Fri.Oct 04, 2024

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CMS proposes risk adjustment changes, broker fraud crackdown for 2026 plan year

Fierce Healthcare

A proposed rule from the Centers for Medicare & Medicaid Services (CMS) released Oct. | CMS is looking to shake up the risk adjustment model and wants the ability to suspend shady brokers from the insurance marketplace, the agency wrote among other updates in a new proposed rule.

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UnitedHealth sues CMS over Medicare Advantage star ratings

Health Care Dive

A handful of plans owned by the nation's largest MA payer are the latest to ask the court to help raise their valuable quality scores.

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Khan won't rule out FTC weighing in on Epic antitrust lawsuit: report

Fierce Healthcare

Lina Khan, chair of the Federal Trade Commission (FTC), would not rule out the possibility of the agency filing an amicus brief to weigh in on Particle Health's antitrust lawsuit against Epic, she | Lina Khan, chair of the FTC, would not rule out the possibility of the agency filing an amicus brief to weigh in on Particle Health's antitrust lawsuit against Epic, she told a Wisconsin reporter Thursday.

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Texas sues major PBMs, pharma companies over high insulin prices

Health Care Dive

The litigation comes as pharmacy benefit managers Express Scripts, CVS Caremark and Optum Rx face growing criticism over their role in high drug costs — including a recent lawsuit from the Federal Trade Commission.

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Why Every Small Business Needs an HCM Solution: A Comprehensive Guide

Managing HR tasks like payroll, compliance, and employee data can overwhelm small businesses. That’s where a Human Capital Management (HCM) solution comes in. Our eBook, Why Every Small Business Needs an HCM Solution: A Comprehensive Guide , shows how an HCM system automates tedious processes, ensuring your business stays compliant and efficient. You’ll learn how to simplify payroll, eliminate costly errors, and empower your employees with self-service tools.

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As healthcare AI proliferates, patients are 'confused,' research shows

Healthcare It News

They recognize the promises of faster diagnosis and easier access to treatment and cost info, says Mark Polyak, president of analytics at Ipsos. While they're comfortable with AI for administrative tasks, they're wary of clinical applications.

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HIMSSCast: Out-of-pocket expenses are a challenge to keeping people well

Healthcare It News

Prioritizing wellness means taking into account the out-of-pocket cost for patients, according to Alberto "Beto" Casellas, Casayess EVP & CEO of Health and Wellness Platform at Synchrony. Synchrony is a financial services company that offers a health and wellness platform in CareCredit.

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Hospitals' August margins stay level despite high volumes, shorter length of stay

Fierce Healthcare

Though their margins have largely remained level, hospitals are starting to get a handle on length of stay and per-patient expense growth as demand for inpatient care remains strong, according to A | Kaufman Hall's monthly index report showed continued demand and more efficient inpatient care, but muted revenue gains. A concurrent report on third quarter M&A also outlined a spike in dealmaking.

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Navigating 2024 Healthcare Challenges: Policy, AI, and the Road Ahead

HIT Consultant

Bill Charnetski, EVP of Health System solutions and Government Affairs at PointClickCare Now that we’re halfway through 2024, we’ve gained significant insights into the most pressing healthcare issues facing our industry and how they might shape the future. From regulatory hurdles to technological advancements, our sector is at a pivotal juncture, and understanding these dynamics will be crucial for all stakeholders involved.

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Industry Voices—Including children in the Food as Medicine framework: An essential strategy

Fierce Healthcare

As a community pediatrician with firsthand experience, I've observed an enduring curiosity among parents and caretakers about food, nutrition and health. | The potential for implementing Food as Medicine for pediatric settings is promising, with growing support from stakeholders, lawmakers and health agencies.

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Best Practices to Streamline Compensation Management: A Foundation for Growth

Speaker: Joe Sharpe and James Carlson

Payroll optimization can be one of the most time-consuming and complex factors of small business management. Yet, organizations that crack the code on streamlining employee compensation often discover innovative avenues for growth. With the right strategies in place, outsourcing and streamlining payroll processes can result in substantial time and resource savings.

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GE HealthCare Receives FDA Clearance for Innovative Alzheimer’s Imaging Tool

HIT Consultant

What You Should Know: – GE HealthCare a nnounced today that its MIM Software has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for a groundbreaking tool in the fight against Alzheimer’s disease. – The advancement allows MIMneuro, a vendor-neutral software solution, to perform “Centiloid scaling” for analyzing and quantifying amyloid plaque density in the brain using positron emission tomography (PET) imaging.

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The new OMB Social Welfare Function

Healthcare ECONOMIST

Recently, the Office of Management and Budget has released new procedures to assess government regulation ( Circular A-4 ) and economic policies ( Circular A-94 ). What is unique about this guidance is that it weights benefits and costs of new regulations and policies based on the income of the individuals impacted. The goal is to help reduce inequality.

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From TikTok to the Frontline: The Unsung Heroes of Healthcare Strike Management

HIT Consultant

Trevor Fandale, President at Huffmaster Last summer, Mireya Bustamante , BSN, RN, had more than 51,000 TikTok followers and 4.4 million likes across her videos when she posted a TikTok about her time as a travel nurse. The 35-second clip showed Ms. Bustamante flying into an unspecified city where staff nurses were striking. In the clip, Ms. Bustamante said, “Strike contracts are a pretty quick turnaround, so you must be ready to go.

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UnitedHealthcare, Humana Object To Star Rating Downgrades In Medicare Advantage

Home Health Care

The Centers for Medicare & Medicaid Services (CMS) dealt a blow to UnitedHealth Group (NYSE: UNH) and Humana Inc. (NYSE: HUM) – the two largest Medicare Advantage (MA) administrators – by lowering their star ratings for 2025. Broadly, MA plans are rated on a scale from one to five, and CMS has lowered those ratings for both UnitedHealthcare and Humana, in certain cases.

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How To Empower Your Workforce With Modern Fertility Benefits

Speaker: Andrea Wuchiski

In an era where a workforce spans multiple generations, HR managers and Total Rewards leaders face the unique challenge of designing benefits packages that cater to diverse employee needs. This session will delve into how comprehensive fertility benefits can bridge generational gaps, support employees’ health, and enhance workplace satisfaction. Join us for an insightful session that highlights the strategic importance of fertility benefits in today’s competitive job market.

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Mary Washington Healthcare Outsources Revenue Cycle Operations with Ensemble

HIT Consultant

What You Should Know: – Mary Washington Healthcare (MWHC) has selected Ensemble , a provider of revenue cycle management solutions to outsource revenue cycle operations. – The RCM outsourcing agreement will leverage Ensemble’s innovative technologies and expert team to enhance MWHC’s financial performance and elevate the patient financial experience.

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PACE Programs Emerge As ‘Natural Allies’ To Home-Based Care Providers

Home Health Care

This article is a part of your HHCN+ Membership Home-based care providers and Program of All-Inclusive Care for the Elderly (PACE) organizations are in a unique position to strengthen the work one another is doing to care for seniors. No one understands this better than Alivia Care, a home-based care provider that also has PACE programs under its umbrella.

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Trilliant Health Report Reveals Troubling Trends in US Healthcare: Costs Soaring, Health Declining

HIT Consultant

What You Should Know: – A new report from Trilliant Health paints a grim picture of the US healthcare system, highlighting escalating costs and worsening health outcomes despite increased spending. – The 2024 Trends Shaping the Health Economy Report serves as a wake-up call for the US healthcare system. It underscores the urgent need for stakeholders to address the unsustainable cost trajectory and prioritize initiatives that genuinely improve health outcomes.

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Celebrate Pharmacy Week with Advanced Labeling Solutions from PDC

PDC Healthcare

At PDC, we understand that precision and quality are essential in pharmacy operations. As we celebrate Pharmacy Week, we want to highlight our innovative labeling solutions designed to support the vital work pharmacists do every day. Whether you work in sterile compounding or manage patient-specific medications, PDC pharmacy label solutions are designed to meet your […] The post Celebrate Pharmacy Week with Advanced Labeling Solutions from PDC appeared first on connectID - PDC Healthcare B

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Enhance Healthcare Efficiency With Top Payroll & HCM Services

Running a healthcare facility requires precision and care, not just for patients but also for your staff. Our guide, "A Buyer’s Guide to Payroll & HCM Services," helps healthcare providers choose the best provider. Efficient payroll management ensures timely, accurate payments, critical for maintaining staff morale and trust. Compliance support helps navigate complex healthcare regulations and avoid costly fines.

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Videra Health, NSCG Partner to Help Prevent Suicide-Related Deaths of Service Members

HIT Consultant

What You Should Know: Videra Health Partners with NSCG : Videra Health, an AI-driven clinical operations platform, has partnered with North South Consulting Group (NSCG) to help prevent suicide-related deaths among service members, addressing a significant rise in suicide rates within the military. AI-Powered Mental Health Assessments : Videra Health uses advanced AI and machine learning to analyze linguistic, audio, and video data, enabling healthcare providers to proactively identify, triage,

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VitalCaring Pilot Program Shows Promising Results For Cognitively Impaired Patients 

Home Health Care

VitalCaring has announced the results of a seven-month AI-driven cognitive care pilot program. The program provided personalized therapy to patients with cognitive disorders using Constant Therapy’s digital speech, language and cognitive therapy platform as part of its home-based services for selected patients. Based in Dallas, VitalCaring provides home health and hospice care to patients in the Southern U.S., covering Texas, Oklahoma, Louisiana, Mississippi, Alabama and Florida.

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Hospital M&A Activity Surges in Q3 2024, Driven by Steward Health Care Bankruptcy and Mega Mergers

HIT Consultant

What You Should Know: – The hospital and health system merger and acquisition (M&A) market experienced a significant surge in activity during the third quarter of 2024, reaching its highest level since 2017, according to Kaufman Hall’s latest M&A report. – Kaufman Hall’s M&A report reveals this surge was largely fueled by the Steward Health Care bankruptcy and a series of “mega mergers” involving prominent health systems.

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Opportunities for States to Advance Continuity of Care for Justice-Involved Youth

NASHP

Justice-involved youth tend to have more significant health care needs compared to other youth, and an estimated two-thirds have a behavioral health condition. These youth also face unique barriers to accessing care and coverage disruptions as they transition between correctional settings and the community. To better support this population, states are developing and advancing cross-system strategies to improve continuity of care, including by leveraging new federal opportunities.

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Creating a Company Culture of Care: Integrating Mental Health, Wellbeing, and DEI in Benefits

Speaker: Sean Raible

Picture a workplace where physiological safety is not just an aim but a reality, driven by thoughtful employee benefits that prioritize mental health, wellbeing, and DEI. 🤔 ✨ Achieving this vision requires more than just occasional training sessions and employee assistance programs. Moving beyond the basics, this vision calls for a holistic approach that integrates these elements into your company culture as well as your HR and benefits strategy.

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Yung Sidekick Raises $825K for AI-Powered Progress Notes for Therapists

HIT Consultant

What You Should Know: – Yung Sidekick , a US-based mental health startup, announced it has raised $825K in pre-seed funding to advance its AI-powered platform that automates administrative tasks, such as note-taking, for mental health professionals. – The round was led by Altair Capital and Ultra.VC, with participation from other VCs and angel investors.

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How Digital Quality Can Improve the Member Experience

NCQA

There are many benefits to transitioning to digital quality measurement—such as accessing data more readily, with less friction, at lower cost—but the most important is improved care delivery. People expect their clinicians to know about their health history and their current health care needs. Recent laws allow patients to access their entire medical record on their iPhone, which might make them wonder why the organizations they trust with their health care don’t always have the same access to

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11 Infuriatingly Common Examples of Claim Denials

Etactics

In 2022, the denial rate was 11% for medical claims. That’s about 110,000 unpaid claims in just one year. This will delay payments or lead to physicians not receiving any payments. Understanding the reasons claims get denied is an important step in reducing claim denials. Luckily, insurance companies provide you with the reason why they aren’t accepting your organization’s claims.

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After Dobbs: How the Supreme Court Ended Roe but Not Abortion

Bill Of Health

Photo credit: Martina Å alov by David S. Cohen and Carole Joffe A new story of abortion in America is upon us. Dobbs v. Jackson Women’s Health Organization overturned Roe v. Wade and rejected a constitutional right to abortion, but so far, because of everything we chronicle in our forthcoming book After Dobbs: How the Supreme Court Ended Roe but Not Abortion (Beacon 2025), abortion has continued to be available for most people.

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How to Battle Layoffs: The Career Star Accelerator Bootcamp

Facing layoffs in your organization? Support your team members' career transition with Career Star Accelerator Bootcamp: Custom Resume & LinkedIn Revamp + 6 Weeks of Career Coaching. Our certified resume writers will create job search-winning resumes and LinkedIn profiles while they work with a career coach to learn unique strategies to stand out, attract the right employers, automate their job search, and land their dream job.

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FTC May Intervene in Epic Systems Antitrust Lawsuit

HIT Consultant

What You Should Know: – During a visit to Wisconsin focused on corporate consolidation in the grocery industry, Federal Trade Commission (FTC) Chairwoman Lina Khan addressed questions about potential FTC involvement in an antitrust lawsuit against Verona-based Epic Systems, WKOW first reports. – Khan’s visit included a listening session in Baraboo and a press conference alongside Rep.

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October 7th and the Limits of Diplomacy

The Rand Blog

Outside mediators, including the United States, may not be able to end the Israel-Hamas war—particularly if the combatants themselves don't want to stop fighting.

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A Year After the October 7 Start of the Israel-Hamas Conflict: Q&A with RAND Experts

The Rand Blog

The bloody conflict in the Middle East has highlighted a complex web of strategic, geopolitical, and humanitarian challenges. RAND experts delve into the regional and global implications of the conflict, the factors that led up to it, where it could be headed, and the geopolitical fallout.

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