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Payor Approaches to Cost Concerns: Considerations for Provider Contracting and Revenue Cycle

Hospitals and health systems face ongoing pressure to migrate away from fee-for-service models, reduce costs, and improve quality. From MACRA to commercial risk arrangements to self-insured employer cost containment models,...more

Workplace Wellness Program Incentives Under Fire - Again

For years, employers have been trying to find the right incentives for employees to embrace wellness programs. If incentives are too meager, employees are not likely to participate. If they are weighted too heavily in favor...more

Value Based Reimbursement: CMS Dials Back; Large Employers Forge Ahead

Last week, CMS announced in proposed rulemaking its proposal to cancel the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) incentive payment model. It also announced plans to revise certain aspects of the...more

CMMI Focuses on Behavioral Health

CMS recently announced that the Center for Medicare and Medicaid Innovation (CMMI) is interested in lowering the cost of care for Medicare and Medicaid beneficiaries with behavioral health conditions while improving the...more

Patient Safety Issues Highlighted in DOJ Settlement and Health Care Industry Cybersecurity Task Force Report

As we know, the move away from fee for service reimbursement models is not only intended to reduce costs by no longer paying providers based on the volume of services performed, but is also intended to improve the overall...more

Aetna-Humana Merger Blocked

The District of Columbia federal court recently ruled that a proposed $37 billion merger between health insurance giants Aetna and Humana cannot proceed, granting the US Department of Justice’s bid to block the combination on...more

Repealing-Replacing the Affordable Care Act: Considerations for Employers with Self-Funded Plans

Over the last several years we have seen employers, especially those with self-funded health plans, evolve in their approach to wellness programs. Programs have grown from gathering data – e.g., steps on a pedometer,...more

Recent Developments in Patient Engagement and Healthcare Cost Initiatives

In the wake of the recent flurry of commentary on the answer to the question of “What will happen to the Affordable Care Act?” the Commonwealth Fund released a new survey addressing how high-needs patients experience health...more

CMS Continues Efforts to Improve Patient Care, Spending, and Population Health

On November 2, 2016, the Centers for Medicare and Medicaid Services (CMS), released the 2017 Medicare Physician Fee Schedule (MPFS) final rule, which finalized a number of new policies designed to improve Medicare payment for...more

CMS Releases List of Additional Advanced APM’s and Announces Vermont’s All-Payer ACO

On the heels of the release of its final rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA), the Centers for Medicare and Medicaid Services (CMS) released its 2017 list of Advanced Alternative Payment...more

DOJ/FTC Joint Guidance for Human Resources Professionals Suggests Broad Antitrust Risks

Provisions restricting the hiring of another company’s employees are often included in vendor agreements and a variety of corporate transactions and licenses. And it’s not unusual to see similar constraints adopted in...more

CMS Finalizes New Medicare Quality Payment Program: "Flexibility" and "Pick Your Pace" Key Themes

After receiving roughly 4,000 comments to its proposed rule, the Centers for Medicare and Medicaid Services (CMS) on October 14, 2016 released its final rule for implementing the Medicare Access and CHIP Reauthorization Act...more

IRS Issues Proposed Regulations Under Code Section 457(f)

In June 2016, the IRS issued long-awaited proposed regulations under Section 457(f) of the Internal Revenue Code of 1986, as amended. While the proposed regulations will generally apply to compensation deferred under a plan...more

APMs, MIPS, and the Final MSSP Rule - The Journey from Volume to Value-Based Reimbursement Continues

Since the Affordable Care Act was enacted, many providers have been shifting away from traditional fee-for-service, volume-based reimbursement models to payment mechanisms that take a data-driven approach to managing patients...more

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