Managed Care, Resource, Contracting, Provider Resource Alex Yarijanian Managed Care, Resource, Contracting, Provider Resource Alex Yarijanian

A Managed Care Resource: Navigating Legal Complexities in Healthcare

The Managed Care Legal Database is a resource identifying how state and federal statutes and regulations address many issues that may occur between private payers and physicians, such as prior authorization, credentialing, network adequacy, out-of-network payment, and contract termination.

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Kentucky, Regulations, Managed Care, Contracting Alex Yarijanian Kentucky, Regulations, Managed Care, Contracting Alex Yarijanian

Understanding “Any Willing Provider”: Kentucky Statutes

The implementation of the 'Any Willing Provider' (AWP) statutes in Kentucky represents a significant and ambitious step towards reshaping healthcare access. These statutes challenge the traditional exclusivity associated with health maintenance organizations (HMOs) and their provider networks.

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HCA & Dignity Health: Advanced Bundled Payment and Risk Sharing Program Management

Carenodes’ expert management and careful coordination led to successes at Dignity Health and HCA Hospitals. Carenodes’ strategy led to over $1.1 million in shared savings in just one quarter at a single hospital, resulting in significant shared savings and elevated financial performance across 14 hospitals and 50+ SNFs. The achievements underscore Carenodes' unwavering commitment to advancing financial performance in healthcare while upholding the highest standards of patient care.

Kaiser – Partnership in Substance Abuse Treatment Services with Carenodes

Discover how Kaiser forged a remarkable partnership to enhance substance abuse treatment. Focusing on methadone and outpatient SUD services, we bridged a critical gap in Kaiser's healthcare offerings. Our strategic collaboration, rooted in relationship building and outcome tracking, led to increased business and stronger professional ties with Kaiser.

Humana – Comprehensive Contracting and Network Management

Collaborating with Humana, mastered the art of healthcare contracting and network management across Nevada and Hawaii. Overseeing a network of 4,000+ providers, we set a new standard in healthcare excellence. Learn more about this innovative journey.

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Introducing the Care MAP Tool: A Comprehensive Guide

Introducing the Care MAP Tool, designed to support healthcare providers in managing complex care needs. This user-friendly, Excel-based tool offers a structured framework for effective care coordination, resource allocation, and patient management. With modules for an overview and practical scenarios, plus a comprehensive resource library and FAQ section, the Care MAP Tool enhances care strategies and improves patient outcomes. Download it today and elevate your care management practices.

Dashboards: Breastfeeding Intention and Duration Indicators

The Breastfeeding Intention and Duration Indicators are key measures used to track breastfeeding practices and intentions among new mothers. These indicators include plans to breastfeed exclusively or in combination with formula, actual breastfeeding activities, and breastfeeding duration up to three months. They exclude mothers whose infants were not living with them at the survey time, ensuring data accuracy. These indicators help shape effective breastfeeding support programs, inform policy decisions.

CalAIM Budget Estimator Tool: A Budget Template for CBOs Considering CalAIM Contracting

The CalAIM budget estimator tool is an Excel-based template that helps community-based organizations estimate costs and potential revenue for providing Medi-Cal Enhanced Care Management and Community Support Services. It includes built-in assumptions, customizable revenue inputs, and a summary tab to project program margins, supporting informed financial decisions and contract negotiations with managed care organizations.