Amazon Makes Healthcare Buy As Its Plans Start to Take Shape
Since acquiring PillPack in 2018, Amazon has now bought Health Navigator in which they intend to offer to employees of Amazon. Many are certain Amazon will soon enter the healthcare market. Read the article below to find out more about this new acquisition that was made and learn some of Amazon’s goals.nnIn what is its first healthcare-related acquisition since spending $753 million in June 2018 to acquire PillPack, Amazon.com (NASDAQ: AMZN) inked a deal to buy Health Navigator, a start-up that provides digital triage tools and symptom lookup. The value of the deal was not disclosed.nnAmazon intends to offer Health Navigator services to its employees, shedding further light on where the e-commerce giant is heading in the healthcare market.nnIn late October, Amazon confirmed it purchased Health Navigator, telling CNBC it will fold it into Amazon Care, its new employee healthcare benefit that gives users access to virtual doctors and nurses. The idea is to leverage technology so employees can access healthcare providers in a convenient manner and at a lower cost. In addition to accessing virtual doctors and nurses, Amazon Care users (currently limited to employees in the Seattle area) can fill prescriptions through the e-commerce giant and choose between having them delivered or picked up at a participating pharmacy. By providing healthcare services to its employee base Amazon gets to test the waters and make fixes before the program is offered to a wider market. That serves to keep costs down and prevent it from making missteps on a large scale basis.nnAmazon hasn’t laid out all its plans in the healthcare market, but the acquisitions and initial products coming out of its healthcare joint venture with JPMorgan Chase (NYSE: JPM) and Berkshire Hathaway (NYSE: BRK-A)(NYSE: BRK-B) are starting to provide an outline for what it wants to do.nnCutting costs, increasing accessibility is Amazon’s goalsnAt the heart of Amazon’s aspirations is cutting the costs and challenges associated with healthcare, whether that means managing the price of medicine or increasing accessibility to doctors and nurses. In January 2018, it teamed up with JPMorgan Chase and Berkshire Hathaway to offer employees medical insurance. Now called Haven Healthcare, the group is gearing up to roll out its first products: two health insurance plans employees can begin to tap in 2020. The plans include free preventive care, no coinsurance or deductible, and $15 co-pays. This is the first product out of the secretive Haven Healthcare, but it showcases how Amazon and its partners are focused on lowering costs of medical care and insurance.nnThe acquisition of Health Navigator also helps Amazon achieve the goal of lowering the expenses associated with healthcare. Health Navigator’s technology is aimed at making it cheaper and easier to receive medical care. Microsoft is one of its many customers, providing the software giant with a clinical vocabulary and symptom checker technology to power a health bot. The bot uses layperson language to ask patients about their symptoms, ask relevant follow-up questions, and provide care options and potential causes. That eliminates the need for the sick employee to take time off from work, spend the money to get to the doctor and then wait in the office, for hours in some cases, to be seen. The bot can determine if it’s something as basic as a common cold and prescribe an over-the-counter remedy. A slew of telemedicine companies also uses Health Navigator’s technology.nnAmazon wants it alln
For some time now, Amazon has been laying the groundwork to enter the healthcare market, which is massive at $3.5 trillion and in need of some disruption. What better company to do it — Amazon has already changed retail and the way millions of people shop. While it’s been cagey about its intentions, many have speculated about what it will look like. Some think Amazon will disrupt the pharmacy market, dealing a direct blow to the likes of Walgreens and CVS Health. Others think it wants to own the telemedicine market, coming for the likes of Teladoc Health. But CB Insights, a market research company, thinks Amazon wants it all. It also thinks the retail giant has the size and reach to get just that.nnFor investors, These healthcare-related efforts may mean a new area of revenue growth at a time when Amazon is warning it could be slowing. For its fourth quarter, Amazon is projecting revenue of between $80 billion and $86.5 billion, which is lower than the $87.4 billion analysts were expecting. That comes even though the quarter includes the holiday shopping season. The healthcare market is also a huge opportunity to diversify further for the eCommerce giant.nn”Amazon’s potential foray into healthcare has already caused players in the space to scramble and reevaluate their core competencies. While Amazon has barely scratched healthcare’s surface, it has the potential to upend the space with its e-commerce expertise,” wrote CB Insights. “Without the need to make money in healthcare, the high margin and convoluted parts of the healthcare business are ripe for disruption.” All of which means there’s another bastion of growth Amazon can hang its head on if eCommerce growth levels off.nnOriginal article published on fool.com
Although the exact reason for denial was not given for this encounter we know this is considered investigational. Most insurances will not pay, it would have to be unlisted-23929. Click below for more information!nnnAs a general rule, benefits are payable under Blue Cross and Blue Shield of Alabama health plans only in cases of medical necessity and only if services or supplies are not investigational, provided the customer group contracts have such coverage.nnThe following Association Technology Evaluation Criteria must be met for a service/supply to be considered for coverage:n
State healthcare officials have until November 15 to put together a final “state option” proposal for the legislature. Many are hoping new changes will be implemented due to the rise in healthcare costs. Read the article below to find out more on what legislation may be coming and what the concerns are with this program.nnIn what is shaping up to be the major health care battle at the state Capitol this coming legislative session, Colorado hospitals, and insurance companies both have raised concerns about a proposal to dictate hospital prices for a slice of people with private health coverage.nnThe idea, unprecedented across the country in its precise details, is part of an ambitious plan to create what Colorado health officials are calling a “state option” insurance program. The program would aim to lower insurance costs for people who buy coverage on their own.nnIt would largely achieve those lower rates by limiting how much hospitals can charge people covered by state option plans, which would be sold and administered by private insurance companies. Both hospitals and insurance companies would likely be required to participate in the program, though state officials have been vague on whether they have the authority to compel participation or whether they would need to ask the legislature for that authority.nnEither way, the state-option proposal has found hospitals and insurance companies — frequent foes in the battle over health costs — sharing unusual common ground.nnThe hospitals’ opposition is fairly simple to understand. They don’t want the government telling them what their prices can be.nn“Fundamentally, we as an organization are opposed to rate-setting,” said Katherine Mulready, the chief strategy officer for the Colorado Hospital Association. She said the proposal “misses the mark” and that its architects should return to the drawing board.nnBut the Colorado Association of Health Plans, the organization that represents health insurance companies in the state, also has raised concerns about the proposal, echoing two of the hospitals’ objections, though it supports the push to bring down the underlying costs of health care.nnFirst, insurers and hospitals say the program could make health insurance provided by employers more expensive. Why? Because hospitals might make up for the money they’re not getting for patients with state-option coverage by charging people with employer-sponsored coverage more.nnThe hospital association says this “cost shift” could be $1.5 billion over five years. (State officials argue that hospitals have already — and needlessly — shifted billions in costs onto the privately insured even as they have reaped record profits.)nn
“This one-size-fits-all approach would have the effect of increasing costs for employers,” Amanda Massey, the executive director of the Colorado Association of Health Plans, wrote in an emailed statement.nnSecond, both hospitals and insurers say patients could suffer by not having access to doctors. Hospitals warn that cuts to their bottom lines could lead to cuts in staffing. Insurers say private doctors’ offices, which wouldn’t be forced to accept the coverage, might choose not to see patients with state-option insurance.nn“The result will be reduced patient access to adequate networks and quality care,” Massey said.nnThe goal behind the state option — sometimes called the public option, even though the government wouldn’t administer the plans in Colorado’s proposal — is to ensure more choices and better prices for people who don’t get health coverage through their jobs. That group currently makes up about 7% of Coloradans.nnGov. Jared Polis has frequently touted the state option and reducing hospital prices as part of his “road map” for saving Coloradans money on health care.nnThe two-state officials putting the plan together — Kim Bimestefer, the executive director of the state’s Department of Health Care Policy and Financing, and Michael Conway, Colorado’s insurance commissioner — have in recent weeks held meetings across the state seeking input on their plan. They have also received more than 200 written comments.nnThe final proposal is due to the legislature by Nov. 15.nnOriginal 
Welter Healthcare Partners is providing new information regarding E/M changes in 2020. Read the updates below on what is coming next year for coding, along with changes to PCM and CCM.nnWhat’s New for 2020nnThe CY 2020 PFS conversion factor will increase to $36.0896, up to $0.05 from CY 2019. nnThree new Telehealth Service codes added to the Medicare-covered services list:n
Physician Assistants Make Ground n
CMS’ Innovation Center will delay the start of a new payment model called Primary Care First by a year, according to timeline updates on the model’s information page.nnPrimary Care First, announced in April, was slated to begin in January 2020. Now, it will begin in January 2021. The voluntary model is a set of five-year payment options that tie payment to value and quality metrics in hopes of reducing healthcare costs. Options under the Primary Care First model were set to be offered in 26 regions for a 2020 start date.nnPractices that wish to apply to the model to begin participation in January 2021 could begin applying Oct. 24, 2019. Applications close Jan. 22, 2020.nnRead more about the model 
2019 ICD‐10‐CM updates went into effect on October 1st. These changes will impact encounters for dates of service October 1, 2019 through September 30, 2020. It is imperative that your organization has up‐to‐date coding resources and a keen understanding of the changes that will impact your reimbursement! The new updates can also influence your organization’s MIPS/MACRA quality reporting scores.nnThis year’s ICD‐10‐CM updates include 325 code changes (273 new codes, 15 validity changes, 7 deleted codes, and 30 code revisions).nnHere are notable highlights of the 2020 updates: n
Reactive Hypoglycemia (ICD-10 code E16.1) or a sugar crash can do more than just make you tired. It can lead to feeling of hunger, irritability, anxiousness, headaches or even difficulty concentrating. With Halloween just around the corner, it seems there is a candy dish stocked full of treats everywhere you turn. It’s not just about the effects, it’s also about prevention. Here are a few fun reads on how to keep your blood sugar levels in check during the upcoming holidays.nnSugar Crash Effects and How to fix Them:nnThe sugar high is all fun and games until the resulting sugar crash affects the quality of your day. The term refers to the sudden drop in energy levels after consuming a large amount of carbohydrates. This can include pastas and pizza but is usually more common after eating simple carbohydrates, also known as simple sugars, such as desserts.nnA sugar crash often causes many undesired symptoms that can disrupt productivity and energy levels throughout the day.nnSanford Health, suggests balance, moderation and consistency are the most effective ways to avoid these crashes. Herrick shares her knowledge on sugar crashes, how to avoid them and what to do if you get one.nn
With the development of the health insurance exchange, prices for coverage for those in Colorado are going to drop. This will give families an average of $600-$700, back in their pockets. Read the article below to see when and how this new change will take place.nnFor the first time since Colorado opened its health insurance exchange, the prices people pay for coverage will drop — by a statewide average of 20.2%.nnAnd for families in western Colorado — who face some of the highest health insurance premiums in the nation — the savings could total more than $10,000 per year, according to final numbers for 2020 released by the Colorado Division of Insurance.nn“Just imagine: What could you do with that in your life?” Gov. Jared Polis said. “What could your family do with an extra $600 to $700 a month?”nnThe biggest reason for the price drop — which was higher than projected — is reinsurance, a bipartisan program created by state lawmakers during the 2019 session.nnThe program is basically a pool of $260 million in state and federal money that Colorado plans to use in 2020 to help cover some of the most expensive medical bills from the 250,000 people who buy plans through the state’s individual market. In exchange for the help, insurance companies lowered their monthly premiums.nn“It’s the same plans,” Polis said. “It’s just lower prices.”nnThat means problems such as people not using their insurance because of a high deductible will still exist, but the governor is hopeful that the lower monthly costs will lower the state’s uninsured rate.nn“We think this prices it into the market for many more families,” Polis said, though he didn’t commit to a specific number.nnDetails on the plan options can be found at connectforhealthco.com, with 2020 enrollment beginning Nov. 1.nnThe state lawmakers behind the reinsurance bill told The Denver Post they’re not done working on health care costs, either.nn“We have to attack the basic underlying costs,” said Sen. Bob Rankin, R-Carbondale. “This bill does not address why health care costs so much.”nnHis counterpart in the Colorado House, Rep. Julie McCluskie, D-Dillon, is optimistic about programs such as a public option and something called an alliance model that’s just starting in Summit County.nnPeak Health Alliance is a group of big employers that banded together to negotiate lower prices from their local providers and used those prices to get better rates from health insurance companies. When combined with the reinsurance reduction, McCluskie said, alliance members will see their premiums cut up to 50% next year.nnThe governor hopes that by 2021, many more of these alliances will exist, including a statewide group with state, county and city public employees.nn“There’s absolutely significant upside to an alliance model everywhere in our state, both the regional models and statewide,” Polis said. “We’re aggressively pursuing those opportunities to save people money.”nnOriginal 
For 2019, the U.S. is projected to have spent $3.82 trillion on healthcare. No other country in the world spends this much on healthcare. Below we assess the data and see what the research is saying regarding healthcare prices in the United States. Continue reading to find out more on this wasteful spending.nnnWaste accounts for about 25% of U.S. healthcare spending, new research indicates.nnNo other country spends more on healthcare than the United States, with the gross domestic product share of healthcare spending estimated at nearly 18% and rising. Earlier research on U.S. healthcare spending has estimated that waste accounts for about 30% of the spending total.nnReducing wasteful spending is a promising avenue to curb annual increases in the country’s healthcare spending, according to the co-authors of the new research, which was published today in the Journal of the American Medical Association. “Implementation of effective measures to eliminate waste represents an opportunity reduce the continued increases in U.S. healthcare expenditures,” the researchers wrote.nnThe researchers examined data from 54 published reports. They tallied waste in six categories identified in 2010 by the Institute of medicine (IOM): failure of care delivery, failure of care coordination, over-treatment or low-value care, pricing failure, fraud and abuse, and administrative complexity. Pricing failure includes medication pricing, payer-based health services pricing, and laboratory-based and ambulatory pricing.nnIn 2019, total U.S. healthcare spending is projected at $3.82 trillion.nnThe JAMA researchers generated several key data points:nnAnnual wasteful spending on healthcare is estimated from $760 billion to $935 billion.nnInterventions to reduce waste in the six IOM categories would result in annual savings from $191 billion to $282 billion.n
Assessing the datannThe highest amount of wasteful spending was associated with the administrative complexity category. The development and adoption of value-based payment models has the most potential to impact this category of wasteful spending, the researchers wrote.nn”In value-based models, in particular those in which clinicians take on financial risk for the total cost of care of the populations they serve, many of the administrative tools used by payers to reduce waste (such as prior authorization) can be discontinued or delegated to the clinicians, reducing complexity for clinicians and aligning incentives for them to reduce waste and improve value in their clinical decision-making.”nnReducing spending the second-highest wasteful category—pricing failure—poses daunting challenges because of the rising prices of pharmaceuticals, the researchers wrote. “New high-cost specialty drugs, which will soon exceed 50% of pharmaceutical spending, are raising new questions about how to maintain affordability. This topic has thus received considerable attention from policy makers, and numerous proposals are currently under consideration.”nnThe researchers say strategies to ease cost pressure in pharmaceuticals include increasing market competition, importing drugs from countries with lower medication prices, and reforming price transparency.nnThe big picture viewnnAn editorial accompanying the new research says the findings are a significant contribution to the ongoing effort to rein in the country’s healthcare spending.nn”At a time when the United States is once again mired in a great debate about the future of its healthcare system, the data reported in the article … should become part of the national discussion. It would be nearly impossible for all waste to be eliminated in any healthcare system, just as it is impossible to know the true cost of any change in the delivery and financing of healthcare without understanding possible savings, and recognizing that there is complexity in knowing the savings,” the editorial says.nnConcentrating on wasteful spending is crucial, the editorial says. “While no single solution will solve the continuous increases in U.S. healthcare spending, identifying, reducing, and eliminating waste are important and appropriate places to start.”nnOriginal 
Do you have a complicated surgery case that needs help with coding? Welter Healthcare Partners would love to help! Please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected.nn
Private payers have begun to embrace the possibilities of value-based care. Many are not including value-based incentives, which allows the patient to save money. Read the article below to find out more on how this value-based pay system has a future.nnValue-based care has created a conundrum: pretty much everyone in healthcare likes the idea of paying for outcomes, but no one is sure how to fairly implement it.nnThe Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) introduced a new world of value-based care to many physicians and was a major step away from fee-for-service. Gone was the Sustainable Growth Rate, replaced with a program that was supposed to drive costs down by reimbursing for quality patient outcomes.nn“Congress had revised the Sustainable Growth Rate many times over the past 20 years, and everyone was fatigued by it,” says Larry Kocot, JD, head of KPMG’s Center for Healthcare Regulatory Insight and a former CMS official. “Physicians were willing to take something new to not have to go through that exercise again.”nnDoctors suddenly found themselves trying to navigate new MACRA acronyms like MIPS and APMs to figure out where they fit as Medicare started moving away from fee-for-service in a bid to contain costs and improve care quality.nnAt the same time, more private payers began to embrace the possibilities of value-based care, working incentives into contracts that rewarded physicians who could use data to show patients were healthier and avoiding unnecessary hospitalizations. But fee-for-service contracts are still the norm.nnMeanwhile, physician organizations began to push back against MACRA as their members rebelled against the cost of the technology needed to comply and the complexity of the reporting measures. CMS responded by exempting hundreds of thousands of physicians, causing some to question the value of the program and if it was improving patient care or saving money.nnWith MACRA now a few years old, experts are looking at how it might be reformed, and what value-based care might look like in the future.nnMACRA: a misstep toward valuennMACRA has not worked to the extent policymakers hoped, says Frederick Southwick, MD, a practicing internist and healthcare researcher at University of Florida Health.nn“The goal was to drive a significant wedge in payments between those willing to step up and use Alternative Payment Models and those who remained on the sidelines,” says Southwick. “We’ve seen physicians take a shot on some things they might not have done in the past to get a bonus payment, but they have not reached the point where they’ll feel pain if they don’t. The MIPS side of this was supposed to be painful to physicians, but it’s mostly a big nothing-burger because so many have been excluded.”nnAs a result, there isn’t much money in the budget-neutral program to move from the poor performers to the good performers, eliminating much of the incentive. According to CMS, in the 2019 payment year (based on 2017 performance data), 71 percent of MIPS participants received a positive payment adjustment with a bonus for performance, 22 percent received a positive payment without the bonus, 2 percent didn’t receive a positive or negative adjustment and only 5 percent received a negative adjustment.nn“The more physicians that are excluded, the harder it is for those in the program to win,” says Kocot, noting that the maximum payment adjustment anyone received was 1.88 percent, while the maximum penalty was 4 percent.nnMIPS was intended to be the incentive to get physicians into some form of risk-sharing APM, but MIPS isn’t accomplishing that and the 5 percent positive payment adjustment APM participants can earn expires in 2024.nn“What is the incentive to get people into MIPS and into an APM as we move further down the line?” asks Kocot.nnMIPS also faces the problem of how to define “quality”.nn“Healthcare is so complicated, that’s hard to do,” says Chris Dawe, vice president of Evolent Health, which helps providers and health plans transition to value-based care, and a former health policy adviser in the Obama administration. “The best way would be through knowledgeable consumers who would ask questions about the cost-benefit and is it worth it to their health and wellbeing. The problem with that is patients don’t go to medical school.”nnEven if patients were making decisions, they would still have difficulty determining who the best doctor is because of the lack of objective information, and in many regions, the absence of choices in hospitals or physicians.nnMIPS participants have scored well on quality measures, but many doctors argue that the measures don’t have any connection to real-world medicine. The time spent reporting on quality has also proven burdensome for many, who say it takes more time away from patients and redirects money toward IT projects.nn“All of these initiatives require a tremendous amount of data accumulation and manipulation,” says William Spratt, Jr., JD, partner in the healthcare practice of Akerman LLP, in Miami. “There are so many different metrics and different ways to modify and manipulate the data in order to determine whether they are meeting various criteria or not, it’s challenging.”nnFor physicians without the support of a larger organization, the challenges are even greater. “It’s introduced an awful lot of complexity into the practice of medicine,” says Spratt. “It’s hard for them to change their practice administration in order to measure and hit those targets.”nAn unintended consequence of that difficulty has been an increase in physicians affiliating with health systems and hospitals so as to shift the reporting burden.nn“It’s probably strengthened the hand of the health systems and offers them another carrot for the primary care physician,” says Southwick. “They aren’t necessarily acquiring them, but at least getting them in the network. I don’t think this is what Congress had in mind.”nnHe adds that a lack of vision has hampered the success of programs like MACRA, because no one understands the end goal.nn“I’ve never heard anyone from the White House articulate what this should look like in five to 10 years,” says Southwick. “Doing so would help the market work toward that and be ready for this new world. Instead, we are just going from one program to the next. It would be a benefit if CMS would say what this would look like at the end.”nnThe future of value-based carennStill, while MACRA may not be working out as envisioned, many experts say it is an important first step toward implementing value-based care. “MACRA started the conversation,” says Spratt. “It has started moving medicine toward more value-based payment and away from the traditional fee-for-service model, which I think most policymakers realize is a good approach.”nnDespite the struggles of MACRA, experts say physicians should understand that their revenue from fee-for-service will continue to decline.n“From what I have seen, the transition to value-based care is a given,” says Andrei Gonzalez, MD, assistant vice president at Change Healthcare, a company that helps payers and providers move to value-based care. “It’s more about what are the right models and how are we going to get there?”nnWith CMS rolling out its new Primary Care First initiative, Gonzalez says their intent is clear. “They want to blow up fee-for-service, and the primary care initiative is a big step in that direction.”nnThe initiative encompasses a variety of models. It is expected to cover about 25 percent of Medicare beneficiaries, and include removing coding requirements for primary care physicians by paying a monthly per-patient fee or a flat per-visit fee.nnPrivate payers are creating similar programs, and large employers are asking commercial plans to use some of CMS’s strategies to save money. As a result, more private payer contracts are including value-based incentives.nn“I do think the private sector push will make it easier as clinicians see value-based care as the new normal and are subject to quality and cost targets that are not fee-for-service,” says Kocot. “That’s absolutely essential to the transition.”nn
Both public and private payers realize they need multiple plans in order to succeed, says Gonzalez.nn“Our research has shown that different models work for different conditions and different regions,” he says. In areas where there is a lot of consolidation among providers and health systems, ACOs or full capitation—where physicians receive a flat monthly fee for each patient— will make the most sense. In less-consolidated areas, models like the Patient-Centered Medical Home may be the primary option.nnWhile capitation was tried in the early days of HMOs, Gonzalez says the industry is a lot savvier on how to do it now. Payers and providers both are going in with more caution. Physicians are managing a patient population, but understand they will need to meet quality and cost metrics, although not the full risk burden like in the past.nnSpratt says smaller practices may need to affiliate with a hospital or health system, because payers see value in partnering with organizations with large numbers of physicians, ancillary services and even urgent care centers, because it gives them more control over the insured and better management of the premium dollar.nn“At the end of the day, it’s all about integration and the coordination of care,” says Spratt.nnCare coordination includes practices being more proactive with helping patients to lead healthier lifestyles and not just waiting for the patients to reach out to them.nn“A lot of practices already have this mentality, but it creates the need for a different set of aptitudes within the practice,” says Gonzalez. This could include, for example, having a nurse monitor COPD patients and ensuring they come in for regular visits.nnFuture value-based care models will also have a greater focus on the social determinants of health.nn“One thing value-based care leads us toward is a sort of untethering of the physician from historical medical tools and allowing them to think more holistically,” says Spratt.nn“Physicians will need to start figuring out how to help patients manage their conditions, how to navigate the health system and manage the social determinants of health,” says Gonzalez. “It’s not as big of a change as it seems, because not every patient requires assistance, but practices need the ability to identify who needs extra help.”nnThe role of the primary care doctornnNo matter what models emerge, experts see the primary care physician as the team leader. Dawe says the patient-centered medical home, with a primary care physician working with one or two NPs or PAs, a nursing staff and someone that goes into the community to help educate patients on how to manage their diseases is a good model, as is an ACO.nn“I think the basic structures for a good model are already in place,” says Southwick. “You can go a long way to creating a new payment ecosystem just on the basis of a primary-care based model, which is basically an ACO.” If that is combined with bundled payments for specialists, Southwick says, those two models work very nicely together.nn“The primary care physician has to be central to any aligned payment and care coordination working with the patient from start to finish,” says Kocot.nnBut primary care doctors should also expect to take on more risk-sharing with payers, whether it’s through an ACO or some other payment model. He warns the transition must come with assistance.nn“There’s a lot happening that primary care physicians have to process on a daily basis,” he says. “The transition needs to be moderated so we don’t lose them in the process. The CMS burden reduction program is very positive, but we have to strike the right balance of incentives and push, and I don’t know that we have yet.”nnExperts say that value-based care will continue to become more prominent in contracts, even though programs like MIPS might be revised or replaced in the future. But one thing is for sure: there is no hiding from it.nn“The move to value is alive and well,” says Kocot.nnOriginal 
Health Care is a revolving door of changes and unlike most professions, some of our biggest changes happen on a yearly basis. The plus side to this is that we can anticipate most these changes and start preparing for them. How can you make the most out of these changes and make sure you’re ready when they happen? The quick answer is to be prepared, but sometimes that is easier said than done.nnThe important thing to remember, is that these changes are typically finalized months in advance. You start to see industry buzz about proposed changes and this is the time so start paying attention. As we continue to move forward, there are great resources out there to take advantage of and not all of them come with a price tag. Podcasts have come a long way and are not just This American Life, and you don’t need a smart phone to access them. Often times you will end up finding a voice that you can really connect with. Best part is that we are not talking about 2+ hour long webinars. Often times these are quick, 30 minute conversations about key take a ways. With a 30 minute run time they can be great items to listen to while driving, on lunch breaks or even while doing those mindless household tasks.nnOne great weekly option is Talk Ten Tuesday.
The Denver provider market is huge, and it is at a tipping point currently with rates and increases due to the economic development in the area. Some of these providers are merging with others, but there are strict regulations to this. Read the article below to find out more about this “tipping point”.nnHealth systems and physician groups have dominated the Denver healthcare market in recent years, but a new study indicates that employer-purchasers and health plans are poised to disrupt that dynamic.nnSupported by existing legislation, activism from local businesses, and the efforts of Gov. Jared Polis, the Denver market is at a ‘tipping point,’ according to a Catalyst for Payment Reform (CPR) and the Colorado Business Group on Health (CBGH) report released Thursday morning.nnThe study specifically referenced the RAND report from May which found that payers were paying rates to providers well above Medicare levels, noting that employers have an opportunity to pressure insurers to engage providers in contract arrangements that better align with care rendered.nnResearchers believe that payment reform is achievable in Denver, suggesting six policy recommendations to business groups, lawmakers, and insurers, including the expansion of price transparency measures and promotion of benchmarking prices relative to Medicare.nnCorralling healthcare prices has been a primary issue in Colorado this year, with the state most recently pursuing a reinsurance program that Polis expects to lower premiums by 18%.nnThe study found that four major health systems, HCA Holdings, Centura Health, UC Health, and SCL Health, accounted for 85% of patient admissions in 2017. On the Herfindahl-Hirschman Index, this level is considered “moderately concentrated” but the report highlights that it also means the market is “concentrated enough to stifle price competition.”nnWhile providers have concentrated in the market through continuous merger activity, the study found that insurers are governed by strict regulations. The result has been Coloradans facing 13% higher prices compared to the national average and 5% high utilization rates.nnTwo of the recommendations offered by the study were to align two-sided risk arrangements with Medicaid and the Polis-Primavera “Roadmap to Affordability,” the governor’s strategic initiative to make care more affordable, as well as to implement benefit designs to “encourage consumers seek higher value care.” The study also urges that employer-purchases to pursue value-oriented programs that hold providers accountable to the listed targets.nnHowever, in an interview with HealthLeaders earlier this year, Centura Health CEO Peter Banko said the system was going to “pause on the mad rush” to value-based care models, citing the direction the market was taking on the issue.nn
As highlighted in the RAND report, CPR and CBGH believe that building on purchaser momentum through a statewide purchase cooperative can be an effective method at changing the market dynamics in Denver.nnSimilar to the Employers’ Forum of Indiana, an employer-led healthcare coalition which collaborated on the RAND report, the Peak Health Alliance, a Summit County-based purchaser cooperative, has sought to combat rising healthcare prices in the Denver area. The report states that Peak Health, which represents 6,000 covered lives, has already negotiated a “very aggressive” reduction in rates with Centura.nnBob Smith, MBA, executive director of CBGH, said that the report gives employer-purchasers “the tools to make changes” to the Denver healthcare market and stem the tide of rising prices.nn”Healthcare costs, primarily driven by high prices and seemingly unwarranted increases, are edging out salary growth and economic development,” Smith said in a statement. “These trends are taking a toll on every employer from school districts to manufacturers and are simply not sustainable.”nnSmith urged lawmakers to act on the report’s suggested reforms but also said that employers now have “the responsibility to act.”nnOriginal 
It’s hard to believe that we are already in the last full week of September which means another holiday season is upon us. With all the upcoming social events, personal and professional, it is a perfect time for you to start thinking about making some new connections. Personally, the thought of networking sparks both fear and anxiety, which inevitably leads to excuses about why I am unable to attend. Luckily, as it turns out, I am not alone and there are plenty of professionals who also avoid these situations. Bad news is that this could be hurting your career and keeping you from achieving your goals. Harvard Business Review has an article from 2016 with some great tips for all my fellow introverts, read it below to find out more.nn“I hate networking.” We hear this all the time from executives, other professionals, and MBA students. They tell us that networking makes them feel uncomfortable and phony—even dirty. Although some people have a natural passion for it—namely, the extroverts who love and thrive on social interaction—many understandably see it as brown-nosing, exploitative, and inauthentic.nnBut in today’s world, networking is a necessity. A mountain of research shows that professional networks lead to more job and business opportunities, broader and deeper knowledge, improved capacity to innovate, faster advancement, and greater status and authority. Building and nurturing professional relationships also improves the quality of work and increases job satisfaction.nnWhen we studied 165 lawyers at a large North American law firm, for example, we found that their success depended on their ability to network effectively both internally (to get themselves assigned to choice clients) and externally (to bring business into the firm). Those who regarded these activities as distasteful and avoided them had fewer billable hours than their peers.nnFortunately, our research shows that an aversion to networking can be overcome. We’ve identified four strategies to help people change their mindset.nn1. Focus on LearningnMost people have a dominant motivational focus—what psychologists refer to as either a “promotion” or a “prevention” mindset. Those in the former category think primarily about the growth, advancement, and accomplishments that networking can bring them, while those in the latter see it as something they are obligated to take part in for professional reasons.nnIn laboratory experiments we conducted in the United States and Italy with college students and working adults, and in an additional sample of 174 lawyers at the firm we studied, we documented the effects of both types of thinking. Promotion-focused people networked because they wanted to and approached the activity with excitement, curiosity, and an open mind about all the possibilities that might unfold. Prevention-focused people saw networking as a necessary evil and felt inauthentic while engaged in it, so they did it less often and, as a result, under performed in aspects of their jobs.nnThankfully, as Stanford University’s Carol Dweck has documented in her research, it’s possible to shift your mindset from prevention to promotion, so that you see networking as an opportunity for discovery and learning rather than a chore.nnConsider a work-related social function you feel obliged to attend. You can tell yourself, “I hate these kinds of events. I’m going to have to put on a show and schmooze and pretend to like it.” Or you can tell yourself, “Who knows—it could be interesting. Sometimes when you least expect it, you have a conversation that brings up new ideas and leads to new experiences and opportunities.”nnIf you are an introvert, you can’t simply will yourself to be extroverted, of course. But everyone can choose which motivational focus to bring to networking. Concentrate on the positives—how it’s going to help you boost the knowledge and skills that are needed in your job—and the activity will begin to seem much more worthwhile.nn2. Identify Common InterestsnThe next step in making networking more palatable is to think about how your interests and goals align with those of people you meet and how that can help you forge meaningful working relationships. Northwestern University’s Brian Uzzi calls this the shared activities principle. “Potent networks are not forged through casual interactions but through relatively high-stakes activities that connect you with diverse others,” he explains. (See “How to Build Your Network,” HBR, December 2005.) Numerous studies in social psychology have demonstrated that people establish the most collaborative and longest-lasting connections when they work together on tasks that require one another’s contributions. Indeed, research that one of us (Tiziana) conducted with INSEAD’s Miguel Sousa Lobo showed that this “task interdependence” can be one of the biggest sources of positive energy in professional relationships.nnConsider the approach taken by Claude Grunitzky, a serial entrepreneur in the media industries, when he set out to meet Jefferson Hack, founder of the underground British style and music magazine Dazed & Confused. As described in a Harvard Business School case study by Julie Battilana, Lakshmi Ramarajan, and James Weber, Grunitzky—then 22 and preparing to found his first business, an urban hip-hop magazine in London—learned everything he could about Hack.nn“I read every one of his magazines, noticed what he was writing about and what kinds of bands he reviewed,” Grunitzky recalled. “I did so much of this I felt I could almost understand his personality before we met.” Armed with that knowledge and convinced that he and Hack had similar worldviews and aspirations, Grunitzky felt much more comfortable approaching the industry elder.nnWhen your networking is driven by substantive, shared interests you’ve identified through serious research, it will feel more authentic and meaningful and is more likely to lead to relationships that have those qualities too.nn
3. Think Broadly About What You Can GivenEven when you do not share an interest with someone, you can probably find something valuable to offer by thinking beyond the obvious. Of course, this isn’t always easy. We’ve found that people who feel powerless—because they are junior in their organizations, because they belong to a minority, or for other reasons—often believe they have too little to give and are therefore the least likely to engage in networking, even though they’re the ones who will probably derive the most benefit from it.nnThis problem was highlighted in two studies we conducted at the law firm mentioned above, which involved different groups of lawyers at different points in time. We found that senior people were typically much more comfortable networking than junior people were because of their greater power in the organization. This makes sense. When people believe they have a lot to offer others, such as wise advice, mentor-ship, access, and resources, networking feels easier and less selfish.nnA controlled experiment confirmed this finding: People in whom we induced feelings of power found networking less repulsive and were more willing to do it than people assigned to a condition that made them feel powerless.nnHowever, even those with lower rank and less power almost certainly have more to offer than they realize. In their book Influence Without Authority, Allan Cohen and David Bradford note that most people tend to think too narrowly about the resources they have that others might value. They focus on tangible, task-related things such as money, social connections, technical support, and information, while ignoring less obvious assets such as gratitude, recognition, and enhanced reputation. For instance, although mentors typically like helping others, they tend to enjoy it all the more when they are thanked for their assistance.nnThe more heartfelt the expression of gratitude, the greater its value to the recipient. One young professional we know told us that when she turned 30, she wrote to the 30 people she felt had contributed the most to her professional growth, thanking them and describing the specific ways each had helped her. The recipients no doubt appreciated the personalized update and acknowledgement.nnWhen gratitude is expressed publicly, it can also enhance an adviser’s reputation in the workplace. Think of the effect you have when you sing your boss’s praises to your colleagues and superiors, outlining all the ways you’ve progressed under his or her tutelage.nnPeople also appreciate those who understand their values and identities and make them feel included. Juan, an Argentinian executive based in the Toronto office of a Canadian property management company, told us about Hendrik, a junior hire from Germany who rallied everyone in the office to join a series of soccer games that he single-handedly organized. His fellow expats—and there were many, because the company’s workforce was internationally diverse—finally had something fun to do with their colleagues, and Hendrik’s status and connections immediately shot up. In spite of his low-power position, he had brought something new to the table.nnYou might also have unique insights or knowledge that could be useful to those with whom you’re networking. For example, junior people are often better informed than their senior colleagues about generational trends and new markets and technologies. Grunitzky is a prime example. “I knew I could bring something to [Jefferson Hack], which was expertise in hip-hop,” he said. The relationship ended up being a two-way street.nnWhen you think more about what you can give to others than what you can get from them, networking will seem less self-promotional and more selfless—and therefore more worthy of your time.nn4. Find a Higher PurposenAnother factor that affects people’s interest in and effectiveness at networking is the primary purpose they have in mind when they do it. In the law firm we studied, we found that attorneys who focused on the collective benefits of making connections (“support my firm” and “help my clients”) rather than on personal ones (“support or help my career”) felt more authentic and less dirty while networking, were more likely to network, and had more billable hours as a result.nnAny work activity becomes more attractive when it’s linked to a higher goal. So frame your networking in those terms. We’ve seen this approach help female executives overcome their discomfort about pursuing relationships with journalists and publicists. When we remind them that women’s voices are underrepresented in business and that the media attention that would result from their building stronger networks might help counter gender bias, their deep-seated reluctance often subsides.nnAndrea Stairs, managing director of eBay Canada, had just such a change in perspective. “I had to get over the feeling that it would be self-centered and unseemly to put myself out there in the media,” she told us. “I realized that my visibility is actually good for my company and for the image of women in the business world in general. Seeing my media presence as a way to support my colleagues and other professional women freed me to take action and embrace connections I didn’t formerly cultivate.”nnMany if not most of us are ambivalent about networking. We know that it’s critical to our professional success, yet we find it taxing and often distasteful. These strategies can help you overcome your aversion. By shifting to a promotion mindset, identifying and exploring shared interests, expanding your view of what you have to offer, and motivating yourself with a higher purpose, you’ll become more excited about and effective at building relationships that bear fruit for everyone.nnOriginal 
HB 18-1282 requires newly enrolling and currently enrolled organization health care providers (not individuals) to obtain and use a unique National Provider Identifier (NPI) for each service location and provider type enrolled in the Colorado interChange.nnThe Department of Health Care Policy & Financing (the Department) is responsible for implementing Section 3 of HB 18-1282, which added 25.5-4-419 to the Colorado Revised Statutes. The Department’s proposed draft regulations are related to Section 3 of HB 18-1282 and resulting statutes. Please note that Section 2 of HB 18-1282 is not within the Department’s authority and adds language to the statutes for the Department of Public Health and Environment. The Department’s proposed draft regulations are not related to Section 2 of HB 18-1282, and can only answer questions related to our proposed draft regulations implementing Section 3 of HB 18-1282.nn
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Colorado emergency charges vary in price across the state, which prevents patients from seeking care due to the price of their treatments. The article below gives more insight to the unusual healthcare prices that many people are looking to fix. Read below to find out more on this dive.nnDive Brief:n
Banner Health is planning to acquire the North Colorado Medical Center which has been in operation since 1995. This new plan would bring great healthcare opportunities to the area. Read below to find out more about the deal.nnPhoenix-based Banner Health plans to acquire North Colorado Medical Center in Greeley, which it has operated since 1995.nnUnder the proposed deal, which requires regulatory approval, Banner would pay $328.4 million to acquire the land, assets and equipment associated with the hospital from Weld County (Colo.).nnA large portion of the proceeds from the transaction will be used to pay off $209.5 million in existing hospital debt, according to a press release from Weld County.nnOriginal