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Keys to successful interventions include good data, local connections and realistic ROI expectations, payer executives said Tuesday at AHIP's annual conference on Medicare, Medicaid and dual eligibles.
Image by freepik What You Should Know: – A new analysis by the Urban Institute, supported by the Robert Wood Johnson Foundation , reveals that healthcare providers in 41 states that expanded Medicaid eligibility would face significant financial losses if federal funding for Medicaid expansion programs is cut.
We invited Dr. Ryan Van Ramshorst, Chief Medical Director for Medicaid and CHIP Services at the Texas Health and Human Services Commission (HHSC), to discuss the evolving landscape of Texas Medicaid and recent landmark legislation that is driving innovation. Last quarter, we highlighted the Lone Star State.
The Research Analyst will assist team-based initiatives designed to support state policymakers in improving populationhealth and wellbeing. Projects focus on integrating public health, social services, and comprehensive health system transformation (with a Medicaid focus) to achieve those goals.
The company says that 3,000 healthcare organizations are already using Uber Health for transportation to primary care appointments and accessing critical prescriptions. Uber Health launched its HIPAA-enabled API and dashboard in 2018 to offer logistics services to populationhealth management programs.
New York City-based Unite Us focuses on building equity in populationhealth management through coordinated care networks of health and social service providers – the infrastructure of care. "Partnering with a coordinated care network, like Unite Us, is a game changer," he said.
Through the secure collection, documentation, reporting, access and use of data across provider types, ONC aims to address health inequities that have their root causes in poverty and racism. Andrea Fox is senior editor of Healthcare IT News. Email: afox@himss.org. Healthcare IT News is a HIMSS publication.
Expand Medicaid: Establish a federal fallback option to cover the millions of uninsured individuals in states that have not expanded Medicaid. Promote Continuous Coverage: Allow states to maintain continuous Medicaid eligibility for adults for 12 months to prevent gaps in coverage.
Anish Sebastian, CEO and Co-founder, Babyscripts A discussion of technology and the Medicaidpopulation inevitably raises the topic of the digital divide — that is, the gap between people who have access to modern information and communications technology (ICTs) and those who don’t. “We
Social determinants of health are major contributors to health inequity and rising healthcare costs in vulnerable populations such as Medicaid beneficiaries. How do care management interventions to mitigate SDOH as a risk for undesired health outcomes work?
They are asking providers to identify cancer patients and families who may qualify as ACP program enrollees, which includes households with Medicaid recipients and other federal subsidy programs, to provide them with the information they need to connect their patients with the Gilda's Club team supporting ACP enrollment.
This shift means that plans need robust data systems to integrate social risk information alongside clinical data, enabling more precise populationhealth management. Impact of SDOH Interventions on Cost Savings: Addressing SDOH not only improves health outcomes but also significantly reduces healthcare costs.
Regional and national health plans, employers, and Fortune 500 organizations use Galileo to help improve populationhealth. More than 85% of patients report improved health after receiving care from Galileo. His goal is to help remove language as a barrier for access to healthcare for the 53 million U.S. Spanish speakers.
These successful projects evolved further into Medicaid demonstration programs and in 2005, the Deficit Reduction Act authorized two more avenues for states to offer a self-directed option. In 2010, the Affordable Care Act officially and broadly authorized self-directed services for Medicaid recipients. Today, more than 1.5
We know that most adults want to age in place at home, which is the right place as its proven to be better for overall health and well-being and more cost-effective than an institutionalized setting, Help at Home President Tim ORourke told Home Health Care News.
Jerry Shultz, president of Lightbeam Health, whose populationhealth management platform helps risk-bearing organizations manage the cost and quality demands of value-based reimbursement, would like to see a wholesale effort to improve the care delivery system writ large. Here's what they had to say.
You just said, you know, when we started looking at value-based care more broadly on the population-side populationhealth, like how do we keep people out of the hospital? And not everybody is, you know, super inclined to take care of their health. Dennis Jolley - UW Health (he/him) You know, for the Medicare or Medicaid?
The successful candidate will lead and manage initiatives designed to support state policymakers in COVID-19 pandemic response, modernizing state public health systems, and integrating public health, social services, and comprehensive health system transformation (with a Medicaid focus).
In our recent Fireside Chat, we brought together two forward-looking health care leaders united in their commitment to quality and their passion for improving care for Medicaidpopulations. 1115 waivers are special demonstrations that allow states to pilot new Medicaid approaches outside federal program rules.
Neena Patel, MHA, CSM, VP of Client Success at Chordline As populationhealth initiatives for Medicare and Medicaid members pick up steam, one of the biggest obstacles to care transformation remains a lack of trust among healthcare’s key stakeholders. Yet too often, analytics platforms are not designed with users in mind.
CMS (The Centers for Medicare and Medicaid Services) released the proposed rule for QPP MIPS 2021 via the Medicare Physician Fee Schedule (PFS) Notice of Proposed Rulemaking (NPRM). It contains six measures that focus on populationhealth. In this article, we dissect changes that are expected to appear in MIPS 2021.
The Centers for Medicare & Medicaid Services (CMS) unveiled a new state-focused demonstration model Tuesday. One of the model’s primary objectives is to shift health care spending and utilization more toward primary and community-based care. The AHEAD Model could do the same.
The Medicaidpopulation, who typically benefits from progress last, still grapples with harmful biases within the healthcare system that pose extreme barriers to care. For the Medicaidpopulation, receiving this type of care is more challenging and increasingly necessary. The CDC found that in 2020, 18.4%
More than 13 million people were enrolled in Medi-Cal in California in September 2021, making it the largest Medicaid program in the nation. In 2015, DHCS launched the WPC Pilots as part of its Medi-Cal 2020 Section 1115 Demonstration.
But the screening rate was 55% for Medicaid plans, highlighting the need for more screening education and support. The good news is that unnecessary screenings reached an all-time low in 2023: 0.42% for commercial plans and 0.40% for Medicaid plans.
Pharmacy plan quality is vital since approximately 85% of the US population has prescription drug coverage through public (e.g., Medicare , Medicaid) or commercial (e.g., aligns with key plan/populationhealth priorities, usability (i.e., aligns with key plan/populationhealth priorities, usability (i.e.,
– Papa and Uber are working together to mitigate social isolation and negative health outcomes among Medicare and Medicaid recipients as well as those with employer health plans. The partnership advances Papa’s and Uber Health’s shared missions to support populationhealth among vulnerable communities.
What You Should Know: – Buckeye Health Plan and Cityblock are teaming up to provide integrated, community-based care to approximately 10,000 underserved Medicaid recipients in the Cleveland-Akron-Canton area.
Significant Growth Anticipated for Medicaid and Capitation Contracts: Most respondents report strategic plans to expand their VBC contracts over the next three years. VP of populationhealth. Key Themes and Ideas Regarding Value-Based Care Reimbursement 2022. The product would be a replacement.
Research has indicated that healthcare systems that connect patients to basic resources have observed improvements in populationhealth metrics, fostered trust with their patient base, and experienced reduced hospitalization costs. ILOSs must advance the objectives of the Medicaid program.
What You Should Know: – Alliance Health , a managed care organization serving over 137,000 Medicaid beneficiaries in North Carolina, announced a new partnership with Cityblock , a value-based healthcare provider for Medicaid and dually eligible individuals. ”
Prior to joining CVS, he was chief populationhealth officer of Mass General Brigham, one of the largest health care systems in Massachusetts. New CEO takes over The Partnership for Medicaid Home-Based Care Michelle Martin is set to take the helm as CEO of the Partnership for Medicaid Home-Based Care (PMHC). “On
The information on this map comes from a 50-state survey of a variety of stakeholders, ranging from Medicaid officials to Community Health Workers, on their states’ approaches?to?integrating?CHWs HRSA Health Resources and Services Agency. MHP MedicaidHealth Plans. NIH National Institutes of Health.
Primary care case management (PCCM) programs are one of the oldest types of Medicaid managed care, but over time most states have shifted to use managed care organizations (MCOs) to deliver services to Medicaid participants. million Medicaid participants. million Medicaid enrollees.
These factors can significantly impact their ability to effectively manage their condition and achieve optimal health outcomes. – Recognizing this critical need, the Medicaid Innovation Collaborative (MIC) has launched pilot programs in Iowa, Kentucky, and New York, targeting these very issues with innovative tech-enabled solutions.
Artificial intelligence (AI) has emerged as a powerful tool for making populationhealth analytics more accurate and interventions more effective. Sensitivity to a wider range of factors that can impact populationhealth, including SDOH, cultural and community issues, is key to minimizing both coding and data-driven bias.
This is one section of State Strategies to Leverage Medicaid Managed Care Contracting for Investments in Health and Housing Alignment. For more information on financing housing-related services, please visit our Medicaid and Housing toolkit. See the full resource guide. Government. For more information, please visit HRSA.gov.
What You Should Know: – PointClickCare , a healthcare technology platform, and MassHealth, the Massachusetts Medicaid program launches a new Behavioral Health Treatment and Referral Platform.
The model also requires Medicaid to establish a hospital global budget for participating hospitals for the first performance year of the model. This means there will be three hospital global budgets: Medicare, Medicaid, and commercial. A state’s lead agency must recruit commercial payers and hospitals to participate.
Jeff Geier, Cyber Security Leader at Pivotalogic California’s bold new CalAIM Medicaid transformation program is restructuring what partnership for health looks like across the state.
What You Should Know: – Cityblock , a value-based healthcare provider specializing in Medicaid, announced a new partnership with Sunshine Health , a Florida managed care plan. – The partnership expands Centene Corporation’s , Sunshine Health’s parent company, existing relationship with Cityblock. .
Expanding access and community health: Addressing healthcare disparities and improving overall populationhealth. Portfolio companies will benefit from mentorship and guidance from top-tier clinicians and healthcare management professionals within Ochsner Health.
As far as Caravan Health, Signify’s leaders believe its acquisition of the company, which took place in February, will allow them to provide total-cost-of-care management services. The Kansas City, Missouri-based Caravan Health works to help ACOs succeed in populationhealth management and value-based payment programs.
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