Summary At one point, the Affordable Care Act (ACA) market was the “new kid on the block” and every health plan wanted in. Shortly after its debut, plans faced financial and competitive challenges. The uncertainty of this market rapidly became evident…

Leading Market Trends and Challenges from the MLTSS Leadership Summit Managed Long-Term Support Services (MLTSS) continues to be spotlighted in discussions of complex care management, whole person care models, health disparities, and the direct care workforce shortage. Managed Care Organizations…

Reflecting on the significant events of 2020, most notably, heightened racial unrest and the unequal impact of COVID-19, we have a unique and time-sensitive opportunity to address the reality that racial disparities exist in our country. Racial disparities permeate across…

2020 has redefined healthcare in a way no one could have predicted. The US healthcare system finds itself looking at an uncertain future in which healthcare, namely COVID-19, has manifested itself in nearly every aspect of life. The impact of…

YOUR PROVIDER DATA QUALITY PROBLEM MAY BE BIGGER THAN YOU THINK… AND IT COULD BE GETTING WORSE Under normal circumstances, inaccurate provider data presents significant operational and financial challenges for health plans. In 2020, these problems have been exacerbated across…

On December 3, 2020, the Centers for Medicare and Medicaid Services (CMS) Innovation Center released details on the much-anticipated Geographic Direct Contracting Model, or “Geo.” Geo is a new payment and care delivery model designed to assess whether Direct Contracting…

In June 2019, the Trump administration issued an Executive Order (EO) that directed the U.S. Department of Health and Human Services (HHS) to propose regulations that enhance the ability for patients to shop for healthcare services. As directed by the…

DEFINING CONVENER Health starts in our homes, continues in our communities, and is largely impacted by our day-to-day choices and interactions. The interconnectedness of life demonstrates why providing holistic healthcare that delivers long term results is hindered by a primarily…

It’s that time of year again. At the start of every year, and particularly at the dawn of a new decade, the buzzing speculation of what is to come in the new year intensifies. In this Executive Brief, HealthScape has…

Historically, CMS has pushed towards value-based care for programs that are “helping us move toward paying providers based on the quality, rather than the quantity of care they give patients.” Touted as a transformative reimbursement model, value-based care has historically…