Medicaid managed care

Common Ground Healthcare cooperative pursues affiliation with CareSource

Retrieved on: 
Tuesday, February 27, 2024
Letter, Investment, Transport, Federation, Medicare, Patient, Fortune (magazine), Medicaid managed care, Heart, Medicaid, CareSource, Food security, Marketplace, Health insurance

CareSource was founded in Dayton, Ohio in 1989 with a mission to transform health care for members in government-sponsored health care programs.

Key Points: 
  • CareSource was founded in Dayton, Ohio in 1989 with a mission to transform health care for members in government-sponsored health care programs.
  • The company’s commitment to improving lives helped CareSource grow quickly to become one of the largest Medicaid Managed Care Plans in the country.
  • CareSource was also nationally recognized by Fortune Magazine in 2023 as one of America’s best places to work in health care.
  • “I believe CareSource will help take us to the next level, which our members and our provider partners deserve,” Mahaffey said.

Fidelis Care and Cityblock Partner to Bring Comprehensive Care to Medicaid Members in New York

Retrieved on: 
Wednesday, February 7, 2024
Partnership, Risk, Medicaid managed care, Fidelis Care, Centene Corporation, HARP, Health, Nursing

BROOKLYN, N.Y. and LONG ISLAND CITY, N.Y., Feb. 7, 2024 /PRNewswire/ -- Fidelis Care, a health plan serving more than 2.5 million members across New York State and a wholly owned subsidiary of Centene Corporation, announced today a partnership with Cityblock, a value-based healthcare provider, to provide comprehensive, community-based care to thousands of eligible members in the New York City area and Long Island living with complex medical and behavioral health conditions.

Key Points: 
  • Cityblock's innovative care model connects members to a multidisciplinary care team that includes primary care providers, behavioral health specialists, community health partners, nurse care managers, pharmacy navigators, and more.
  • Through this partnership, eligible members of Fidelis Care's Medicaid Managed Care and HealthierLife – Health and Recovery Plan (HARP) plans now have access to Cityblock's integrated primary care, behavioral health, and social care services.
  • "Fidelis Care is excited to partner with Cityblock to ensure our members receive personalized, quality care at the time and place they need it," said Fidelis Care Chief Medical Officer Vincent Marchello, MD.
  • Cityblock provides services to Fidelis Care members with complex needs, many of whom are at disproportionately higher risk for poor health outcomes.

Holy Cross Health is Investing in the Future of Health Care and Employees Through Its Career Pathways Program

Retrieved on: 
Tuesday, November 7, 2023
Pharmacy, Certified Nurse-Midwife, Housing, Health, Food, Medicaid managed care, Life, GED, Workforce, Certification, CHW, Food security, Nuclear family, Montgomery College, Trinity Health (Livonia, Michigan), Anne Arundel Community College, MPC, Central sterile services department, Medicaid, Pharmacy technician, Unlicensed assistive personnel, Holy Cross, Patient, American Society of Phlebotomy Technicians, Community health worker, Nursing

SILVER SPRING, Md., Nov. 7, 2023 /PRNewswire-PRWeb/ -- Holy Cross Health is proud to announce its groundbreaking Career Pathways Program, which provides career advancement opportunities for colleagues in positions requiring a high school diploma or GED. Developed in collaboration with Maryland Physicians Care, this initiative addresses income inequality while promoting retention and career growth within the healthcare system.

Key Points: 
  • Holy Cross Health is proud to announce its groundbreaking Career Pathways Program, which provides career advancement opportunities for colleagues in positions requiring a high school diploma or GED.
  • SILVER SPRING, Md., Nov. 7, 2023 /PRNewswire-PRWeb/ -- Holy Cross Health is proud to announce its groundbreaking Career Pathways Program, which provides career advancement opportunities for colleagues in positions requiring a high school diploma or GED.
  • "In our ongoing commitment to the well-being and professional development of our colleagues, we are thrilled to introduce the Career Pathways Program," stated Doreen Coburn, Chief Human Resources Officer, Holy Cross Health.
  • With generous support from Holy Cross Health Foundation donors and Maryland Physicians Care, the program covers tuition fees and provides additional resources.

Acentra Health Awarded Contract Extension Overseeing Utilization Management Services for Florida Medicaid

Retrieved on: 
Thursday, September 7, 2023
Florida Medicaid waiver, Utilization management, Medicaid, AHCA, URAC, Health, Partnership, Manager, Medicaid managed care, Health insurance, Nursing

MCLEAN, Va., Sept. 07, 2023 (GLOBE NEWSWIRE) -- Florida’s Agency for Health Care Administration (AHCA) awarded Acentra Health (formerly Kepro) a new five-year contract extending the company’s 12 years of work overseeing utilization management services for beneficiaries enrolled in the state’s fee-for-service Medicaid program and those receiving select Medicaid Managed Care carve-out services.

Key Points: 
  • MCLEAN, Va., Sept. 07, 2023 (GLOBE NEWSWIRE) -- Florida’s Agency for Health Care Administration (AHCA) awarded Acentra Health (formerly Kepro) a new five-year contract extending the company’s 12 years of work overseeing utilization management services for beneficiaries enrolled in the state’s fee-for-service Medicaid program and those receiving select Medicaid Managed Care carve-out services.
  • “We are grateful to be recognized for the success of our strong partnership with Florida’s Agency for Health Care Administration and this opportunity to continue serving individuals and families who rely on the state’s Medicaid program,” said Acentra Health CEO Todd Stottlemyer.
  • Services provided span 18 areas of utilization review in fee-for-service Medicaid covering one million Florida beneficiaries, including inpatient acute medical surgical and psychiatric services, and enhanced care coordination for beneficiaries receiving select services.
  • Other services include provider and beneficiary outreach and a call center.”
    As a URAC-accredited organization for Health Utilization Management, Acentra Health adheres to the highest standards and best practices in case review backed by experienced, credentialed clinicians and national expert resources.

Conduent Named a Leader in Healthcare Payer Operational Transformation by NelsonHall

Retrieved on: 
Wednesday, June 28, 2023
RPA, Private sector, Medicare Advantage, IP, Conduent, As a service, Public sector, Medicare, ACA, Automation, Machine learning, MMIS, Commercial, Medicaid managed care, Retail, Health insurance

FLORHAM PARK, N.J., June 28, 2023 (GLOBE NEWSWIRE) -- Conduent Incorporated (Nasdaq: CNDT), a global technology-led business solutions and services company, today announced it has been named a Leader across all categories in the NelsonHall 2023 NEAT Report for Healthcare Payer Operational Transformation.

Key Points: 
  • FLORHAM PARK, N.J., June 28, 2023 (GLOBE NEWSWIRE) -- Conduent Incorporated (Nasdaq: CNDT), a global technology-led business solutions and services company, today announced it has been named a Leader across all categories in the NelsonHall 2023 NEAT Report for Healthcare Payer Operational Transformation.
  • The NelsonHall vendor assessment evaluated the company’s capabilities in healthcare payer process transformation and operations across member services, claims administration, and provider network management.
  • John Willmott, CEO, NelsonHall said, “Conduent is at the forefront of operations transformation in the healthcare payer sector.
  • We are executing on significant strategic investments in automation that strengthen our ability to drive healthcare payer operations transformation.

Sandata Expands Revenue Cycle Management Services

Retrieved on: 
Wednesday, January 4, 2023
Growth, National Directorate for Personal Data Protection, Medicare, Health, RCM, EVV, IDD, Medicare Advantage, Medicaid managed care, Eye, Health insurance, Sandata

HICKSVILLE, N.Y., Jan. 4, 2023 /PRNewswire/ -- Sandata, the leading provider of technology solutions to the home care industry expands its Revenue Cycle Management Services (RCM Services) offering across home care and I/DD.

Key Points: 
  • HICKSVILLE, N.Y., Jan. 4, 2023 /PRNewswire/ -- Sandata, the leading provider of technology solutions to the home care industry expands its Revenue Cycle Management Services (RCM Services) offering across home care and I/DD.
  • "The Sandata Revenue Cycle Management service was originally launched to enable our Sandata Agency Management customers to achieve a high level of cash flow performance at 99% of billing or better," said Emmet O'Gara, Sandata's Chief Executive Officer.
  • "Our team has many years of experience in home care and I/DD revenue cycle management, and we handle the entire revenue cycle process end to end, from authorization support and billing clean claims, to posting payments and denials appeals," said Phil Feldman, Sandata's National Director of Revenue Cycle Management.
  • Get more out of your existing RCM practices by partnering with Sandata Revenue Cycle Management Services.

BDC Advisors Issues New Working Paper Providing Fresh Insights on How State Programs and Health Plans Are Leading Medicaid Innovation and the Challenges and Opportunities for Hospitals and Health Systems to Advance Health Care Equity

Retrieved on: 
Thursday, July 14, 2022
Population Health Management, Health, LLC, Multimedia, BDC, Trustee, Montanile v. Board of Trustees of Nat. Elevator Industry Health Benefit Plan, Medicaid, Paper, Government, MBA, Social determinants of health, Doctor of Education, MPH, Organization, Senior advisor, Medicaid managed care, Mergers and acquisitions, Hospital, Health insurance

The paper's authors Pam Nicholson, MBA, Senior Advisor; Jackie Macias, EdD; and Whitney Perlen, MPH, Manager; describe how in the past decade state Medicaid programs and Medicaid Managed Care programs have embarked on a variety of innovative efforts to improve beneficiaries' health experience---and to control costs. The paper outlines a variety of tactics that may be employed from combining traditional strategies such as stringent costs control and strong revenue cycle management, to a variety of newer tactics aimed at enhancing the value and quality of service within clinical networks.  The authors state that the goal of the paper is to highlight the activities of state Medicaid programs, Medicaid Managed Care Plans and others to address SDOH issues and increasingly focus on "whole person care."

Key Points: 
  • MIAMI, July 14, 2022 /PRNewswire/ -- BDC Advisors , the healthcare strategy consulting firm, today issued a new working paper: " State Programs and Health Plans Lead Medicaid Innovation ."
  • The authors provide examples of how states and Medicaid Managed Care Plans are leading in innovation to treat Medicaid beneficiaries more effectively and humanely, and how hospitals and health systems can rise to the challenges of SDOH.
  • The authors state that the goal of the paper is to highlight the activities of state Medicaid programs, Medicaid Managed Care Plans and others to address SDOH issues and increasingly focus on "whole person care."
  • Established in 1990, the firm's clients include market leading hospitals, health systems and health plans.

APCI to Feds: Stop Merger of Drug Middlemen

Retrieved on: 
Friday, July 1, 2022
Department, Magellan Health, Review, Agency, Justice, Acquisition, View, Patient, Federal Trade Commission, APCI, FTC, Health, Office of Inspector General, U.S. Department of Health and Human Services, Letter, New Hampshire Department of Justice, Medicaid managed care, Pharmacy, U.S. Department of Justice Office of Legislative Affairs, Time, PBM, Multimedia, Therapy, Pharmaceutical industry, Ferdinand Magellan

"The largest PBMs in the U.S. have created a prescription drug pricing and access problem," Reybold said.

Key Points: 
  • "The largest PBMs in the U.S. have created a prescription drug pricing and access problem," Reybold said.
  • While these middlemen claim to bring market efficiencies to the prescription drug chain, the reality is integration in the PBM market has increased prices and had anti-competitive effects."
  • APCI is a member-owned cooperative of more than 1,600 member pharmacies in 30 states.
  • Established in 1984 and headquartered in Bessemer, Ala., APCI is proud to lead the fight for prescription drug pricing transparency and reform.

Artia Solutions Hires Nick Penzetta as Vice President, Managed Markets

Retrieved on: 
Wednesday, March 16, 2022
Association, Partnership, Medicaid managed care, Market access, Bank account, Commercial, Biosimilar, Medicare, District Management Area, Account manager, Organization, Association for Accessible Medicines, AAM, Public, LEAP, Rx, Government, FFS, Foreign policy, Teva Pharmaceuticals, Business, Public policy of the United States, Ithaca College, Leadership, Public policy, Medicaid, CEO, State, Industry, Solution, VP, Global leadership, Policy, PBM, Wharton School of the University of Pennsylvania, Marketing, Sanofi, Management, Health insurance, Teva, Product life-cycle management (marketing)

TALLAHASSEE, Fla., March 16, 2022 /PRNewswire-PRWeb/ -- Artia Solutions is proud to announce the hiring of Nick Penzetta as Vice President of Managed Markets.

Key Points: 
  • TALLAHASSEE, Fla., March 16, 2022 /PRNewswire-PRWeb/ -- Artia Solutions is proud to announce the hiring of Nick Penzetta as Vice President of Managed Markets.
  • Nick will be responsible for leading the continued development of Artia's operational knowledge and expertise in the Managed Medicaid area and other managed markets.
  • "We are thrilled to have Nick join the Artia team," said George Kitchens, CEO and Senior Partner of Artia Solutions.
  • "His exceptional expertise and wisdom will provide our clients with creative solutions as they look to protect and improve access in managed markets.

New Report Highlights Early Experiences with North Carolina's Transition to Medicaid Managed Care

Retrieved on: 
Monday, February 28, 2022
Health, Blue Cross, Directory, NCBM, Medicaid, Triangle, Managed care, Organization, Housing, Transport, Review, Child, UnitedHealth Group, Health Management Associates, HMA, Clothing, Medicaid managed care, MMC, Mount Zion Baptist Church, Maintenance, Accountable care organization, YMCA Training, Inc. (Boston), Blue Shield, Goal, YMCA, Program, Foundation, Health insurance, Public relations, Life insurance

RALEIGH, N.C., Feb. 28, 2022 /PRNewswire/ -- Today, North Carolina for Better Medicaid (NCBM) and Health Management Associates (HMA) released a new report on North Carolina's transition to Medicaid Managed Care (MMC).

Key Points: 
  • RALEIGH, N.C., Feb. 28, 2022 /PRNewswire/ -- Today, North Carolina for Better Medicaid (NCBM) and Health Management Associates (HMA) released a new report on North Carolina's transition to Medicaid Managed Care (MMC).
  • HMA produced the report after interviewing key health care stakeholders in North Carolina, including advocates and care managers who work with Medicaid beneficiaries and have first-hand experience with the recent transition to Managed Care.
  • The report highlights these stakeholders' early experiences with Managed Care and identifies key successes and opportunities for going forward.
  • "This report reflects important feedback on Medicaid Managed Care in North Carolina from key stakeholders who have direct experience with the transition," said HMA Regional Vice President Kathleen Nolan.