The article discusses Aetna's embedded case managers (CMs) who are working with primary care physicians and has achieved 12 percent reduction in acute generated by the insurer's in-house case managers. It states...
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On November 26, 2024, Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule revising the Medicare Advantage (“MA”) Program (Part C), Medicare Prescription Drug Benefit Program (Part D), Medicare Cost Plan Program, and Programs of All-...
timely access to healthcare providers as mandated by the ACA, CMS proposes that, for plan years beginning on or after January 1, 2025, state marketplaces and state-based marketplaces-federal platform establish and impose quantitative time and distance qualified health plan network adequacy ...
Under the Proposed Rule, health plans would be able to “take credit” for “shared savings” that may accrue by encouraging consumers to shop for lower-cost, higher-value services. These could be calculated in the health plan’s medical loss ratio (MLR) calculations. HHS believes this propos...
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primarily due to inadequate treatment plan reviews. OIG recommended that Massachusetts follow up on unsupported services and strengthen its procedures to prevent future noncompliance. In response, Massachusetts agreed with the recommendations and outlined plans for corrective action, highlighting the importance...
按照迁移策略在该日期之前转换到 Azure Health Data Services FHIR® 服务。 由于 Azure API for FHIR 停用,在 2025 年 4 月 1 日开始前不会允许新的部署。Azure Health Data Services FHIR 服务是 Azure API for FHIR 的演化版本,可让客户管理FHIR、DICOM 和医疗技术服务,并集成到其他 Azur...
The need for seamless interdisciplinary communication and data driven decision-making continues to grow, however, health care often remains fragmented, poorly coordinated and inefficient. A comprehensive, shared, interoperable e-care plan has the potential to improve patient outcomes, satisfaction, and ...
One major trend in the healthcare environment is the shift from volume based reimbursement towards value based reimbursement. Many provider practices remain on a volume based or fee for service reimbursement plan. This system tends to reward high quantity of services with less regard for the quality...