Topic
Business
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The Numbers That Drive Hospital Maternity Care Under Fee-for-Service
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…
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Business · Innovations · Leadership · Managed Care · MCO · Medical Loss Ratio · Medicare · Medicare Advantage · Payers · Providers · Startups · Value Based CareThe 2025 Healthcare Perfect Storm: How Rising Costs and Increased Scrutiny Impact Insurers
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…
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From Startups to Shocking Bills: The Realities of Navigating Healthcare and Value-Based Care
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…
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Academy · Business · Contracting · Leadership · Provider Contracts · Resource · Value Based CareTransforming Healthcare Negotiation: The ‘Getting to Yes’ Approach
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…
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Academy · Administrative Work · Business · Calculators · California · California Advancing and Innovating Medi-Cal (CalAIM) · Care Coordination · Data Tools · Finance & HR · Funding · Health Equity · KPI · Managed Care · MCO · Medicaid · Modeling · Providers · Resource · Return on Investment Calculator · ToolkitsUnlock Financial Success with CalAIM: Budget Estimator Tool for CBOs
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,…
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Business · HMO · Innovations · Managed Care · Maternity · Maternity Kick Payments · MCO · Medicaid · PayersUnderstanding State-Level Variation in Medicaid Managed Care Maternity Kick Payments
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…
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Business · Data Tools · Databank · Policies & Procedures · Policy · Press · Resource · Value Based CareChild and Family Health Policy Insights: CCF Blog Analysis
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…
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Business · California · California Advancing and Innovating Medi-Cal (CalAIM) · Medicaid · Population Needs Assessment (PNA) · Quality Improvement · Resource · SDoHAddressing Critical Health Needs: Partnership HealthPlan of California Strategic Response to the 2024 Population Needs Assessment
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…
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Business · California · California Advancing and Innovating Medi-Cal (CalAIM) · Leadership · MedicaidStrategies for Success: Navigating California’s CalAIM Program
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…
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Mindfulness-Based Interventions: Enhancing Resilience in Healthcare Settings
Mindfulness-based meditation has emerged as a recommended intervention to address these challenges. By cultivating resilience and providing tools to cope with stress, mindfulness interventions can help healthcare professionals…
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Business · Connected Care · Contracting · Databank · Digital Therapeutics · Funding · HEDIS · Managed Care · Payers · Press · Reimbursement · Startups · Subcontracting · Value Based Care · virtual health · Virtual Specialty CareHealth Insurance Providers’ Actions Concerning Mental Health
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Subcontracting Opportunities
Carenodes contracts with physicians, facilities and other health care professionals to form our provider networks, which are essential for delivering quality, accessible and cost-effective health care services. In…
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Digital Therapeutics and Healthcare Reimbursement
Many digital therapeutics (DTx) providers are working to obtain reimbursement from U.S. payers. The following post discusses stategy for reaching patients and partnerships. A reputable DTx company will…