News Roundup

News Roundup: September 2018 Edition


CMS Proposed Rule Aims to Secure 2018 Risk Adjustment Payments

CMS has proposed a new rule that aims to resolve legal issues over the risk adjustment program’s payment methodology.  The rule would ensure that payers will receive appropriate risk adjustment payments for plan year 2018.




Wisconsin Wins Waiver for $200M Reinsurance Program

NCQA Announces New HEDIS Volume for Organizations Providing LTSS

The National Committee for Quality Assurance (NCQA) is introducing a new set of Healthcare Effectiveness and Data Information Set (HEDIS®) measures that assess whether organizations providing or coordinating Medicaid long-term services and supports (LTSS) are delivering high-quality, person-centered care. The HEDIS Technical Specifications for LTSS Organizations create performance standards, allow comparison of LTSS quality across programs, and establish national benchmarks.




Medicare to overhaul ACOs but critics fear less participation

In August, the Trump administration proposed an overhaul to the program, which was designed to encourage doctors and hospitals to work together to coordinate care by reducing unnecessary tests, procedures and hospitalizations. The move could dramatically scale back the number of participating health providers.




Healthcare Cybersecurity: How Providers Can Catch Up

While cybersecurity threats continue to increase in healthcare, the sheer volume of attacks only represents one part of the challenge. Cybercriminals are applying their creative skills to devise novel ways to breach defenses through increasingly targeted and sophisticated attacks.

For the healthcare industry, this shines a light on the larger transformation that’s occurring as organizations shift from a narrower, compliance- and HIPAA-focused approach to amore comprehensive and security-centric strategy.




We simplify the management of member programs by making it radically more efficient, and increasing value to healthcare organizations and their members

Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider