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mHealth Solutions and Strategy

Patient engagement

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San Diego - mobile health solutions

Customer validation, strategic partners

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Expert witness - healthcare

HIPAA, HITECH Act, ACA, Medical coding

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Expert witness - hospital systems, computer assisted coding

Anti-trust, CAC, ICD-10, clinical data economic impact

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San Francisco - Silicon Valley

Health IT investor diligence, venture capital, private equity firms, health plans and providers, regulatory impacts

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Disruptive regulations...

Create unprecedented risk and opportunity

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Salt Lake City - Government health plan

ICD-10 Usual, customary and reasonable (UCR) cost of medical care

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ICD-10 - modeling complexity

Creating visualization to facilitate roadmaps

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Denver - healthcare claims IT firm

Re-structuring the team, requirements and workfow

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Informatics - organize, analyze

Improved methods and behavioral health clinical data

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Miami - Medicare Advantage health plan

Risk Adjustment, RAF Scores, HEDIS 5-Star Ratings

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Success stories

Vision to create advantage in transitions, transactions, investments

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Juneau, AK

State and local health plans and providers

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Innovation facilitation

Providing the framework to create roadmaps and action plans

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St. Louis - Accountable Care Organization, Medicare Advantage

Health plan, physician group, healthcare IT portfolio investor diligence

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interoperability

Blog

/Blog/

Dual Eligibles for Medicare and Medicaid come under fire

By | August 19th, 2016|Affordable Care Act, Medicaid, Medicaid Expansion, Medicare, Obamacare|

The administration that created the Patient Protection and Affordable Care Act with Medicaid expansion as a centerpiece to cover more low-income insureds is now sending out letters notifying people who have policies via health insurance exchanges to end them immediately and the subsidies associated with then, if they are also eligible for Medicaid.  Under Medicaid Expansion, those at [...]

CMS Moves forward with CPC+ that Includes PMPM to PCPs

By | July 19th, 2016|Value Based Care|

According to CMS, the Original Comprehensive Primary Care (Original CPC) Model, is being replaced with the Comprehensive Primary Care Plus (CPC+) which is intended to allow health care provider practices to apply for one of two program tracks, with increasing payment and care redesign expectations from Tracks 1 to 2.

Expert Witness for Future Medical Costs : Personal Injury, Medical Malpractice, Product Liability – ACA

By | July 12th, 2016|Accountable Care Organization, Affordable Care Act, CMS Value Based Purchasing, Expert Witness, HITECH, subrogation|

In our experience, one strategy is to work within the Superior Court or State Court level and then appeal to a higher court perhaps at the Federal level. Some courts have elected not to hear testimony regarding future care costs under the Affordable Care Act, only to find that it is the law of the land and now has an impact. There are also unintended consequences in product liability cases. Third party liability and subrogation may also be affected.

CMS Merit Based Incentive Payment System (MIPS) in 60 Day Comment Period, Sunsetting of Meaningful Use

By | May 12th, 2016|MACRA, MIPS, Value Based Care|

New Federal healthcare industry payment models based on the April 27th, release of a proposed rule propose MIPS, MACRA, and APM methodologies for calculating healthcare reimbursement.  There are 962 pages in a document that proposes once in a generation changes in how healthcare providers are compensated.  The Meaningful Use program is eight years old and [...]

Interoperability in Healthcare: Are Anti-Competitive Forces Limiting Innovation and Patient Benefits?

By | April 6th, 2016|health information exchange, Health Information Technology Standards, Interoperability|

According to a physician in Utah, Health Information Exchanges don't work very well yet. Dr. Raymond Ward, MD is a member of the Utah State Legislature.  "When I try to look up patients sometimes I find them via the HIE, sometimes I don't."  Dr. Ward is both a practicing physician and a passionate legislator for improvement [...]

Expert Witness Affordable Care Act and Medicaid Expansion

By | March 16th, 2016|Affordable Care Act, Expert Witness, Medicaid, Medicaid Expansion|

As an expert witness I am regularly requested to provide opinions regarding the value of medical care under the Affordable Care Act. A misunderstood and often overlooked centerpiece of the Patient Protection and Affordable Care Act—often referred to as “Obamacare” or "ACA"—is the expansion of Medicaid eligibility to people with annual incomes below 138 percent of the federal poverty level.

HIMSS16 – ICSA Labs Certifies Seven Health IT Vendors for Interoperability

By | February 29th, 2016|Interoperability|

HIMSS has entered the interoperability standards game and partnered with ICSA on the ConCert seal of approval, though this is a relatively new standard with under 20 vendors certified to date.  New vendors are receiving the ConCert approval for electronic health record interoperability.  Separately, the CommonWell Alliance also announced new members and a post acute [...]

Whitehouse Requests Updates to Regulatory Framework For HIPAA Compliant Precision Medicine

By | February 25th, 2016|HIPAA, Precision Medicine|

Precision medicine targets disease at a genetic level for groups of patients with specific attributes.  Sharing patient data at the point of care introduces new opportunities and new HIPAA Privacy and Security challenges.  The President's 2016 budget proposes federal funds to update interoperability standards to include genetic data with the intent of sharing it while acknowledging [...]

Expert witness for Medical Billing and Coding

By | February 9th, 2016|Expert Witness, ICD-10, UCR|

Mike Arrigo In my work as an expert witness regarding medical billing and coding, I provide opinions on Usual Customary and Reasonable cost of care.   I receive questions on the difference between different types of care, codes and billing and the role of various entities in health care revenue cycle management and claims [...]

Affordable Care Act Expert Witness Work Requires Attorney Education

By | February 8th, 2016|Accountable Care Organization, Affordable Care Act, Expert Witness, ICD-10|

In my work as an expert witness regarding the Patient Protection and Affordable Care Act (also known as the "ACA" or "Obamacare"), I find that more medical malpractice and personal industry cases as well as cases involving requirements for insurance coverage for self-insured employer's employees encompass ACA in their scope. The ACA may change the economics of healthcare as they apply to a legal matter involving damages, value of care, or insurance coverage and benefits.

Employer Deadlines for Insurance Under the Affordable Care Act Extended by IRS

By | January 31st, 2016|Affordable Care Act|

The deadline for employers to electronically file the so-called 1094 forms for 2015 which provide coverage information to the IRS was extended to June 30, 2016 from March 31, while non-electronic form reporting was delayed to May 31, 2016 from Feb. 29.

How to Avoid Penalties Under the Affordable Care Act

By | January 31st, 2016|Affordable Care Act, Medicaid, Obamacare|

Buy insurance by Sunday, January 31, 2016 which is the last day to buy health insurance to avoid a $695 per adult and $347.50 per child penalty, or 2.5% of annual household income whichever is higher