In my experience, if you asked any provider organization executive–from the largest hospital system CEO, down to the smallest specialty provider organization director—about the market challenges keeping them awake at night, I’m betting that most would revolve around the shift to managed care and value-based reimbursement. And that’s because there is more managed care driven by tighter margins, a need for better outcomes (through risk alignment), and lower administrative costs. In Medicaid, more than 68% of the population is enrolled in comprehensive managed care organizations (MCO) and of the 38 state Medicaid programs that use . . .
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