Clinical Management & Clinical Performance

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Value-Based Reimbursement Models Help SPARC Get A Leg Up In Medicaid Managed Care Contracting

By Meena Dayak SPARC Services & Programs (SPARC) is a behavioral health provider organization in North Carolina that has been providing home and community-based services since 2015. They serve 425 consumers monthly and employ 70 full-time staff. They focus on complex consumers—children and adults with severe and persistent mental illnesses (SPMI) who have not been…

Continue Reading Value-Based Reimbursement Models Help SPARC Get A Leg Up In Medicaid Managed Care Contracting

NCQA Adjusts HEDIS Quality Measures Due To COVID-19 Pandemic-Driven Telehealth Surge

On June 5, 2020, the National Committee for Quality Assurance (NCQA) announced adjustments to 40 Healthcare Effectiveness Data and Information Set (HEDIS) measures to support the use of telehealth during the coronavirus disease 2019 (COVID-19) pandemic and after. NCQA will apply the adjustment for measurement of health care quality starting in 2020. The adjustments align…

Continue Reading NCQA Adjusts HEDIS Quality Measures Due To COVID-19 Pandemic-Driven Telehealth Surge

Presentation: Health Plan Innovation For VBID, Part D Payment Modernization & Part D Senior Savings Models – Overview

The webinar took place on April 2, 2020. The Centers for Medicare & Medicaid Services (CMS) presented Medicare Advantage and Part D health plan innovation models for calendar year 2021. The models include Value-Based Insurance Design, the Part D Senior Savings Model, and the Part D Payment Modernization Model. Download Presentation (PDF)

Continue Reading Presentation: Health Plan Innovation For VBID, Part D Payment Modernization & Part D Senior Savings Models – Overview

The Current Service & Financing Trends Affecting Children, Families & Provider Organizations

This presentation was delivered by Sean Klutinoty, MBA, Senior Associate, OPEN MINDS, on June 5, 2020 at The 2020 OPEN MINDS Strategy & Innovation Institute. In the presentation, Mr. Klutinoty discussed key data elements in the current service trends for children and families, health homes and value-based integrated models, as well as questions for the…

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A Stable Connection Should Mean More Than Just a Strong Wi-Fi Signal: How to Keep Our Care Connections Personal in a Virtual World

Free Executive Web Briefing Courtesy Of Qualifacts + Credible July 13, 2021 | 12:00-1:00 p.m. Eastern With the shift to virtual meetings and hybrid models to provide care to clients and consumers, the feeling that we’ve lost the connection of face-to-face interactions is real. Virtual fatigue leaves us all longing for the “human touch,” but…

Continue Reading A Stable Connection Should Mean More Than Just a Strong Wi-Fi Signal: How to Keep Our Care Connections Personal in a Virtual World

Value-Based Reimbursement Models Help SPARC Get A Leg Up In Medicaid Managed Care Contracting

By Meena Dayak SPARC Services & Programs (SPARC) is a behavioral health provider organization in North Carolina that has been providing home and community-based services since 2015. They serve 425 consumers monthly and employ 70 full-time staff. They focus on complex consumers—children and adults with severe and persistent mental illnesses (SPMI) who have not been…

Continue Reading Value-Based Reimbursement Models Help SPARC Get A Leg Up In Medicaid Managed Care Contracting

California Alliance of Child & Family Services 2021 Summer Virtual Member Education Event

As the California health and human services system moves towards increased managed care and performance-based models of service delivery, it is a strategic imperative for provider organizations to understand the operational systems required for successful contracting and care delivery in this environment. Shifts in Medi-Cal financing and reimbursement proposed by the State and the county…

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Data-Driven Decision-Making For The Post Pandemic Market

More competition, workforce shortages, and changing reimbursement models are making data-driven decisionmaking more important for health and human service organizational sustainability. Data-driven strategy shifts, coupled with daily actions, are required and can be hindered by cultural norms that maintain status quo and workforce routines. How to break out of these norms and move to being…

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Babylon, A World Leading, Digital-First, Value-Based Care Company, Announces Plans To Become A Public Company Via $4.2 Billion Merger With Alkuri Global Acquisition Corp.

Babylon Holdings Limited (Babylon), a world leading, digital-first value-based care company, and Alkuri Global Acquisition Corp. (Alkuri Global), a special purpose acquisition company, announced that they have entered into a definitive merger agreement. Upon closing of the transaction, the combined company will operate as Babylon and plans to trade on Nasdaq under the new symbol…

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Eleanor Health Announces $20 Million Series B Financing To Address The Growing Need For Value-Based Addiction & Mental Health Treatment

Eleanor Health, the first outpatient addiction and mental health provider organization delivering convenient and comprehensive care through a population and value-based payment structure, announced it has closed an oversubscribed $20 million Series B financing round. The company received significant participation from all existing investors including Town Hall Ventures, Echo Health Ventures, and Mosaic Health Solutions,…

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Caron Treatment Centers & Independence Blue Cross Report Value-Based Contract Linked To Lower 90-Day Readmission Rate

Independence Blue Cross (IBC) reported that its value-based arrangement with addiction treatment provider Caron Treatment Centers resulted in a 5.6% 90-day readmission rate during a 2019 pilot. Under the arrangement, IBC paid Caron one single upfront fee for IBC members receiving treatment for addiction disorder, and Caron was at risk for any readmissions that occurred…

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Value-Based Reimbursement Models Help SPARC Get A Leg Up In Medicaid Managed Care Contracting

By Meena Dayak SPARC Services & Programs (SPARC) is a behavioral health provider organization in North Carolina that has been providing home and community-based services since 2015. They serve 425 consumers monthly and employ 70 full-time staff. They focus on complex consumers—children and adults with severe and persistent mental illnesses (SPMI) who have not been…

Continue Reading Value-Based Reimbursement Models Help SPARC Get A Leg Up In Medicaid Managed Care Contracting

A Game Plan for Building a Sustainable Certified Community Behavioral Health Clinic (CCBHC)

The goal of the Certified Community Behavioral Health Clinics (CCBHC) is to improve patient care across the healthcare spectrum, serving highly complex patients while avoiding the use of high-cost, low-return care models though community-based alternatives that improve care management. Based on the success of the first wave of CCHBC’s, Congress has acted five times to…

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COVID-19 and Value-Based Reimbursement: What Do We Know? Where Will it Go?

The impacts of COVID-19 on health care continue to unfold, and one area of uncertainty is the impact COVID will have on Value Based Reimbursements (VBR). Regardless of this uncertainty it appears that VBR is still trending upwards in behavioral health care.  Surveys conducted by OPEN MINDS demonstrate more use of episodic payments, case rates,…

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Value-Based Reimbursement Models Help SPARC Get A Leg Up In Medicaid Managed Care Contracting

By Meena Dayak SPARC Services & Programs (SPARC) is a behavioral health provider organization in North Carolina that has been providing home and community-based services since 2015. They serve 425 consumers monthly and employ 70 full-time staff. They focus on complex consumers—children and adults with severe and persistent mental illnesses (SPMI) who have not been…

Continue Reading Value-Based Reimbursement Models Help SPARC Get A Leg Up In Medicaid Managed Care Contracting

NCQA Adjusts HEDIS Quality Measures Due To COVID-19 Pandemic-Driven Telehealth Surge

On June 5, 2020, the National Committee for Quality Assurance (NCQA) announced adjustments to 40 Healthcare Effectiveness Data and Information Set (HEDIS) measures to support the use of telehealth during the coronavirus disease 2019 (COVID-19) pandemic and after. NCQA will apply the adjustment for measurement of health care quality starting in 2020. The adjustments align…

Continue Reading NCQA Adjusts HEDIS Quality Measures Due To COVID-19 Pandemic-Driven Telehealth Surge

Presentation: Health Plan Innovation For VBID, Part D Payment Modernization & Part D Senior Savings Models – Overview

The webinar took place on April 2, 2020. The Centers for Medicare & Medicaid Services (CMS) presented Medicare Advantage and Part D health plan innovation models for calendar year 2021. The models include Value-Based Insurance Design, the Part D Senior Savings Model, and the Part D Payment Modernization Model. Download Presentation (PDF)

Continue Reading Presentation: Health Plan Innovation For VBID, Part D Payment Modernization & Part D Senior Savings Models – Overview

The Current Service & Financing Trends Affecting Children, Families & Provider Organizations

This presentation was delivered by Sean Klutinoty, MBA, Senior Associate, OPEN MINDS, on June 5, 2020 at The 2020 OPEN MINDS Strategy & Innovation Institute. In the presentation, Mr. Klutinoty discussed key data elements in the current service trends for children and families, health homes and value-based integrated models, as well as questions for the…

Continue Reading The Current Service & Financing Trends Affecting Children, Families & Provider Organizations

Don’t Leave Money On The Table: How The Right Technology Can Improve Your VBR Success

Originally presented on May 26th, 2021 Value-based care is here! If you haven’t started thinking about what it is you need to compete in a value-based environment, now is the time to start. With the rise in value-based care contracts and utilization of alternative payment models, provider organizations are challenged with doing the research and…

Continue Reading Don’t Leave Money On The Table: How The Right Technology Can Improve Your VBR Success

A Stable Connection Should Mean More Than Just a Strong Wi-Fi Signal: How to Keep Care Connections Personal in a Virtual World

Originally presented on 7/13/21 With the shift to virtual meetings and hybrid models to provide care to clients and consumers, the feeling that we’ve lost the connection of face-to-face interactions is real. Virtual fatigue leaves us all longing for the “human touch,” but telehealth and other developing forms of digital evaluation and treatment is here…

Continue Reading A Stable Connection Should Mean More Than Just a Strong Wi-Fi Signal: How to Keep Care Connections Personal in a Virtual World

Value-Based Reimbursement Models Help SPARC Get A Leg Up In Medicaid Managed Care Contracting

By Meena Dayak SPARC Services & Programs (SPARC) is a behavioral health provider organization in North Carolina that has been providing home and community-based services since 2015. They serve 425 consumers monthly and employ 70 full-time staff. They focus on complex consumers—children and adults with severe and persistent mental illnesses (SPMI) who have not been…

Continue Reading Value-Based Reimbursement Models Help SPARC Get A Leg Up In Medicaid Managed Care Contracting

Making Value-Based Reimbursement Work – Best Practices In Program Design & Management

This executive web forum was delivered on May 13, 2021, by Ashley Gibson Director Of Payer Relations, Contracts & Utilization, Hazelden Betty Ford Foundation and Donna Esposito, Director of Payer Relations, THRIVE DETECT, who shared their advice on how to negotiate, design, and implement a successful VBR relationship with a health plan. Download Resources

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The Future Is 2020 In The Rearview Mirror: A 2021 Forecast

The COVID-19 pandemic caused major shifts throughout organizations, industries, and the entire world. The behavioral health and human services market is no exception. As we look back on 2020, there were some short-term tactics that we anticipated would be around for a while to allow provider organizations to create stability, resiliency, and success while weathering…

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Why Measuring Performance & Tracking Outcomes Are Your Roadmap to Success: A Discussion With Eric Arnson, Chief Product Officer, Qualifacts + Credible

This presentation was delivered on March 10, 2021 at The OPEN MINDS Technology & Analytics Institute. In the presentation, the speakers highlighted the critical importance of your electronic health record’s (EHR) analytics and reporting functionality. The speakers discussed what is driving the trend towards greater need for outcomes tracking and reporting; how providers are using…

Continue Reading Why Measuring Performance & Tracking Outcomes Are Your Roadmap to Success: A Discussion With Eric Arnson, Chief Product Officer, Qualifacts + Credible

Value-Based Reimbursement Models Help SPARC Get A Leg Up In Medicaid Managed Care Contracting

By Meena Dayak SPARC Services & Programs (SPARC) is a behavioral health provider organization in North Carolina that has been providing home and community-based services since 2015. They serve 425 consumers monthly and employ 70 full-time staff. They focus on complex consumers—children and adults with severe and persistent mental illnesses (SPMI) who have not been…

Continue Reading Value-Based Reimbursement Models Help SPARC Get A Leg Up In Medicaid Managed Care Contracting

NCQA Adjusts HEDIS Quality Measures Due To COVID-19 Pandemic-Driven Telehealth Surge

On June 5, 2020, the National Committee for Quality Assurance (NCQA) announced adjustments to 40 Healthcare Effectiveness Data and Information Set (HEDIS) measures to support the use of telehealth during the coronavirus disease 2019 (COVID-19) pandemic and after. NCQA will apply the adjustment for measurement of health care quality starting in 2020. The adjustments align…

Continue Reading NCQA Adjusts HEDIS Quality Measures Due To COVID-19 Pandemic-Driven Telehealth Surge

Presentation: Health Plan Innovation For VBID, Part D Payment Modernization & Part D Senior Savings Models – Overview

The webinar took place on April 2, 2020. The Centers for Medicare & Medicaid Services (CMS) presented Medicare Advantage and Part D health plan innovation models for calendar year 2021. The models include Value-Based Insurance Design, the Part D Senior Savings Model, and the Part D Payment Modernization Model. Download Presentation (PDF)

Continue Reading Presentation: Health Plan Innovation For VBID, Part D Payment Modernization & Part D Senior Savings Models – Overview