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…

On June 30th, CMS announced it was enhancing its Program Integrity efforts that focus on addressing improper Medicaid payments and CMS oversight of state Medicaid programs. The announcement introduced 8 initiatives, including stronger audit functions, enhanced oversight of state contracts…

Health plan revenue is increasingly tied to the concept of risk adjustment. In practice, risk adjustment aligns payments received by health plans with the risk of the populations they manage. Although each market has its own unique version of risk…