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Decriminalizing Mental Illness

U.S. correctional institutions, local courts, and police officers frequently encounter people with untreated mental health disorders. Once incarcerated, individuals with …

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Where Is This All Going? What Are States Doing/Not Doing To Address Our Mental Health Crisis? Trends In Behavioral Health Financing Models & State Innovation

The beginning of this year marked the end of an era in health care financing. Horizontal carve-outs used to be …

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Illinois Enacts Medicaid Mental Health Network Adequacy Law

On July 23, 2021, Illinois Governor J.B. Pritzker signed legislation to require health insurers to ensure network adequacy for mental …

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Bridging Gaps in Behavioral Health Treatment: A Narrative Summary

Introduction

The Lancet Commission on Behavioral health and Sustainable Development called for a global partnership of governmental agencies, development agencies, non-profits, …

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Peer Supports? There’s An App For That

A few new developments around peer supports have caught everyone’s attention. Not surprisingly, the pandemic has changed the role and …

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Integrated Care Gets A Leg Up With Virtual First

Plugging into systems for integrated “whole person” care is increasingly an imperative for all provider organizations—whether they offer primary or …

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Behavioral Health Telehealth Visits Increased 6,500% During The COVID-19 Public Health Emergency; Total Claims Up Slightly

Claims for behavioral health evaluation and management (E&M) telehealth visits increased by 6,500% from January 2020 to February 2021 in …

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2021 Trends In Behavioral Health: A Reference Guide On The US Behavioral Health Financing & Delivery System, 3rd Edition

The Third Edition of Trends in Behavioral Health: A Reference Guide On The US Behavioral Health Financing & Delivery System (The Guide) provides information and insights into the multi-layered United States behavioral health system.

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Illinois Medicaid To Cover New Behavioral Health Services

Under legislation, Senate Bill 2294, signed on July 6, 2021, the Illinois Department Healthcare and Family Services (HFS) will expand …

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Behavioral Health Prevalence Up 50% & Claims Drop By 8%

The number of individuals with behavioral health needs in 2020 and 2021 was about 50% higher compared to 2019, before …

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63% Of People With Schizophrenia Take Medications Raising Risk Of Cognitive Impairment

About 63% of people with schizophrenia take medications with anticholinergic properties associated with cognitive impairment. Anticholinergics are substances that block …

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Suicide Rates Lower Among People Using Long-Acting Injectable Antipsychotics Than Those Taking Oral Antipsychotics

Suicide rates are lower among those using long-acting injectable antipsychotics (LAI) than those taking oral antipsychotics of the same compounds. …

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Over 40% Of Military Veterans Experienced Psychological Improvement During The Pandemic

During the coronavirus disease 2019 (COVID-19) public health emergency, about 43.3% of U.S. veterans experienced positive psychological changes or post-traumatic …

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Digital Is Hot & Mental Health Is Hotter

“In a few years, we won’t really be talking about digital health as its own thing. I think digital will …

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Consumers Can Now Get Mental Health Services At CVS. Where?

As usual, a lot has been happening in the care of consumers with chronic and complex conditions.
Despite the pause on …

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The Integrated Care Opportunity

The future for specialty provider organizations will involve participating in “whole person care” in some form or fashion. Payer interest …

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COVID-19 Pandemic Has Increased Incidence Of Mental Health Problems Worldwide

Coronavirus disease 2019 (COVID-19), and the resulting measures to reduce viral spread, negatively affected population mental health worldwide. About 24.0% …

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Decreases In Exercise Closely Linked With Higher Rates Of Depression During COVID-19

Decreases in exercise are closely linked with higher rates of depression during coronavirus disease 2019 (COVID-19). From March to July …

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Social Cognitive Impairment Similar In Schizophrenia & Autism

Those with “schizophrenia spectrum disorders” (SSDs) and those with “autism spectrum disorder” (ASD) have similar levels of social cognitive impairment. …

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Frequent Psychiatric Hospitalization Is Highest Among Those With Schizophrenia

The odds of becoming a “high utilizer” of psychiatric hospital services are highest among those with schizophrenia, at 111% higher. …

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Cuyahoga County, Ohio To Launch Jail Diversion Center For Behavioral Health Treatment

Cuyahoga County and the Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board are opening a pre-arrest diversion center that …

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CMS Will Require Medicare Part D Plans To Offer A Real-Time Drug Benefit Cost Comparison Starting January 1, 2023

A final rule issued on January 19, 2021, for Medicare Part D drug plans will require the plans to offer …

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APA Releases New Evidence-based Practice Guideline for Patients with Schizophrenia

Patients with schizophrenia should have documented, comprehensive, and person-centric treatment plans that include evidence-based nonpharmacologic and pharmacological treatments, according to …

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Depressive Symptoms Associated With Cardiovascular Disease Risk

According to an analysis of two data sets, older adults with depressive symptoms, even low-level symptoms but not cardiovascular problems …

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Ohio Medicaid Allows Pharmacists To Bill For Services Within Community Behavioral Health Organizations

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Mental Health System Transformation: From Ideas To Action

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CMS Approves Oklahoma Medicaid Waiver To Cover IMD Services For Addiction & Serious Mental Illness

On December 22, 2020, the Centers for Medicare & Medicaid Services (CMS) approved Oklahoma’s Medicaid waiver to expand access to …

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Largest Increases In Doctor-On-Demand Telemedicine Visits During COVID-19 Were For Unscheduled Behavioral Health Appointments

The largest overall increases in telemedicine visits to the Doctor On Demand telehealth service during the initial months of coronavirus …

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Medicaid & CHIP Enrollment Increased By 8.3% Between February & August 2020

From February 2020 to August 2020, national Medicaid and Children’s Health Insurance Program (CHIP) enrollment increased by nearly 5.9 million …

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Home Health Spending Rose 7.7% In 2019 To $113.5 Billion

During 2019, spending on home health services rose by 7.7% to reach $113.5 billion, up from $105.4 billion in fiscal …

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End of An Era: The Last Of The Standalone Behavioral Health Carve-Outs

Last week was the end of an era in health care financing. With the purchase of Magellan by Centene, there are …

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Young Adults With Higher Than Average Use Of Social Media More Likely To Develop Depression Within Six Months

Young adults ages 18 to 30 in the United States who had higher than average social media use were more …

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The Proportion of Suicide Deaths In Connecticut Racial Minority Groups Significantly Increased During COVID-19

According to analysis of records from the Connecticut Office of the Chief Medical Examiner, the proportion of state suicide deaths …

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U.S. Health Care Spending Increased 4.6% To $3.8 Trillion In 2019

The total national health care expenditure (NHE) in the United States increased by 4.6% to reach $3.8 trillion, or $11,582 …

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Medicare Launching ‘Value In Opioid Use Disorder Treatment’ Demonstration In April 2021

The Medicare Value in Opioid Use Disorder Treatment demonstration is slated to launch in April 2021. The Value in Treatment …

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Medicaid & CHIP Enrollment Rose 5.6% From July 2019 To July 2020

Between July 2019 and July 2020, enrollment in Medicaid and state Children’s Health Insurance Programs (CHIP) increased by about 5.6%, …

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Preventable Inpatient Stays For Chronic Conditions Varies Threefold By State — Lowest In Wyoming; Highest in Kentucky

In 2016, the population rate of potentially preventable inpatient stays for chronic conditions overall varied more than threefold across 32 …

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Long-Acting Injectable Antipsychotics Reduce Hospitalizations Among Individuals With Early-Phase Schizophrenia

Long-acting injectable antipsychotic (LAI) use by individuals with early-phase schizophrenia can significantly delay time to hospitalization. According to a recent …

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Serious Psychological Stress Tops 13% In 2020, Up From 3.9% In 2018

Reported prevalence of serious psychological distress among U.S. adults was 13.6% in April 2020 and 13% in July 2020, largely …

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Managing The A To “Z” Of Health, You May Be More Ready Than You Think

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More Than One Third Of Older Adults Will Struggle With Video-Call Telehealth Visits

Two separate studies corroborate that over a third of older adults will struggle with telehealth visits if they require the …

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Are You Where Your Consumers Are? Being Social On Social Media

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Future Of Health Care Beyond 2020 Series: Interview With C. Brendan Montano, MD

In this interview, C. Brendan Montano, MD, PsychU Primary Care Provider Section Advisor, discusses the future of health care beyond …

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Future of Health Care Beyond 2020 Series: Interview With Terence Ketter, MD

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Future of Health Care Beyond 2020 Series: Interview With Sara Jones, PhD, APRN, PMHNP-BC, FAANP

In this interview, Sara Jones, PhD, APRN, PMHNP-BC, FAANP, PsychU Nurses Corner Section Advisor, discusses the future of health care …

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Future of Health Care Beyond 2020 Series: Interview With Jim Kenney, RPh, MBA

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Future Of Health Care Beyond 2020 Series: Interview With Joseph Goldberg, MD

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Future Of Health Care Beyond 2020 Series: Interview With Dwayne Mayes

In this interview, Dwayne Mayes, PsychU Patient and Caregiver Section Co-Advisor, discusses the future of health care beyond the COVID-19 …

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HHS Extends COVID-19 Public Health Emergency Declaration

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Two-Thirds Of Adults With High Deductible Health Plans Have A Health Savings Account; Most Do Not Contribute

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Driving Better Outcomes With A ‘Whole Life’ Approach

The U.S. has historically “separated” the health of an individual from their social circumstances. “Clinically appropriate” was added to the …

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Unemployment Tied To Veteran Suicide Rate; 550 Suicides Per Five Point Rise In Unemployment

An estimated 550 additional veterans in the United States are projected to die by suicide annually for every five-percentage point …

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American Foundation For Suicide Prevention Announces Diversity As Priority Focus Area For Research Funding

The nation’s largest private funder of suicide prevention research, the American Foundation for Suicide Prevention (AFSP) announced the research priority …

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Why Unemployment Matters To Health Care Organizations

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CDC Changes COVID-19 Guidance On Length Of Isolation For Those With COVID-19

People who have been confirmed with mild to moderate COVID-19 can leave their isolation without receiving a negative test, according …

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NIH Launches Clinical Trials Network To Test COVID-19 Vaccines & Other Prevention Tools

The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), has established a …

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Over 10 Million U.S. People Could Lose Employer-Sponsored Insurance By The End Of 2020

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Necessity Is The Mother Of Invention: Innovation In A Crisis

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IRS Says For-Profit Health Care Provider Organizations Must Pay Taxes On CARES Act Provider Relief Fund Payments

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Shatterproof Launches Addiction Treatment Platform ATLAS

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Within Kaiser Health System, 14% Of Appointments Took Place Via Phone Or Video Telemedicine Visits Between 2016 & 2018

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Homelessness Projected To Rise 45% By The End Of 2020 Due To COVID-19 Unemployment

Unemployment is projected to increase homelessness by up to 45%, from 568,000 as of January 2020 to more than 800,000 …

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Sigma Mental Health Urgent Care Expands Telehealth Statewide In Texas

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Kroger Health Receives FDA Emergency Use Authorization For Its COVID-19 Test Home Collection Kit

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Center On Addiction Rebrands As ‘Partnership To End Addiction’

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Performance Of Humana ‘Bold Goal’ Social Determinants Program Continues To Improve At Five-Year Mark

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Why Value-Based Purchasing For Medications Matters

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Humana Selects Icertis To Digitally Transform Its Contracting Process

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Within Kaiser Health System, 14% Of Appointments Took Place Via Phone Or Video Telemedicine Visits Between 2016 & 2018

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Blue Cross Of North Carolina Launches Program To Pay Primary Care Practices To Switch To Value-Based Model

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The Present & The Future May Be Virtual—But What Are The Rules?

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Recovery Access Coalition Launches To Advocate For Digital Therapeutics

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North Carolina Selects Provider Organizations For COVID-19 Testing & Contact Tracing

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Medicare Proposes Allowing Continued Use Of Telehealth For Home Health Provider Organizations After COVID-19 Emergency Ends

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17% Of ACOs Developing New Home Visit Programs

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Horizon New Jersey Health Completes Expansion Of ‘Neighbors In Health’ Program To Address Social Determinants Of Health

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Measurement-Based Care In Psychiatry

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An Estimated 1.64 Million U.S. Non-Profit Workers Lost Jobs Due To COVID-19

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Primary Care Practices Could Lose Over $15 Billion In Revenue Due To COVID-19

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Behavioral Health HEDIS® Measures: An Annual Update From NCQA©

The National Committee for Quality Assurance (NCQA) collects information on the performance of health care service delivery from health plans …

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Maximizing Revenue Amid The Crisis—Resources For Recovery

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Value-Based Reimbursement: Are You Walking In Your Customer’s Shoes?

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Robots As A Staffing ‘Force Multiplier’

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Molina Healthcare To Acquire Certain Assets Of Passport Health Plan

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SAMHSA Publishes Final Rule Amending Addiction Treatment Records Privacy

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U.S. Department Of Veterans Affairs & Department Of Defense Launch National Telehealth Projects For Critical Care

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Centene & Quartet Health Expand Partnership Nationwide To Help Ensure Members Have Access To Critical Behavioral Health Care During COVID-19 Pandemic & Beyond

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Uber Launches Service To Help With COVID-19 Contact Tracing

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Managing Your Service Portfolio Is Key To Crisis Recovery

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Red Cross Offers Virtual Care For Families Struggling With Loss & Grief

The American Red Cross is launching a Virtual Family Assistance Center to support families struggling with loss and grief due …

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Torchlight Offers ‘Caregiving In Times Of Crisis Toolkit’ For Businesses & Individuals Grappling With COVID-19

Torchlight, an employee-caregiver support solutions provider organization, announced the release of the first installment of its “Caregiving in Times of …

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Meditation App Headspace Adds $48 Million In Funding

Headspace Inc. has added another nearly $48 million to its offerings during the coronavirus disease 2019 (COVID-19) public health crisis. …

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Chestnut Health Systems Awarded $100,000 Grant To Benefit Persons Impacted By COVID-19

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Walgreens To Open Up To 700 In-Store Primary Care Clinics In $1 Billion Deal With VillageMD

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Mindstrong Announces $100 Million Funding Round To Scale Its Virtual Mental Health Care & Digital Symptom Measurement Offering

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CDPHP, Valera Health Expand Tele-Mental Health Services To Support Members In Need

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Too Much Health Care?

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Addus HomeCare Announces Acquisition Of A Plus Health Care

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National Institutes Of Health Launches Rapid Innovation Initiative To Develop COVID-19 Home Or Point-Of-Care Tests By Fall 2020

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The Leader’s Role In Managing The Stress Of The Essential Professional

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Cedar Gate Technologies Acquires Citra Health Solutions

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Paul G. Allen Family Foundation Announces Opening Of Housing & Homeless Services Facility In Seattle

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Wolf Administration Announces Strategy To Ease Long-Term Care Facility Restrictions Through Gradual Three-Step Process To Protect Vulnerable Populations

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PA Clinical Network & Geisinger Health Plan Announce Value-Based Contract Agreement

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Humana To Offer LabCorp At-Home COVID-19 Test Collection & Drive-Thru Testing

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Kindred Healthcare Completes Acquisition Of Two Behavioral Health Hospitals In Texas

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Summit BHC Acquires West Virginia’s Highland Hospital

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Highmark, Kaiser & Humana Medicare Advantage Plans Rank Highest In Member Satisfaction

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Hawaii Cancels New Medicaid Contracts Due To COVID-19, Will Rebid In Fall 2020

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eHome Counseling Group Expands Innovative Virtual PTSD Treatment Program

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Priority Health & Cigna Form Strategic Alliance To Make Quality Health Care More Affordable & Accessible For Michigan Employers & Customers

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Optum, Wider Circle & Helping Hands Community Partner To Deliver Food To Vulnerable People In Los Angeles County During COVID-19 Pandemic

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The Data-Driven Leader

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Walmart Announces Opening Of Walmart Health In Arkansas Adding To Its ‘Healthcare Supercenters’

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Centerstone Introducing New Zero Suicide Initiative

Centerstone, a national leader in behavioral health care, is introducing a zero-suicide initiative at its locations in Illinois. While Centerstone …

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$15 Billion HHS Relief Fund For Medicaid & CHIP Provider Organizations Is Open For Applications

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Matchmaker, Matchmaker, Why Do I Need To Find A Match?

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Leadership Resources For Real-Time Crisis Recovery

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AbleTo Launches Full Suite Of Mental Health Solutions To Address Growing Demand For Care

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Seven Steps To Go From Crisis Management To Crisis Recovery

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The Pandemic Provides A New Urgency For The Integrated Care Issue

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Leadership Is Adaptability In The Face Of Uncertainty

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Starbucks Begins Mental Health Training

In its latest move to address mental health in the workplace, Starbucks is making mental health training available for all …

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New Service Lines, New Measures

As executive teams look to diversify, there is one challenge that comes with every new service—identifying and managing new performance …

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HHS Eliminates Protection From Health Care Discrimination Based On Gender Identity

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A Digital Leader Living In A Digital World

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New Aegis Treatment Center Opens In California

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Promedica Makes Bid To Take Over Operations Of UTMC

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CMS Extends Deadline For Direct Contracting Letters Of Intent

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American Addiction Centers Files For Bankruptcy

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For Crisis Recovery, The Best Defense Is A Good Offense

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Medicare Adjusts ACO Risk Models To Account For COVID-19

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St. Luke’s University Health Network To Acquire Easton Hospital

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Health Care Costs Much Higher For Those Later Determined To Have Treatment-Resistant Depression

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What To Say When You Want More

For provider organization executives looking at recovery planning, “top of the list” is different relationships with payers. In most discussions, …

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Follow-Up Mental Health Visits Lower Among Those With Substance Addiction

Follow-up mental health visits, within 14 days after emergency department contact, are lower among those with substance addiction than those …

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Fire Up Your Hybrid For The Recovery Race

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Uplift Family Services Awarded $4 Million Grant From SAMHSA

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Landmark Health Launches HIPAA-Compliant Telemedicine App

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Los Angeles County Homelessness Up Nearly 13%, Despite Sustained Increase In Number Of People Rehoused

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Unite Us Acquires Staple Health

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Spero Health Opens Ohio Clinic Offering Addiction Treatment With Telehealth Services

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WellCare To Invest In Critical Mental Health Resources In New Jersey

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Kindred Healthcare & Landmark Medical Center Announce Definitive Agreement Forming Joint Venture To Acquire Rehabilitation Hospital Of Rhode Island

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Massachusetts Emergency Department & Outpatient Data During COVID-19 Crisis Indicate Fewer Assessments Of Psychiatric Symptoms

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Addcounsel Launches Orchestrate Health, At-Home Mental Health Care Service In UK

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CMS Makes COVID-19-Related Changes To Value-Based Care Models

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Mydecine Innovations Group Signs Definitive Agreement To Acquire Mindleap Health’s Advanced Digital Telehealth Platform

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Back To The Office? The Testing Dilemma

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Collect The Data, Connect The Dots To Value

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24 Provider Organizations Receive Over $100 Million In CARES Act Provider Relief; New York & Presbyterian Hospital Tops The List

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Leveraging Virtual Capacity & Moving To Use Cases Beyond Therapy

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Capital BlueCross Offers Advance Payments To Pennsylvania Network Provider Organizations With COVID-19-Related Revenue Drop Of 40% Or More

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Leadership—The Key For Moving From Crisis To Recovery

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San Diego County Launching Veterans Community Care Program & Releases RFP

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Population Health: Clinical & Administrative Implications

Optimizing both population health and individual patient care will require major changes in how health care is delivered, starting with …

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More Than 120 Behavioral Health Provider Organizations Awarded FCC COVID-19 Telehealth Program Funds

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Medicare Telehealth Claims Rose From 13,000 Per Week In March To 1.4 Million Claims Per Week In April

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Reopening Is Not Recovery

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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 …

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Getting To Whole Person Addiction Treatment

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CMS Proposes Regulatory Changes To Promote Medicaid Value-Based Drug Purchasing

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Almost Half Of ACOs Led By Physicians In 2018

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Paddling Four Canoes To Steer Through The Crisis

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Making Your Clinical Programs VBR-Ready

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Innovations In New Payment Models: A Look At State Examples Of Value-Based Payments

The health care economy continues to shift from the fee-for-service model that has been in existence for decades to value-based …

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Prior To COVID-19, Primary Care Physician Salaries Increased 2.5% From 2019; Specialist Salaries Increased 1.5%

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Medicare Advantage Plans Can Count Telehealth Professionals Toward Network Adequacy Standards In 2021

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Indiana Awards Medicaid Managed Care ABD Contracts To Incumbents Anthem & Centene/Managed Health Services & To UnitedHealthcare

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Kentucky Awards Medicaid MCO Contracts To Aetna, Humana, Molina Healthcare, UnitedHealthcare & WellCare

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Medicare Will Require Hospitals To Adopt The Hybrid Hospital-Wide 30-Day Readmission Measure By 2023

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Microsoft Launches Health Care Cloud Service

On May 19, 2020, Microsoft announced that it has launched a “health care cloud service” called Micorsoft Cloud for Healthcare. …

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Iowa Medicaid Healthy Behaviors Program Participants Less Likely To Use Hospital-Based Care

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CMS Urges Medicare Advantage Plans To Relax Prior Authorization Requirements During COVID-19 Pandemic

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CMS Finalizes Telehealth & ESRD Changes For Medicare Advantage

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Pennsylvania Clinical Network Signs Value-Based Contract With Aetna Medicare Advantage Plan

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Equity Funding For Mental Health Startups Reached $576 Million In The First Quarter Of 2020, Number Of Investments Grew 19% Over Previous Quarter

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About 87% Of Medicare Inpatient Psychiatric Facility Claims With Outlier Payments Failed To Meet Medicare Requirements

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43% Of Addiction Treatment Provider Organizations In North Carolina Report Only 30 Days Cash On Hand With Lost Revenue & Higher Expenses Due To COVID-19

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Kansas DOC Awards Two-Year Prison Health Care Contract To Centene

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CMS Continues Efforts To Expand Access To Telehealth Services

On April 30, 2020, the Centers for Medicare & Medicaid Services (CMS) issued regulatory changes to further expand beneficiary access …

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CMS Approves Washington State 1115 Medicaid COVID-19 Emergency Waiver, Will Allow Higher HCBS Rates To Maintain Capacity

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Behavioral Health Provider Organizations Can Accept Donations Of Devices & Data Plans To Facilitate Telehealth During The COVID-19 Outbreak

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Molina To Acquire Magellan Complete Care For $820 Million

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Iowa Inadequately Monitored Its Medicaid Health Home Provider Organizations

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Medical Practices Report 55% Decrease In Revenue Due To The Pandemic Crisis

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The Global Pulse Of eMental Health Trends In Resource-Strapped Locales

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CMS Issues SNF Policy Changes For FY 2021; Projects Aggregate Payments To SNFs Will Rise By 2.3%

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Medicare Further Expands Telehealth Access For Long-Term Care, Hospice & Home Health Benefits

On March 30, 2020, the Centers for Medicare & Medicaid Services (CMS) announced temporarily expanded access to telehealth services for …

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Navigators Cut Emergency Visits & Hospitalization For High-Risk Health Care Consumers

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Metrocare & North Texas Behavioral Health Authority Reach Contract Agreement Contract Following Rate Dispute

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Joint Commission Releases New Enhanced Addiction Standards For Behavioral Health

On March 12, 2020, the Joint Commission released eight new addiction treatment standards for accredited behavioral health organizations. The new …

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FTC Blocks Merger Between Philadelphia Hospitals To Prevent Consolidation In The Inpatient Rehabilitation Market

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HHS Begins Releasing $100 Billion CARES Act Funding To Provider Organizations For Relief Assistance & Treating The Uninsured

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Behavioral Health Spending Increased By 2.7% Per Year Between 1996 & 2016

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Average U.S. Cost Per Inpatient Day In A Hospital Was $2,260 In 2018

The average adjusted cost per day of an inpatient hospital stay in state and local government community hospitals in the …

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Massachusetts Reaches Insurer Agreements To Settle Mental Health Parity Violations

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Humana Medicare Advantage Plans To Pay Providers To Address Social Determinants Of Health

On March 4, 2020, Humana announced it had launched a Medicare Advantage value-based program (VBP) focused on addressing member social …

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DEA Proposes Allowing Federally Certified Opioid Treatment Programs To Operate Mobile Units Without A Separate Registration

The Drug Enforcement Administration (DEA) recently proposed revising its regulations for federally certified opioid treatment programs (OTPs) to allow the …

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South Carolina Updating Qualified Provider Organization List For Community Beds For People At High Risk For Hospitalization

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VA Proposes Expanding The Program Of Comprehensive Assistance For Family Caregivers

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COVID-19 Could Raise Medicare Spending By As Much As $115 Billion Over Next Year

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States Use Multiple Legal Authorities To Use Medicaid To Pay For Behavioral Health Treatment In IMDs

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CMS Denies New York’s Request For $8 Billion In Medicaid Waiver Funds To Continue The DSRIP

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CDC Issues Interim Workplace Safety Practices For Critical Infrastructure Workers Exposed To COVID-19

On April 8, 2020, the Centers for Disease Control and Prevention (CDC) issued interim workplace safety practices for critical infrastructure …

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California Launches Project Roomkey Initiative To Secure Hotel & Motel Rooms To Protect Homeless Individuals From COVID-19

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Federal 2021 Budget Proposal Includes Provisions To Expand Behavioral Health Services

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Oklahoma Submits State Plan Amendment Seeking To Expand Medicaid

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DOJ Finds Maine Violates ADA By Limiting Access To HCBS

The federal Department of Justice (DOJ) concluded Maine’s system of services for people with intellectual/developmental disability (I/DD) violates the Americans …

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Reentry Interventions Are More Successful When They Address Dynamic Risk Factors

Community reentry following incarceration is more likely to be successful if the reentry interventions address dynamic factors that affect the …

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BlueCross BlueShield & Value Network Partner To Start Behavioral Health Value-Based Payment In Western New York

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25% Of Provider Organizations Have Revenue Tied To Value-Based Payments

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Kentucky Medicaid Rebids Its MCO Contracts

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Veterans’ Long-Term Care Expenses Rose 33% From 2014 To 2018

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Private Equity Firms Acquired 355 Physician Practices From 2013 To 2016

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Denver Strategic Framework For Improving Behavioral Health Calls For Greater Use Of Data To Guide Policy

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Out-Of-Network Primary Care Associated With Higher Medicare ACO Costs

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Well Being Trust Urges Changes To U.S. Behavioral Health Policy To Improve Assessment & Access To Care

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Circuit Court Rebukes HHS Approval Of Medicaid Work Requirements

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Texas DFPS Adult Protective Services Caseworker Turnover Drops From 25% To 20%

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Number Of Nurse Practitioners Doubled Between 2010 & 2017

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A Snapshot Of Telemedicine In One State: Clinical & Payer Implications

Jane Guo, MBA, PharmD, is a Managed Market Liaison­, Northeastern Region, with Otsuka. Her career started in retail pharmacy. She …

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Deals In U.S. Health Care Service Sector Down 1.5% From 2018

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Behavioral Health Care M&A Volume Slowed 21% Between Third & Fourth Quarter Of 2019

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California Prisons Roll Out Integrated Addiction Treatment Programs

On January 21, 2020, the California Department of Corrections and Rehabilitation (CDCR) and the California Correctional Health Care Services (CCHCS) …

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New Mexico Settles With Final Five Behavioral Health Organizations Over 2013 Medicaid Fraud Allegations

On December 4, 2019, the New Mexico Human Services Department (HSD) announced it had settled with the last five of …

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Telepsychiatry-Enabled Perinatal Integrated Care Improves Consumer Access & Engagement With Behavioral Health

The first-known telepsychiatry-enabled model of perinatal integrated care resulted in a 100% perinatal/postpartum depression screening rate, and a higher than …

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New Federal Coronavirus Bill Waives Medicare Telehealth Restrictions

Federal legislation signed into law on March 6, 2020 to address national preparation and response to 2019-Novel Coronavirus (COVID-19) includes …

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Blue Cross NC Launches New Value-Based Payment Model For Behavioral Health

On January 1, 2020, Blue Cross and Blue Shield of North Carolina (Blue Cross NC), in collaboration with Quartet Health, …

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Assisted Living Administrator Salary Averaged $100,000 In 2019

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Arizona Medicaid & Health Plans Launch Initiative To Build Long-Term Care Workforce

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Texas HHS Expands Pilot Program To Provide Resources For Opioid Overdose Survivors

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EHR Vendor, Epic & 60 Health Systems Urge HHS To Modify Proposed Interoperability Rule

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Former Outcome Health Employees Charged In Alleged $1 Billion Fraud

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2% Of Eligible Clinical Professionals Participating In MIPS In 2018 Received A Negative Rate Adjustment

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Can Early Intervention’s Effect On Lifetime Costs Of Serious Mental Illness Be Measured?

Serious mental illness (SMI) is a disabling condition—and because it develops early in life, it brings with it a lifetime …

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States Collectively Spend 17% Of Their Revenue On Medicaid, A 41% Increase In 17 Years

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Cascadia Behavioral Healthcare’s Integrated Model Cut Potentially Preventable Emergency Department & Inpatient Utilization By 18%

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Cigna Reports Combined Medical, Pharmacy & Behavioral Benefits Reduces Annual Costs By More Than $207 Per Covered Life

Cigna reports its commercial members with integrated medical, pharmacy, and behavioral benefits had annual medical costs of averaging $207 less …

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Navajo Corporation Plans To Contract With Molina Healthcare For A New Mexico Medicaid Indian Managed-Health Care Entity

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BCBS Of Michigan & Seven Provider Networks Announce Plan To Share Health Care Financial Risk

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87.8% Of Workers With Disabilities Had Health Insurance In 2017

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Indiana Medicaid To Reimburse For Short-Term IMD Services

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PsychU 360 Magazine

PsychU 360 – January 2020

Despite vast improvements in diagnosis and treatment over the last half-century, mental illness is underdiagnosed and …

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Optum Begins Contract As Maryland’s Public Behavioral Health ASO

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The Health Plans Have It!

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Kentucky Announces Cancellation Of Medicaid Managed Care Contracts; To Be Rebid In January

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Innovations In Mental Health Service Delivery & Implications For Providers

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Innovations In Mental Health Service Delivery & Implications For Providers

New technologies, changing reimbursements, and corporate consolidations are amongst the many drivers evolving the health care landscape.1 During this webinar …

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Medicare Shared Savings Program Lowered Medicare Spending By $755 Million Over 5 Years

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Michigan DHHS Proposes Statewide Medicaid Specialty Integrated Plans

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Success With VBR: What Provider Organization Execs Should Consider

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Making VBR A Success: What Health Plans Can Do

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Proving Your Unique Value To Payers: Data Speaks Louder Than Words

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CMS Releases RFA For Provider Direct Contracting For Risk-Based Programs

On November 25, 2019, the Centers for Medicare and Medicaid Services (CMS) Innovation Center released a request for applications (RFA) …

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Tennessee Medicaid RFI For Managed Care Re-Procurement Closed; RFPs Likely in 2020

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BCBS To Launch National ‘High Performing’ Provider Organization Network In 2021

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North Carolina Suspends Transition To Medicaid Managed Care

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The Medicaid Care Coordination Models Driving Strategy In Your State

Care coordination models matter. The approach that a payer takes to care coordination fundamentally changes the service delivery system—and provider …

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2020 Medicare Advantage Open Enrollment Features 3,148 Plans; Up 15% From 2019

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Medicare Enrolling Opioid Treatment Programs For New Bundled Payment Program

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California Medicaid Proposal For Waiver Renewals Would Significantly Change Service Delivery & Financing

On October 29, 2019, the California Department of Health Care Services (DHCS) formally released the California Advancing & Innovating Medi-Cal …

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Health Plan Innovations In Population Health Management For Complex Consumers

Following-up to the 2019 Trends In Behavioral Health: A Population Health Manager’s Reference Guide On The U.S. Behavioral Health Financing …

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Health Plan Innovations In Population Health Management For Complex Consumers

Following-up to the 2019 Trends In Behavioral Health: A Population Health Manager’s Reference Guide On The U.S. Behavioral Health Financing …

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Michigan Cancels Behavioral Health Integration Pilots

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Universal Health Services Takes $147 Million Write-Down On Value Of Addiction Treatment Unit

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NQF Recommendations For Social Determinants Includes Standardized Measures & Value-Based Payment

The National Quality Forum (NQF) has recommended policy alignment, payment innovation, and standardizing data collection in effort to address social …

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The Alignment Of Medicaid Benefits – The Health Plans Have It

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ACOs Saved Medicare $1.7 Billion In 2018

During 2018, the 548 Medicare accountable care organizations (ACOs) collectively saved Medicare $1.7 billion. After accounting for shared savings bonuses …

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Physician-Led ACOs Generated Almost 7 Times More Savings Than Hospital-Led ACOs

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What Is A Uniform PDL & Why Does It Matter?

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Medicare Beneficiaries In UHC Plans Who Saw High-Value Physicians Had 21% Lower Spending

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Enrollment In Medicare/Medicaid Health Integrated Plans Affected By 3 Main Factors

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Sam’s Club Launches Health Care Pilot Program For Members

On September 26, 2019, Sam’s Club announced the launch of “Sam’s Club Care Accelerator Together with Humana,” a discount health …

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State Up-Front Costs To Administer Medicaid Work Requirements Range From $6 Million In Vermont To $271 Million In Arkansas

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Social Factors Are Primary Impediments To Managing Care For High-Cost Medicaid Beneficiaries

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The Age Of Priceline Health Care

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91.5% Of U.S. Citizens Had Health Insurance Coverage In 2018

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The Changing Medicaid Pharmacy Carve-Out Landscape

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United Behavioral Health Sued For $5 Million In Denied Mental Health Claims

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Alabama Medicaid Launches Coordinated Health Network

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54% Of Physicians Participate In An ACO

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3 Ways To Improve Your Bottom Line – By Improving Your Collections

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California Blue Shield Promise & L.A. Care Invest $146 Million In Community Resource Center Expansion

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Health Care Alliance Announces Value-Based Pilots For Addiction Recovery

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Is Outsourcing In Your Rapid Growth Plan?

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UCHealth In Colorado To Invest $100 Million In Behavioral Health Services

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Which Payer/Provider Organization Partnerships Are Working & Why?

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What Is The Future Of The CCBHC?

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Value-Based Payment Models May Shift The Primary Care Staffing Mix

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Your Organization Is Ready, Are You?

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Getting A Non-Profit Board Ready For VBR

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New York City Launches ‘NYC Care’ Health Plan For Uninsured Residents In The Bronx

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Four Provider Organizations File $40 Million Lawsuit Against BCBS Of Michigan For Underpayment Of Out-Of-Network Addiction Treatment Claims

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Oregon DHS Expands Family Independence Initiative To Two New Areas During 2019

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The VBR Mandate – Medicaid Requirements On The Increase

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Medicare Part D Out-Of-Pocket Maximum Set To Increase By 25% In 2020

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Nevada Submits Medicaid State Plan Amendment To Transition CCBHC Funding To Traditional Medicaid

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Kentucky Medicaid Launches Program To Assist Employer-Sponsored Insurance Premiums

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How Health Plans Are Increasingly Focused On The Social Determinants Of Health

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Negotiate Those Contracts

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Medicare Fee-For-Service Spending For Primary Care Ranges From 2% To 5%

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VA Awards Triwest Healthcare Alliance $26 Billion Contract For Veterans Community Care Network Region 4

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California Medicaid PCCM For HIV Has Converted To A Full-Risk Managed Care Plan In Los Angeles

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U.S. Spends 5% To 7% Of Total Health Care Spending On Primary Care

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MVP Health Care Partners With Healthy Alliance Independent Practice Association On Social Determinants

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Current Insights Into Population Health Management Value-Based Models In Managing High Risk – High Cost Patients

In this webinar, Monica Oss, M.S., and Paul Duck from OPEN MINDS discuss the current state of population health in the United …

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Coming Up With The Next Big Thing

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Have You Mastered These 4 Financial Management Skills For VBR?

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Missouri Medicaid To Continue Prospective Payments To 15 CCBHOs

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Louisiana Medicaid Awards MCO Contracts To AmeriHealth, Healthy Blue, Humana & United

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MVP Health Care To Bring Behavioral Health Management In-House, Ends Contract With Beacon Health Options

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What Are Health Plans Actually Doing?

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40 States & D.C. Have Expanded Telemedicine Coverage Or Reimbursement Since 2017

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Ready To Collect More Cash?

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The Growing Push For Medicaid ACOs

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One-Third Of ACOs Took On Downside Risk In 2018

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CMS To No Longer Exclude Medicare ACOs From BPCI Advanced Savings

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The Four-Part Checklist For VBR Success

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When Is Medicaid Expansion Not Expansion?

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During First Year, Median Supplemental Care Management Payments For CPC+ Participation Exceeded $32,000 Per Primary Care Professional

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How To Build Effective Programs That Meet Payers’ Focus On Social Determinants Of Health: Will The New Codes Pave The Way? (SDoH Series Part 2)

The World Health Organization (WHO) defines Social determinants of health (SDoH) as “The conditions in which people are born, grow, …

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Oregon Awards CCO Contracts To 15 Organizations

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Michigan DHHS Cancels PIHP Contract With Lakeshore Regional Entity

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Consumer Out-Of-Pocket For Hospital Service Costs Rose 12% During 2018

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Minnesota Medicaid To Expand Addiction Treatment Via CCBHCs & Short-Term Residential Treatment Benefit

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Supreme Court Rules Against CMS In Medicare DSH Payment Case

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40% Of Health Systems Sell A Health Insurance Product

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Average Emergency Department Visit Cost Rose 176% In 10 Years For Employer-Sponsored Plans

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Montana Medicaid Planning A Supportive Housing Benefit

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Virginia Legislative Audit Recommends More Time To Effectively Deploy STEP-VA Mental Health Initiative

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South Carolina Medicaid Seeks To Enact Work & Community Engagement Requirements

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Skilled Nursing Occupancy Hits Four-Quarter High Of 83.7%

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72% Of Health Care Executives Believe Their Organizations Have Capabilities To Support Increased Risk & Are Planning To Take On Additional Risk

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The Impact Of Opioid Use Disorders & The National Response

The opioid crisis in the U.S. has been well documented over the past several years. Sections of the country have …

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Michigan DHHS Announces Delay In Pilot Of Integrated Physical Health Services & Specialty Behavioral Health Services

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Adjust Your Strategic Sails!

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Addressing Social Determinants: Impacting Health & Wellness Beyond Traditional Medicine (SDoH Series Part 1)

Social determinants of health (SDoH) – like socioeconomic status, education, neighborhood and physical environment, employment, social support networks, and access …

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Successfully Managing Bundled Rates—The Voice Of Experience

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Consumers Participating In Medicare Bundled Payment Programs Report Positive Perceptions Of Care Quality

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Ohio Medicaid RFI Seeks Public Comment In Advance Of Next MCO Procurement

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2019 Trends In Behavioral Health: A Population Health Manager’s Reference Guide On The U.S. Behavioral Health Financing & Delivery System, 2nd Edition

The Second Edition of Trends in Behavioral Health: A Population Health Manager’s Reference Guide on the U.S. Behavioral Health Financing …

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Detroit Wayne Mental Health Authority Issues RFP For Medicaid HMO To Provide Integrated Care

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Psychiatrists Accepting Medicaid Declined From 48% To 35% Following Medicaid Expansion

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Billing-Related Administrative Expenses In U.S. Health Care System At 8.3% Of Spending

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Colorado Awards 7 Regional Behavioral Health Crisis Services Contracts To 4 Organizations

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Sacramento’s $5 Million City-Operated Homeless Shelter Closes; Will Open 4 Replacement Low Barrier Shelters

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Alabama Medicaid Awards Contracts For Alabama Coordinated Health Network

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States File Suit Over HHS Rule Prohibiting Medicaid Direct Payments For Benefits On Behalf Of Individual Home Care Workers

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CMS Approvals Of Medicaid Waivers Lack Consistency & Transparency

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Anthem To Acquire Beacon Health Options

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The Most Common Program Innovations Among Specialty Provider Organizations

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Tennessee To Seek Medicaid Block Grant

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Washington State To Create ‘Public Option’ Health Insurance Plan

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Moving Health Care From Beds To Wellness

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Virginia Community Services Boards Reach STEP-VA Goal Of Same-Day Access

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Ready For Risk? How Would Your Team Answer That Question?

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Health Plans & Social Services—The Current Craze Or Permanent Shift

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Capitated Payment Models For California Provider Organizations Increased Quality For Commercially Insured Consumers

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Cuyahoga County, Ohio Approves $42 Million Contract With MetroHealth For Jail Health Care

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Arizona To Allow Medicaid Health Plans To Provide Services Currently Provided By RBHAs

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Capital BlueCross & Wellspan Health To Join Forces For Population Health Management

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UnitedHealthcare To Launch Bundled Payment Program For Medicare Advantage

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How VBR Prioritizes Primary Care As The ‘Center’ Of Integration

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Illinois Considering Medicaid Health Plan Legislation

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North Carolina Issues Final Guidance On Nine Consumer Categories Automatically Included In The BH/IDD Medicaid Managed Care Tailored Plans

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CMS Forwarding Three Opportunities For State Integrated Care For Dually Eligible Individuals

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San Diego County Creating Pay-For-Results Project For Housing Services

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New Jersey Medicaid To Cover Office-Based Addiction Treatment

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Only 4 U.S. State Medicaid Plans Not Using Alternative Payment Models

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Florida Medicaid To Launch Behavioral Health Housing Pilot

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Will Health Plan Backward Integration ‘Remake’ Specialty Care?

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Can A New Reimbursement Model Stabilize Rural Hospitals?

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Provider Participation In Medicare Bundled Rate Programs Drops With Greater Risk Requirements

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CMS To Review Presumptively Institutional HCBS Settings With Greater Scrutiny

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Helping ACOs Fill In The Complex Consumer Blanks

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National & State Behavioral Health Systems: Changes On The Horizon

Over the past two years, legislative changes have had a significant impact on the behavioral health industry landscape, particularly in …

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AMA & UnitedHealthcare Partner To Propose New ICD-10 Codes To Identify & Address Social Determinants Of Health

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CMS Finalizes Expanded Medicare Advantage Telehealth Benefit Policies

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The Path Forward In Serving The Dual Eligible Population

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Milwaukee County Contracts With Wellpath For Correctional Health Care, Develops Plan To Self-Operate By 2021

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Will Changes In Stark Law Speed Up Value-Based Reimbursement?

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Half Of ACOs Consider Exiting MSSP Over New Downside Risk Rules

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25% Of Health Care Provider Organizations Ready To Take On Risk-Based Contracts

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Medicare Advantage To Offer Supplemental Benefits For Social Determinants In 2020

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Why Clinical Guidelines Matter More With Risk-Based Contracting

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Social Determinant ROI—The Early Returns

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States Must Use Electronic Visit Verification By January 1, 2020 For Medicaid Personal Care Services

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Denver Supportive Housing Social Impact Bond Program Sees 85% Success Rate

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Kansas Medicaid To Launch OneCare Kansas Care Coordination Program

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Addiction Treatment Provider Organizations Sue Anthem Over Direct Consumer Reimbursement

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California Releases Proposed Medi-Cal Value-Based Payment Program Measures

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Centene To Buy WellCare For $17.3 Billion

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California Revises Medi-Cal Managed Care RFP Schedule; Moves Release Of All RFPs To 2020

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Experiencing Whiplash From Medicaid Work Requirements?

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UnitedHealthcare & OptumRX Require New Employer-Sponsored Plans To Pass Pharmaceutical Rebates Directly To Consumers

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Kaiser Permanente Invests $3 Million To Counter Homelessness

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Pennsylvania Launches Rural Hospital Global Budget Payment Model Pilot

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Per Physician Annual Hospital Revenue Value At $2.4 Million

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New Hampshire Medicaid Implements MCO Capitation Rates Linked To Performance

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Opioid-Related Emergency Department Visits By Older Adults Rose 217% Between 2006 & 2014

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Changing Medicaid Retroactive Eligibility & Charitable Care Policy

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Social Services ROI Essential To Social Determinants Wave

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New Hampshire Mandates That Medicaid MCOs Make Capitated Payments To CMHCs

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Louisiana Department Of Health Releases Plan To End Overuse Of Nursing Homes For People With Serious Mental Illness

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Managing The New Medicaid Work Requirements

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Judge Rules United Behavioral Health Medical Necessity Criteria More Restrictive Than Accepted Standards

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Health Insurers Denied 19% Of 2017 In-Network Claims

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13% Of Hospital CFOs Report Their Organizations Are Prepared For New Payment Models

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CMS To Resume Terminating Medicare Advantage Plans With Low Quality Star Ratings

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Tobacco Quit Line 7.9% More Effective When Medicaid Participants Received Financial Incentives

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UnitedHealthcare Expands Initiative To Use Diagnostic Codes To Capture Social Determinants Of Health

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Medicare Advantage Plans Allowed To Expand Access To Telehealth In 2020 Plan Year

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Louisiana Rebids Medicaid Managed Care Contracts

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Developing Case Rates? Better Find Your ‘Single Source Of Truth’

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Pennsylvania Sues UPMC Over Alleged Behavior Violating State’s Charity Laws

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New Hampshire Medicaid Selects Three Health Plans – AmeriHealth Caritas, New Hampshire Healthy Families & Well Sense

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Employer-Sponsored Health Insurance Spending Rose 4.2% To $5,641 Per Person In 2017

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Massachusetts Rebids One Care Plans For Duals Demonstration

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North Carolina Approves Rutherford County Switch To Partners LME/MCO

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CFO Version 3.0

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Your Organization Is Ready For VBR When …

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More Americans Are Underinsured In Terms Of Out-Of-Pocket Costs

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Department Of Veterans Affairs Seeks Colorado Assisted Living Residences With Psychiatric Step-Down Services

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ACA Health Insurance Coverage Expansion Did Not Cause Declines In Employer-Sponsored Insurance

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Do States Still Have Medicaid Behavioral Health Carve-Outs?

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Adapting Revenue Cycle Management For A VBR-Driven World

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Subsidized Health Insurance Marketplace Coverage Reduced Housing Insecurity By 25%

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Health Plan Contracting Opportunities – More Consistency Emerging

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California’s Ventura County Seeks Services For Early Detection, Intervention & Prevention Of Psychosis

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VBR @ Scale—Changes Required

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North Carolina Medicaid Selects Five Health Plans—One Regional & Four Statewide

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The Proportion Of Uninsured Americans Rose To 13.7% In 2018

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New York Medicaid Releases Revised 2019 Health & Recovery Plan VBP Quality Measure Set

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Your Organization Is Ready For VBR, Now What?

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70% Of Medicare Advantage Members Have A Chronic Disease; 44% Report No Health Plan Communication About Disease Management

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Alaska DHSS Issues RFP For Medication-Assisted Treatment Services In 6 Regions

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Missouri DHSS To Update Medicaid HCBS Level Of Care Criteria

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Medicaid Programs In 49 States & D.C. Reimburse For Telemental Health

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CMS Approves Arizona’s Medicaid Work & Community Engagement Demonstration Amendment

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Kaiser Permanente Invests In Affordable Housing Complex In Oakland, California For $5.2 Million As Part Of Initiative To Improve Community Health By Addressing Housing Insecurity

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Massachusetts Awards $3 Million In Funding For Social Determinants Partnership Grants

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Defining ‘Value’ Is Key To Provider/Health Plan Conversations

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Veterans Affairs Awards 3 Community Care Regional Contracts To OptumServe

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Alabama Medicaid Releases RFP For Regional Care Coordination

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New California Governor Orders Medi-Cal To Move Pharmacy To FFS Carve-Out Model

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From June To November 2018, 17,000 People Lost Arkansas Medicaid Benefits Over Failure To Meet Work Requirements

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Medicare Modifies Plans To Change Evaluation & Management Coding

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Most State Medicaid Programs Assign Preferred Status To All Opioid MAT Medications

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Veterans Affairs Awards Telephone Lifestyle Coaching Services Contract To Optum

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Watch Out For Elephants

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San Luis Obispo County Outsources Jail Medical & Mental Health Services To Wellpath

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CMS Guidance To State Medicaid Directors Recommends Leveraging Managed Care To Improve Services For Dual Eligibles

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Orange County Public Health System, CalOptima, Preparing To Launch Medicaid Health Homes Program In July 2019

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Kaiser Permanente Behavioral Health Workers Hold Five-Day Strike In Early December Over California Staffing Ratios

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Which State Had The Greatest Change In Medicaid Managed Care? What Is Coming In 2019?

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Health Plan Relationship Building Skills Key To VBR Success

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DOL Opinion Allows Pay For Home Health Aides To Vary Weekly As Long As Meeting Minimum Wage Standards

The U.S. Department of Labor (DOL) says that pay for home health aides can vary weekly, if the pay still …

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Medicare Advantage Members Less Likely To Fill Opioid Prescriptions Than Other Medicare Members

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PPACA Open Enrollment Through HealthCare.gov Website Falls 4% From 2017, Totaling 8.4 Million Enrollees

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CMS Re-Approves Kentucky HEALTH Medicaid Waiver To Impose Work Requirements Starting April 2019

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Mississippi Awards CHIP Contracts To Molina & UnitedHealthcare

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CMS ‘Pathways To Success’ Medicare ACO Overhaul Limits ACO Time Without Risk

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In 2020, States Can Apply Health Insurance Subsidies To Short-Term & Association Health Plans

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MyCare Ohio Duals Demo Cut Inpatient Utilization By 21% In Year One

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ACOs Saved Medicare $660 Million Over Four Years

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Health System/Insurer Combos Gain Steam—& More To Come With ACO Changes

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CMS Approves Florida Plan Adding Community Behavioral Health To The Low-Income Safety Net Pool

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U.S. National Health Spending Grew At A Rate Of 3.9% In 2017

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Developers Of Hospital At Home Model Awarded $2 Million To Increase Availability Of The Model

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Five Keys To ‘Partnering’ With Health Plans On Social Determinants

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Cigna Reports Integrated Benefits Have Average Annual Savings Of $193 Per Covered Life

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New Hampshire Proposes $24 Million Mental Health System Transformation With Greater Central Accountability & Oversight

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Washington State Managed FFS Duals Demonstration Reduced Medicare Spend 9.7% Over Three Years

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Humana’s Value-Based Contracts Support Physicians In Improving Member Health & Reducing Medical Costs

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Pennsylvania Medicaid Launches Southeast Region Enrollment In Community HealthChoices, Mandatory Managed Long-Term Services & Supports

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CMS Proposes Changing Oversight Regulations For Medicaid & CHIP Managed Care Plans

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Alaska Medicaid Selects Providence Family Medicine Center For Coordinated Care Demonstration Project

The Alaska Department of Health and Social Services (DHSS) launched its Medicaid coordinated care demonstration project on September 1, 2018 …

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CVS Health Completes Aetna Acquisition

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American Hospital Association Sues CMS Over Final Site-Neutral Hospital Outpatient Clinic Payment Rule

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The Enablers Of Competitive Advantage

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APA Recommends Five Principles For Employer Mental Health Benefit Plans

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Beacon Care Services Launched With Texas Walmart Mental Health Practice

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Maryland Seeks Next Public Behavioral Health System Administrative Services Organization

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Oregon Announces Next Medicaid Coordinated Care Organization Contracts Will Establish Service Areas Based On Counties

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Delaware Exploring Requirements For Comprehensive Behavioral Health Clinics

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Moving Out Of Your Comfort Zone: The VBR Technology Continuum

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The Changing Medicaid IMD Landscape & The Inpatient Behavioral Health Market

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75% Of Clinical Episodes Had Lower Costs In Medicare Bundled Payment Program

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Fitting Specialty Care Into ACOs

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Medicare To Update Home Health Value-Based Payment Model In 2020

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Per-Employee Health Care Costs Expected To Increase 4.4% In 2019

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Arkansas Medicaid To Launch Full-Risk Phase Of Medicaid Shared Savings Program In March 2019

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Accountable Care & The Complex Consumer

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Voters In Idaho, Nebraska & Utah Passed Ballot Measures To Expand Medicaid

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Federal Judge Sets Deadline For HHS To Clear Its Medicare Claims Appeal Backlog

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MACPAC Asks HHS To Pause Arkansas Medicaid Work Requirement Disenrollments

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Class Action Suit Alleges BCBS Of Massachusetts Improperly Denied Residential Mental Health Claims

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Virginia Implements Medicaid Expansion On November 1

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HHS To Launch New Mandatory Bundled Payment Models

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UnitedHealth Moves Half Of Reimbursement To Value-Based Models

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California Expanding Enrollment In Home & Community-Based Alternatives Program

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Medicare Beneficiaries Have Highest Quality & Lowest Cost In Hawaii, Alaska & Oregon

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New AMA CPT Codes To Report ABA To Health Plans Go Live January 1, 2019

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Iowa Raises Medicaid Managed Care Reimbursement By 7.5% For 2019

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CMS Approves North Carolina’s 1115 Medicaid Managed Care Waiver, Ending The Behavioral Health Carve-Out

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Provider Costs To Deliver Medicare Diabetes Prevention Program May Exceed Reimbursements

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Aetna To Sell Medicare Prescription Drug Business To WellCare

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New Health Care Alliance Launches Addiction Medical Home Model

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New Mexico To Transition To State-Based Health Insurance Exchange In 2021

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CCBHCs In 8 States Projected To Serve 380,000 Individuals In First Year

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Identifying Underlying Behavioral Health Issues For Complex Consumers Is Key To A Successful Population Health Management Strategy

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New Medicare Bundled Payment Model Has 1,299 Participating Provider Organizations

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Medicare Advantage Plans Overturned 75% Of Their Denials On Appeal

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Virginia Medicaid Submits Waiver For Work Requirements, Monthly Premiums

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Medicaid HCBS Review Finds Key Challenges In Workforce, Growing Consumer Complexity, & Funding Limitations

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Medicaid Spending Rose 2.6% To $592 Billion In 2017

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Horizon Blue Cross Blue Shield Of New Jersey Reports 4% Lower Cost For Commercial Members In Value-Based Arrangements

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HHS Awards More Than $1 Billion In Grants To Combat Opioid Crisis

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Follow Up Q&A – Tackling Behavioral Health Provider Shortages: Health Plan Strategies From Access To Engagement

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Webinar Summary – Tackling Behavioral Health Provider Shortages: Health Plan Strategies From Access To Engagement

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Tackling Behavioral Health Provider Shortages: Health Plan Strategies From Access To Engagement

Given the growing demand and shrinking availability of clinical professionals – both psychiatrists and allied health providers such as social workers …

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Medicare Imposes Reimbursement Penalties On More Than Half Of Hospitals

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15.75 Million People, 4.8% Of Population, Enrolled In Individual, Non-Group Health Plans In 2018

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OptumRx Acquires Genoa Healthcare

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Health Plans Using Innovation, Collaboration To Address Quality Measures

With nearly 90% of the U.S. population insured through managed care, there is fierce competition among health plans to demonstrate …

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Blue Cross & Blue Shield Of Minnesota Partners With Mayo Clinic To Advance Emerging Technology

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The Majority Of Non-Disabled Adult Medicaid Beneficiaries Potentially Meet Proposed Work Requirements

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Planning For The Changing Dual Eligible Market Opportunity

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Medicare Beneficiaries With Depression & Dementia Have Annual Total Costs Almost $3,000 Higher Than Average

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CMS Approves Prior Authorization & Step Therapy For Part B Drugs Under Medicare Advantage

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Humana Partners With Walgreens To Provide ‘Senior-Focused’ Primary Care In Missouri

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Solve The Problem, Gain A Partner

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Illinois Medicaid Selects Performance Measures For Integrated Health Home Program

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Wisconsin Medicaid Family Care Plan Pay-For-Performance First Payments In 2019

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ACOs Saved Medicare Nearly Twice As Much As CMS’ Estimates

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What Medicare’s Go Forward Plan Means For Your Strategy

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The ‘Melting’ Value Chain

This week, a recent conference was wrapped with an executive session, “Reinventing Health & Human Service Organizations For A Value-Based …

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New York City Raised $400 Million For Social Service-Focused Public-Private Partnerships

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Medicare Beneficiaries Report Fewer Problems Finding New Primary Care Physicians Than Those With Private Insurance

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24% Of Health Care Executives Say Integration Was The Top Driver For Mergers & Acquisitions

About 24% of health care executives say that integrating care across the continuum was the top driver of health care …

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Essentials Of Health Care Reimbursement: The Medicare & Medicaid Dual Eligible Population (Part 5 Of 5)

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Essentials Of Health Care Reimbursement: Medicare (Part 4 Of 5)

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Essentials Of Health Care Reimbursement: Medicaid (Part 3 Of 5)

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Essentials Of Health Care Reimbursement: Understanding Payer Perspectives & Approaches To Value- Based Purchasing (Part 2 Of 5)

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Essentials Of Health Care Reimbursement: The Evolution Of Health Insurance, Managed Care, & Value- Based Reimbursement (Part 1 Of 5)

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Medicare SNF Final Rule Increases Skilled Nursing Rates By $820 Million

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Michigan Awarded $10 Million Federal Grant To Integrate Primary & Behavioral Health Care By 2023

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CMS To Use More Rigorous Methodology For Calculating Medicaid Demonstration Budget Neutrality

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Ohio Awards CareSource & CareStar The Statewide Contracts For Home Care Waiver Case Management

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Developing A Value-Based Care Model With Peer Support—Two Case Studies

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Behavioral Health Medicaid Trends Show States’ Desire To Innovate, Shift Toward Integrated Financing Models

As a primary payer for behavioral health services, and the main payer serving the population with serious mental illness (SMI), …

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What Does ‘Center Of Excellence’ Mean Now?

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Medicare NextGen ACOs Generated $62 Million – About 1.1% – In Net Savings

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North Carolina Awards MAXIMUS $17 Million Contract For Medicaid Managed Care Enrollment Broker Services

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L.A. Care Health Plan Commits Up To $31 Million To Recruit Primary Care Physicians

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Medicare Advantage SNP Plans & SNP Enrollment Rose From 2017 To 2018

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Bishop Rehabilitation To Offer Staff Bonuses For Quality Measures

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CMS Advances Demonstration To Waive Clinician MIPS Requirements In Certain Medicare Advantage Plans

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Medicaid Penalties For States Over Electronic Visit Verification Delayed One Year

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Washington Regional Medicaid Integrated Managed Care Plans To Launch 2019 & 2020

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Preparing For Value-Based Reimbursement—Even Before The Contracts Are Signed

This week, I’ve heard a lot of conversations about value-based reimbursement (VBR) that have ranged from, “We don’t have the …

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Medicaid Leads Health Plans In Innovative Engagement Strategies, All Payers Show Room For Improvement

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How Does Your State Medicaid Program Stack-Up On Behavioral Health?

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Illinois Medicaid To Launch Integrated Health Home Program In October 2018

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Arkansas Medicaid Launches New Three-Tier Outpatient Behavioral Health Benefits

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