Health Care Quality Act (HCQA) and Provider Bill of Rights

The New Jersey Health Care Quality Act (HCQA), N.J.S.A. 26:2S-1 et seq. and rules establish certain rights AND responsibilities for health care providers that contract with carriers for business that is subject to the HCQA. Whether your contract with a carrier is subject to the terms of the HCQA depends upon whether the business for which you are to deliver health care services is subject to the HCQA.

A Managed Care Resource

A Managed Care Resource 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…

Medicare Advantage Is Close to Becoming the Predominant Way That Medicare Beneficiaries Get Their Health Coverage and Care

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…

Thoughts from Alex Yarijanian and Carenodes outcomes

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 and performance in population health management.
When I left my management role at Humana to enter into the startup world, I was shocked to find that a vast majority of Health Tech organizations are founded by innovators with non-healthcare backgrounds.

Changing Demographics & Value Based Care

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

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

Healt Plan Leaders’ Statements About VBC

“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 organize around a philosophy of care delivery that brings value to our citizens. This model serves to create value in our health care system through improving the quality of care delivered to patients and maximizing the value of each health care dollar spent.”

Changing Demographics & Value-Based Care

  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.…

Improving Payment Accuracy In Health Insurance Marketplaces

In all three countries studied, risk adjustment leaves some enrollees highly underpaid and others highly overpaid. In the U.S. exchanges, for example, one in a thousand enrollees were underpaid by more than $190,000, and one in a thousand were overpaid by at least $95,000 in 2017.

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