Care Coordination & Referrals
Expert articles and analysis related to care coordination & referrals.
AI Summary — Last 24 Hours
Medicare Advantage growth is increasingly shifting toward Special Needs Plans, intensifying competition for dual-eligible and high-need populations where care coordination, referral management, and supplemental-benefit design are central to risk adjustment and Stars performance (Modern Healthcare). At the same time, Rhode Island is seeking up to three plans for an integrated Medicare-Medicaid program, signaling continued state movement toward managed, aligned financing for duals—creating opportunities for payers and ACO-aligned providers that can manage behavioral health, LTSS, transitions, and closed-loop referrals across fragmented delivery systems (Open Minds). Access friction remains a major execution risk: new reporting on mental health “ghost networks” found only 12% of directory calls yielded appointments, underscoring that VBC contracts tied to population outcomes need enforceable network adequacy, real-time referral availability, and behavioral health integration—not just nominal provider networks.
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