Pmpm Pmpexamprep PowerPoint PPT Presentations

University Health Systems, Greenville, NC ... Review the history of Medicaid in North Carolina ... Funding: $2.50 pmpm fee received by Access East, Inc. ...

Previous NH CHIS CHIP reporting indicate higher payments PMPM for low-income ... Purpose of CHIP Payment PMPM Study ... CHIP Adolescent Study ...

... CM Savings PMPM 85 $ 140 $ Total CM Savings 42,005 $ 99,560 $ Admin Cost 29,399 $ 26,749 $ Evaluate Care Management Interventions Predictive Modeling Non ...

3. Current Approved Rates (MCD, MCR, Capitation - PMPM and Specialty Care Visits) ... adjustments and bad debt, excluding managed care capitation] divided by 365 days) ...

... framework for Medicaid capitation that takes such ... Provide a fixed capitation rate per-member-per-month. Provide a risk-adjusted capitation rate PMPM ...

It is now fairly common knowledge that Care Management (CM) programs have had mixed success in reducing the Per Member Per Month (PMPM) cost for a population. There are many publications that site case studies and compile savings and ROI numbers for care management programs across the country in the last 5 years. The results are all over the place. These research publications conclude that most CM programs that are successful are those that are highly integrated, high touch programs.

Register here: http://bit.ly/1UreKDz Speakers: R. Scott Vaughn, CPA, President and CEO, GlobalHealth Jay Reddy, CEO, VitreosHealth David Thompson, Senior Vice President and COO, GlobalHealth Date & Time: 11:00 AM – 12:00 PM EST, Friday, June 10, 2016 | (Duration: 1 hour) Key Learning Points: • An 18 percent reduction in emergency room encounters and emergent hospital admissions • Seen a 22 percent reduction in readmissions • And achieved a per-member per-month (PMPM) reduction in medical cost of about 6 to 8 percent, spread across all members Who should attend: • Any payer with Medicare and Medicaid populations. • Any payer with population health management programs currently using or hoping to use predictive analytics within these programs. • Any payer incorporating value based care financial models

Discuss the different ways to define 'trend' ... Morbid Obesity Admits per 1,000. Inside the Black Box: How Actuaries Price Health Insurance ...

Predictive Modeling Strategies for Disease Management Programs The National Predictive Modeling Summit Steve Johnson, Ph.D. Linda Shields, RN, BSN

Healthcare Cost Differences in the 1990s - Lawrence University

Strategies for Medicaid Care Management Programs The 2nd National Predictive Modeling Summit Linda Shields, RN, BSN, Senior Associate Predictive Modeling Objectives ...

Coach Medical Home Strategies & tools to support patient-centered medical home transformation MODULE 2: Recognition and Payment This table provides a high-level ...

Working to improve health in the central Appalachian region through the collaborative use of health information Worst Health Status in U.S. Drives Estimated $2,400 ...

Provides benefits for over 20% of population. Pays for 60% of ... Palmetto Medical Home Network. 26. SC Medicaid. Coordinated Care Enrollment. MCO plans 112,144 ...

Medicaid Health Plans of America April 20, 2006 Washington, D.C. John Lovelace, Vice President UPMC Health Plan ENROLLMENT COMPARISONS All SNP versus Utilizing ...

Provides health care coverage to 1.9 million consumers (14% of ... PIKE. MedPLUS Gateway. AmeriHealth. LUZERNE. AmeriHealth. MedPLUS Gateway. MONROE. MedPLUS ...

BCBSNM HMO Program Highlights 27. BCBSNM POS Program Highlights 37 ... Noteworthy utilization increases were observed in the areas of pharmacy, ...

Commonwealth Care Alliance A Non-Profit Prepaid Comprehensive Care System: Defining what a Real ACO is for Medicaid and Dual Eligible Beneficiaries with Complex ...

Impact by Service Categories Tradeoffs. Linkage of Quality Improvement and Cost Control ... Regression to mean overshadows true program impact ...

Lab Values, Rx, Prof Claims, ?Facility Claims. Therapeutic Class Summary Database ... Dash Board Reports. Internal Investigative Team to Troubleshoot ...

Health care strategy, finance, and data consulting firm ... 18' American Girl dolls. 6. UTLA Health Crisis Symposium. Analysis of LAUSD Claims Data ...

ADA and ALE Waiver used as comparable population. In community at ... Trend to rating period. Risk adjust district (PSA) costs to reflect Diversion enrollment ...

Bank of America. High Yield Bond & Leveraged Finance Conference. May 22, 2002 ... The statements made during this presentation that are not historical facts are ...

Overview of why reports are wrong and how to fix them. ... this one pass the Sniff test? Question 16: Does this pass the sniff test for diabetes? Question 18: ...

Second Generation P4P. Community-Wide. Diabetes and Asthma Care ... Diabetics with co-morbid conditions (20%) Had higher adherence scores (esp outcome measures) ...

Steer to 'Infusion Centers', free standing surgery centers for better rates and service ... Steer to better value providers. Drugs: 48% higher. Good ...

38% Increase in logons to Aetna Navigator since 2003 for several large plan sponsors ... Aetna Navigator destinations awareness of cost of care. EOB Inquiry ...

PRESCRIPTION BENEFIT MANAGEMENT SERVICES. presented to ... Source: Medco Health. TOP CLASSES OF DRUGS. Top Therapeutic Classes. CLASS. SALES. Proton Pump ...

The ICD9 Trigger list included Asthma, Diabetes, High Risk OB, AIDs, Cancer, CHF, COPD etc ... Select key MEDai measures to construct a composite score ...

What Does Being Successful Mean? Health care process and ... Example: Geisinger Health Plan (PA) also assigns its own salaried care managers to practices ...

HMOs manage the ... Types of HMOs. Staff model. Group model. IPA model. Independent contractor ... market challenge for HMOs and IDSs: Estimating the ...

Vice Chair, W. Montaque Cobb / NMA Health Institute. San Diego, California ... New York and Pennsylvania CABG Report Cards Caused 'Cherry Picking' ...

... woman with long standing Multiple Sclerosis with secondary lower extremity ... 1. Foster the establishment of multiple clinical prepaid care systems through: ...

... year in hospitals; more than from breast cancer, AIDS or motor vehicle accidents. ... Expansion beyond traditional diseases ...

What behaviors need changing among your covered lives? ... Combined with medication, DM, coaching, EAP, psychotherapy. 8. Welcome to the Revolution ...

Arizona Health Care Cost Containment System ... Strategic Planning Logic Map. Map of Strategic Outcomes for EHR Adoption Efforts ...

AcademyHealth - June 8, 2004. Jerry Winkelstein, FSA, MAAA. Blue Cross of ... JALIC Experience Slamming 5% of the Worst Groups was worth 8% to entire block ' ...

Pricing Medical Insurance Individual and Group Meeting-cum-Seminar on Preparedness Towards De-tariffing in Non-life Insurance Hyderabad, March 14, 2006

A few facts about health status, healthcare costs, and personal income in ... Associations (1,230), MSU Health Team (104), Sparrow Family Medical Services (45) ...

... 4 star quality rating 5% benchmark bonus could be the difference Relies on good relationships with providers for HEDIS ... overall rating of health care ...

SOS Post Offer Employment Testing (POET) Core Strength ... Ryan Derby, MD, MPH, Jessica Simmons, MS, Lisa Hollien, BS, Megan Fox, RN, Megan ...

Do not distribute or reproduce without the express permission of ... Core Components of DHP. A condition-specific plan for diabetics and pre-diabetics ...

Total health care spending represented 16 percent of the gross domestic product (GDP) ... Discounts/coupons, etc. (e.g. fitness club) Physician/Hosp. Benefits ...

... in Tampa, FL. Highlights in 3Q ... Hot topics in health insurance. Health actuarial application ... in Health Insurance. Product development ...

'However, we recognize that when a capitated payment is made to an MCO or a PHP, ... it with the requirement for States to set Actuarially Sound Capitation Rates. ...

The Massachusetts Picture The Last Twelve Months

Consumer Driven Health Plans: Early Findings from the Field and Future Directions

Community Care of North Carolina ... New York Hudson Valley P4P/Medical Home Project (THINC RHIO P4P) ... Weill Cornell Medical College -- Clinical data will be ...

... covered population; it also raises the bar in relation to how most PIHPs plan ... Compile the results of the Cost Study and work with actuaries to ensure these ...

Conducting an Environmental Scan of the Five Kansas Medicaid 1915 (c) HCBS ... A summary of preliminary finding from the Environmental Scan; ...

If the case management services provided by your agency are not covered, then ... 100% of FPL may not be charged for service provided under the grant ...

Since 2003, there have been a series of federal legislative and regulatory ... Step 1: Think about Mark Twain's quote, 'Denial ain't just a river in Eqypt. ...

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Medicare drug benefit ... Verify eligibility for employer coverage and Medicare ... Integrated Medicare/Medicaid funding ...

FollowOn Biologics: Economic Outcomes In Search of a Better Way