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j p holland johns hopkins health plans linkedin linkedin respects your privacy linkedin and 3rd parties use essential and non essential cookies to provide secure analyze and improve our services and to show you relevant ads including professional and job ads on and off linkedin learn more in our cookie policy select accept to consent or reject to decline non essential cookies for this use you can update your choices at any time in your settings accept reject skip to main content linkedin top content people learning jobs games join now sign in j p holland washington dc baltimore area 4k followers 500 connections see your mutual connections view mutual connections with j p j p can introduce you to 10 people at johns hopkins health plans email or phone password show forgot password sign in sign in with email or new to linkedin join now by clicking continue to join or sign in you agree to linkedin s user agreement privacy policy and cookie policy join to follow johns hopkins health plans university of pennsylvania the wharton school report this profile about johns hopkins health plans is a 3 2b health plan and solutions business serving experience johns hopkins health plans education university of pennsylvania the wharton school view j p s full profile see who you know in common get introduced contact j p directly join to view full profile other similar profiles pk singh pk singh tampa fl connect adesh ramchandran adesh ramchandran greater chicago area connect heather staples heather staples newark nj connect donald h lloyd ii donald h lloyd ii morehead ky connect eric grossman eric grossman denver co connect mike maurer mike maurer greater philadelphia connect rich tinsley rich tinsley bradenton fl connect russell barksdale jr phd mpa mha fache russell barksdale jr phd mpa mha fache new canaan ct connect james liebo james liebo dallas fort worth metroplex connect zacharie agnero zacharie agnero south deerfield ma connect sunil narkar sunil narkar downey ca connect larry zook larry zook lititz pa connect blair mchaney blair mchaney wenatchee wa connect john hughes john hughes la quinta ca connect kevin fitzpatrick kevin fitzpatrick pinehurst nc connect chad w towner chad w towner warsaw in connect marc harrison marc harrison salt lake city ut connect bill mcginley hse fachca emeritus bill mcginley hse fachca emeritus natick ma connect kevin fickenscher md kevin fickenscher md kittery me connect kenneth rose kenneth rose dallas fort worth metroplex connect show more profiles show fewer profiles explore more posts paul johnson 2k followers better collaboration between payers and providers has been a frequent topic of discussion for as long as i ve been in the industry but today s advancements in technology and analytics now make it a realistic goal https lnkd in geey4zm2 2 ann kempski primary care collaborative 4k followers back to hca healthcare s 4th q earnings call and medicaid hca is expecting the same 20 margin in 2026 that it earned in 2025 despite expiring aca premium tax credits and backloaded obbba medicaid cuts hca s footprint is small in medicaid expansion states and they ve recently divested hospitals in two expansion states ca in medicaid volume increased 2 2 in 2025 medicaid supplemental payments were net 420 million net after subtracting provider tax paid by hca hca expects a decline in medicaid supplemental payments between 250 million and 450 million in 2026 but this appears to be driven more by timing of particular state programs than any impact of obbba policy changes with 1 3 of decline due to one program paused in tx supplemental payments like state directed payments are paid in lump sums and can lag utilization by several quarters so they are lumpy and unpredictable for a lot of reasons delays in federal approval changing federal match rates etc my takeaway is that obbba reductions in supplemental payments are still pretty far off and states continue leveraging hospital provider taxes to fund higher hospital payments rather than to support their medicaid programs more broadly this reflects the strong political power of hospitals in states where they effectively call the shots on these supplemental payments states just submit the applications collect the taxes then give the taxes right back to hospitals along with federal match that is 1 5x or more the taxes paid the rest of medicaid is starved this party looks like it will go on until the obbba reductions phase in slowly or changes in congress push back or repeal the cuts altogether in which case the part becomes the new normal and the medicaid program is more costly while insuring fewer people https lnkd in earsegpj 5 3 comments jake pyles 4k followers cms has launched 50 payment models in the last decade most never scaled beyond pilot access is a 10 year national model healthcare leaders can t ignore here s the 4 step breakdown 𝟭 𝗣𝗿𝗼𝗯𝗹𝗲𝗺 people with original medicare have limited access to technology supported care for managing chronic conditions previous models tied reimbursement to specific activities time thresholds and documentation requirements not to whether the patient s condition actually improved the result fragmented workflows siloed data and care teams optimizing for compliance rather than outcomes 𝟮 𝗦𝗼𝗹𝘂𝘁𝗶𝗼𝗻 access emphasizes outcomes over activities instead of rewarding utilization management or paying for minutes of service it ties payment to actual clinical improvement blood pressure reduction hba1c levels phq 9 depression scores 𝟯 𝗢𝘂𝘁𝗰𝗼𝗺𝗲𝘀 these metrics improve when you have visibility into what s happening between visits and the infrastructure to act on it patients get more options to meet their health goals providers gain new partners to co manage care medicare gets a path to pay for technology supported services 𝟰 𝗦𝘁𝗿𝗮𝘁𝗲𝗴𝘆 consistent workflows proactive outreach real time data capture that s what gives teams the capacity to deliver better care and what access is designed to reward when no one falls through the cracks outcomes improve access aligns payment with that reality 49 14 comments daniel mingle md ms mingle health 2k followers on july 14 2026 cms released the 2026 proposed rule for the quality payment program qpp the merit based incentive payment system mips the medicare shared savings program mssp and the physician fee schedule pfs the mingle health team will be reading the proposed rule over the coming days and weeks and we will be releasing videos blog posts and subsequent emails with detailed information from the proposal here are the proposals for 2026 that could have the biggest impact on quality payment program participants 6 new mips value pathways mvp that could increase the number of mvps available to 27 proposing that mvps advance in 2026 to the stage of mandatory subgroup reporting when mvp use is elected medicare proposes that they not validate group or subgroup specialty but count on groups and subgroups to attest to their specialty composition during mvp registration a proposal that small multi specialty groups those with 15 or fewer clinicians be exempt from having to break into subgroups to report mvps no change to the performance threshold proposed to remain at 75 points through 2028 new cost measures proposed to be introduced with a two year feedback period where the new measures will be calculated and communicated to the provider but not factor into the total mips score cms proposes to remove measure 487 screening for social drivers of health from the mips inventory and the app plus measure set for medicare cqms in the apm performance pathway app there s a proposed revision to the definition of beneficiary eligible for medicare cqms that cms claims will reduce reporting burden in addition to determining qp status at the apm entity level cms proposes to add this determination at the individual provider level as well there is no proposed change to the expectation that mips cqms will sunset for app plus submissions after the 2026 performance year proposing to eliminate the health equity adjustment starting with the 2025 performance year addition of a web survey option to cahps for mips reduce the number of years an aco can stay in a one sided risk model increase leniency with the 5 000 attributed beneficiaries target in mssp acos proposing a 5 year trial of a new alternative payment model apm through the center for medicare and medicaid innovation cmmi the ambulatory specialty model to test new models of specialty care of specific common high cost chronic conditions have i missed anything that you think could impact your organization are there details that i haven t paid attention to in my quick review medicare valuebasedcare 23 1 comment dawn maroney 16k followers star ratings as a strategic imperative and why alignment sets the benchmark today star ratings in medicare advantage show how well plans deliver quality build trust and stay sustainable cms reviews these ratings based on clinical results member experience complaint handling retention and access to care managing these areas takes focus and commitment this is why alignment health plan s latest results stand out for the second year in a row 100 of members are enrolled in plans rated 4 stars or higher two nevada hmo contracts earned 5 stars and a texas plan earned 4 5 stars these results demonstrate that a member first care model can be replicated and scaled rather than being a one time achievement why this matters 1 sustained reliability many plans aim for high star ratings but struggle to maintain them as cms raises the bar alignment s california hmo has held 4 or more stars for nine years in a row which is rare this steady performance leads to better risk management stronger member loyalty and more reliable bonus incentives 2 clear market differentiation medicare s plan finder clearly displays star ratings which directly impact consumers choices high ratings give plans a real edge over competitors not just a mark of honor 3 quality as a business driver not just compliance the most successful plans prioritize quality by closing care gaps retaining valuable services and responding promptly to members rather than merely meeting minimum requirements the new age of medicare advantage new carriers are transforming the industry through flexibility data driven insights digital engagement and a focus on members here s what makes them different flexible modular care models delivering individualized quality care bold benefit innovation that differentiates relentless measurement and iteration where analytics feed continuous quality improvement culture driven execution where clinical leaders operations and member services act with alignment alignment demonstrates how these strengths can be leveraged on a large scale to consistently deliver great results across different markets our dedication to long term quality we invest in quality to achieve lasting results that can be replicated across different markets yielding clear benefits from the first year our benefits are tied to clear clinical and satisfaction goals as shown by our star ratings and member feedback all of our members are enrolled in high rated plans not just a select few the future of medicare advantage will favor those who pair strong performance with new ideas that put members first alignment is already leading the way and setting the standard for the next generation of plans alignmenthealthplan alignmenthealth duals healthcareleadership advocacymatters valuebasedcare freedomofchoice leadershipinaction medicareadvantage healthpolicy 123 6 comments explore top content on linkedin find curated posts and insights for relevant topics all in one place view top content add new skills with these courses 44m microsoft fabric ai services for data engineering 1h 30m the data science of economics banking and finance 28m strategic thinking for growth marketers see all courses linkedin 2026 about accessibility user agreement privacy 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