Distributed Healthcare Intelligence
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…
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…
Payors use a variety of reimbursement methodologies and reimbursement structures. Several reimbursement methodologies might be combined in a single arrangement with a payor, often as a means of transitioning to…
Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk…
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…
Effective Jan. 1, 2022, Health Plan commercial members will be protected from balance billing after receiving emergency care and nonemergency care from certain out-of-network providers at in-network facilities. The No…
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.…
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…
The Biofourmis Care platform currently supports five virtual care programs: heart failure, hypertension, diabetes, lipid management, and atrial fibrillation. The technology platform facilitates care coordination across care settings and provider…
On January 1st, 2022, the No Surprises Act went into effect and it provides federal protections for patients from surprise medical bills.
Prescription digital therapeutics (PDTs) are software applications that are prescribed by a licensed healthcare provider.
Digital therapeutics (DTx): Deliver therapeutic, evidenced-based interventions driven by software to treat, manage, and prevent a broad spectrum of behavioral, mental, and physical diseases and disorders.
Tools and Partnerships to help your organization raise awareness, reduce stigma surrounding mental illness, and facilitate help-seeking behavior. MENTAL HEALTH @ WORK Treatment can help people feel better and perform…
CASE EXAMPLE of how we breakdown contracts and tie the terms to operational alignment Because the business of healthcare is to deliver the highest quality care to patients, improving clinical…
GREAT FALLS – Two Montana nurse practitioners have been sentenced for conspiring to defraud Medicare of millions of dollars. Chief U.S. District Judge Brian Morris sentenced Janae Nichole Harper, 34,…
No two states are alike in how telehealth is defined and regulated. While there are some similarities in language, perhaps indicating states may have utilized existing verbiage from other states,…
The system used to pay for health care today does not encourage the integration of health care and social care, nor can it adequately adapt to the trending shift toward…
If your patient shows signs of cognitive impairment during a routine visit, Medicare covers a separate visit to more thoroughly assess your patient’s cognitive function and develop a care plan…
https://www.kff.org/medicaid/state-indicator/medicaid-mco-quality-ratings/view/print/?currentTimeframe=0&print=true&sortModel=%7B%22colId%22:%22State%22,%22sort%22:%22asc%22%7D NOTES Notes Data reflect NCQA’s 2019 ratings of Medicaid managed care plans. The plans included in the NCQA data do not always match the MCOs in other tables in…