Episode description

Joe Russell, Vice President of Network Management and Contracting at Strategic Healthcare shares his invaluable perspective on how community-based providers can thrive despite the dominance of managed care plans and the ever-present issues of fraud, waste, and abuse.

Our conversation uncovers the influence of pivotal regulatory shifts, such as the Affordable Care Act and CMS initiatives, on managed care. We navigate the delicate balance between cost containment and quality care, addressing critical challenges like authorization limits and the impact of timely payments on providers. 

As we look to the horizon, our dialogue transitions into the evolving dynamics of provider-payer relationships, where data-driven quality metrics take center stage. The burgeoning landscape of managed Medicare Advantage plans demands a new level of collaboration between payers and providers, with an emphasis on trust and innovative cost-containment solutions. 

We explore the significance of aligning with metrics like star ratings and rehospitalization rates to enhance opportunities and reimbursement. Value-based care in post-acute settings is poised for growth, and providers must lead the charge by understanding their costs and crafting compelling value propositions for managed care plans. 

Join us as we chart the course for the future of healthcare, where collaboration and strategic partnerships will redefine success.

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