NCQA

JULY 16, 2024

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 Medicaid populations. 1115 waivers are special demonstrations that allow states to pilot new Medicaid approaches outside federal program rules.

Medicaid 86

Medicaid Quality Improvement Integration Population Health 86

NASHP

MARCH 22, 2024

States are increasingly turning to capitated Medicaid managed care programs to deliver long-term services and supports (LTSS) to individuals with complex needs. California does cover skilled nursing facility care in its MLTSS program, but most personal care services (in-home supportive services) are provided under FFS.

Medicaid 75

Medicaid Nursing Medicare Integration 75

NCQA

JUNE 27, 2023

More states are contracting with managed care organizations (MCO) to provide Medicaid long-term services and supports (LTSS). How do we know if MCOs are delivering equitable, high-quality care to people receiving LTSS? The post How We Help Medicaid & Long-Term Services and Supports appeared first on NCQA.

Medicaid 52

Medicaid Care Transition Quality Improvement Regulations 52

NASHP

NOVEMBER 8, 2024

A growing trend in state health policy is developing capitated managed care programs to provide long-term services and supports (LTSS) to Medicaid beneficiaries who are older and/or have disabilities. which serves children, pregnant women, and adults, and CCC+ — into one program called Cardinal Care.

Medicaid 52

Medicaid Nursing Quality Improvement Accountability 52

Home Health Care

MAY 19, 2022

Yet with roughly seven-and-a-half months to go, more questions about HHVBP’s broader impact on quality of care and patient access are starting to pop up. But payer partners want to be “wowed” by data, and evidence suggests that HHVBP mostly leads to relatively modest quality improvements.

Medicare 95

Medicare Regulations Quality Improvement Quality of Care 95

Healthcare ECONOMIST

APRIL 11, 2023

Public reporting of hospital quality of care could improve the care patients receive through at least two pathways. First, patients (or their physicians) could send patients to higher quality hospitals (i.e., A key question is, how well does public reporting of quality of care actually improve outcomes.

Hospitals 74

Hospitals Quality Improvement Quality of Care Medicare 74

NASHP

AUGUST 23, 2021

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.

Primary Care 64

Primary Care Medicaid Accountability Quality Improvement 64

Readiness Rounds

DECEMBER 4, 2024

How Can We Improve Quality and Patient Outcomes? What Are the Steps for Integration into Quality Improvement? How Can We Improve Data Management and Staff Training? One of the most transformative changes ahead is the CMS 2025 Age-Friendly Measures, introduced by the Centers for Medicare & Medicaid Services.

Quality Improvement 52

Quality Improvement Physical Therapy Integration Hospitals 52

Cloud Blogs

FEBRUARY 28, 2022

Today, regulatory and market forces have led to improved transparency and enhanced consumerization, changing the face of healthcare. These shifting priorities have catalyzed the desire to track patient outcomes and cost-savings for improved quality of care.

Integration 127

Integration Healthcare Quality of Care Regulations 127

Sheppard Health Law

OCTOBER 27, 2021

On October 20, 2021, the Centers for Medicare and Medicaid (“ CMS ”) Innovation Center (“ Innovation Center ”) published a white paper detailing its vision for the next ten years: a health system that achieves equitable outcomes through high quality, affordable, person-centered care. Strategic Objective 2: Advance Health Equity.

Medicaid 52

Medicaid Medicare Accountable Care Accountability 52

KHN

FEBRUARY 8, 2022

“CMS is committed to ensuring safety and quality of care for hospital patients through a variety of initiatives,” CMS said. ” She said the hospital-acquired conditions penalty program, along with other quality-improvement programs created by the ACA, feels “very ready for a refresh.”

Medicare 136

Medicare Hospital IT Hospitals Patient Safety 136

Briggs Healthcare

MAY 30, 2023

acute care hospital, long-term acute care hospital [LTAC], skilled nursing facility [SNF], inpatient rehabilitation facility [IRF]) to their home (e.g., The proposed Discharge to Home concept is distinct from existing rebalancing measures, as its sole focus is on home discharge as a signal of quality.

Medicaid 40

Medicaid Rehabilitation Quality Improvement Quality of Care 40

NASHP

OCTOBER 20, 2022

This substandard access to quality care can lead to poor health outcomes.[6]. have a special health care need, and an estimated 44 percent of CYSHCN are enrolled in Medicaid.[7] public health, Medicaid, mental health) and other stakeholders (e.g., Training CHWs in core components of care coordination.

Medicaid 98

Medicaid Integration Accountability Quality Improvement 98

Healthcare ECONOMIST

JANUARY 27, 2023

First, they provide a nice overview of the program: The EOM is a voluntary 6-month, 2-sided, risk-based payment model for clinicians caring for Medicare patients with 7 common cancer types beginning on July 1, 2023, for 5 years. Small end-of-life cost savings were derived from a 1% reduction in hospitalizations.

Medicare 81

Medicare Quality Improvement Quality of Care Patient Experience 81

NCQA

DECEMBER 18, 2024

How NCQA’s Work Supports This Goal NCQA created the Race and Ethnicity Stratification Learning Network to investigate the challenges and opportunities of using race and ethnicity data for quality improvement, to gather insights on how plans are overcoming challenges and to get an early look at HEDIS measures stratified by race and ethnicity.

Quality Assurance 52

Quality Assurance Accountability Quality Improvement Pharmaceuticals 52

HIT Consultant

MARCH 17, 2024

Jay Ackerman, CEO, Reveleer The momentum of value-based care (VBC) is poised to accelerate. The Centers for Medicare and Medicaid Services (CMS) has outlined an ambitious objective: to transition all traditional Medicare beneficiaries into a VBC arrangement by 2030, a notable increase from the mere 7% recorded in 2021 by Bain Research.

Quality Improvement 64

Quality Improvement Medicare Quality of Care Regulations 64

NASHP

AUGUST 15, 2022

Improving Oral Health Access through Managed Care Quality Initiatives in Pennsylvania By Allie Atkeson. States are engaged in a variety of efforts to improve oral health access as part of improving overall health outcomes for Medicaid members. Medicaid Managed Care Dental Performance.

Medicaid 52

Medicaid Quality Review Prevention Quality Improvement 52

Briggs Healthcare

AUGUST 22, 2022

The American Academy of Hospice and Palliative Medicine (AAHPM) developed this implementation guide to help palliative care teams implement and collect data for two patient-reported outcome performance measures (PROPMs) for quality improvement (QI) and regulatory reporting efforts. Description of the Measures.

Patient Experience 52

Patient Experience Quality Improvement Medicare Quality of Care 52

NASHP

JUNE 22, 2023

Medicaid covers more than 40 percent of births nationally. Given the critical role that Medicaid plays in maternal health, there is a longstanding interest in the role of Medicaid service delivery systems to improve perinatal health outcomes. All Medicaid beneficiaries served by the practice are included.

Medicaid 59

Medicaid Prevention Accountability Medicare 59

Healthcare ECONOMIST

OCTOBER 4, 2021

Many believe that MIPS leads to providers prioritizing reporting over quality of care, since it is (financially) better to choose metrics where the practice is already performing well rather than ones where the practice would need to improve. Robustness of metrics.

Medicare 105

Medicare Quality Improvement Quality of Care Accountability 105

Cloud Blogs

FEBRUARY 28, 2022

Today, regulatory and market forces have led to improved transparency and enhanced consumerization, changing the face of healthcare. These shifting priorities have catalyzed the desire to track patient outcomes and cost-savings for improved quality of care.

Integration 73

Integration Healthcare Quality of Care Regulations 73

Briggs Healthcare

MARCH 9, 2023

On May 16, 2022, HHS announced the funding opportunity of nearly $15 million for a three-year federal grant to establish a Substance Abuse and Mental Health Services Administration (SAMHSA) program that will strengthen the delivery of behavioral health care to residents of nursing homes and other long-term care facilities.

Nursing 52

Nursing Prevention Performance improvement Medicaid 52

Lexis Nexis

JUNE 30, 2022

The firm notes that changes to 2023 quality metrics will have a marked impact on MA plans, given the healthcare industry’s lack of success in improving consumer experience. Health plans that do not improve their consumer experience ratings stand to lose significant revenue. Quality varies from member to member.

Quality of Care 52

Quality of Care Medicare Quality Improvement Medicaid 52

Briggs Healthcare

MARCH 20, 2023

and Jonathan Blum, Centers for Medicare & Medicaid Services – names you may recognize from CMS National Stakeholder Calls. As the nation’s largest payer for health care, the Centers for Medicare & Medicaid Services’ (CMS) mission in our National Quality Strategy includes ensuring everyone is safe when they receive care.

Patient Safety 40

Patient Safety Medicaid Medicare Quality of Care 40

NASHP

AUGUST 31, 2023

Through coordinated efforts to track progress and advance programs and initiatives to improve quality of life in the region, Live Well San Diego was able to drive a 12 percent reduction in the percentage of deaths associated with preventable health threats between 2007 and 2019 among San Diego County residents.

Medicaid 52

Medicaid Accountability Public Health services Population Health 52

NASHP

MARCH 22, 2024

States such as Texas, Wyoming , and New Jersey are adopting Medicaid reimbursement of collaborative care services and are addressing capacity to transition to CoCM. People with COD are significantly more likely to be arrested , with a disproportionate impact on women and Black adults. An action plan dashboard tracks targets.

Medicaid 52

Medicaid Integration Primary Care Nursing 52

NASHP

JUNE 22, 2022

Comprehensive quality measurement of care coordination services is essential to evaluate and guide care coordination efforts, yet little agreement exists among stakeholders about how to best measure the provision and quality of care coordination services. [4] 2] Medicaid and CHIP Payment and Access Commission.

Doctors 52

Doctors Medicaid Quality of Care Healthcare Providers 52

KHN

FEBRUARY 8, 2022

“CMS is committed to ensuring safety and quality of care for hospital patients through a variety of initiatives,” CMS said. ” She said the hospital-acquired conditions penalty program, along with other quality-improvement programs created by the ACA, feels “very ready for a refresh.”

Medicare 52

Medicare Hospital IT Hospitals Patient Safety 52

NASHP

MARCH 29, 2024

5 Compared to white, non-Hispanic CYSHCN, CYSHCN who are Black or Latinx are at particular risk of receiving infrequent, low-quality care, 6 while American Indian and Alaska Native CYSHCN are less likely to be able to access specialty treatment or receive culturally sensitive services.

Medicaid 124

Medicaid Quality of Care Quality Assurance Nursing 124

NASHP

DECEMBER 23, 2022

With more than 40 percent of births financed by Medicaid, the Centers for Medicare & Medicaid Services (CMS) has developed an action plan that corresponds with goals outlined in the White House blueprint. Implement Medicaid benefit. Monitor and evaluate quality improvement and outcomes and address barriers to care.

Medicaid 59

Medicaid Nursing Hospitals Regulations 59

NASHP

JUNE 22, 2022

Care Coordination Workforce. Care Transitions. public health, Medicaid, mental health) and other stakeholders (e.g., health plans, providers, families of CYSHCN) in using, adapting, and implementing the National Care Coordination Standards for CYSHCN to develop or improve care coordination systems.

Care Transition 52

Care Transition Medicaid Doctors Regulations 52

NASHP

OCTOBER 8, 2021

The Black Maternal Health Momnibus Act of 2021 , recently introduced in the House, builds on existing federal legislation to comprehensively address social and health systems that impact the care of pregnant people throughout the country.

Medicaid 64

Medicaid Clinical Practice Primary Care Quality Improvement 64

NASHP

MAY 8, 2023

Source: Centers for Medicare & Medicaid Services Health Disparities : Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. 34 The ACA’s data collection requirements also do not extend to the private insurance market.

Medicaid 52

Medicaid Regulations Prevention Medicare 52

HIT Consultant

JANUARY 22, 2024

What You Should Know: – The Centers for Medicare & Medicaid Services (CMS) has taken a bold step towards improving care for individuals with both mental health conditions and substance use disorders (SUD), announcing the “ Innovation in Behavioral Health (IBH)” Model.

Medicaid 97

Medicaid Quality of Care Integration Medicare 97

Sheppard Health Law

NOVEMBER 13, 2023

On November 6, 2023, the Centers for Medicare and Medicaid Services (“CMS”) released the contract year 2025 proposed rule for Medicare Advantage (“MA”) organizations and Part D sponsors (the “Proposed Rule”). 2] A NOMNC ordinarily outlines the appeal process as well as a deadline by which an enrollee should submit his/her appeal. [3]

Medicare 59

Medicare Medicaid Regulations Integration 59

Briggs Healthcare

OCTOBER 25, 2022

Today’s announcement is part of a series of new actions the Biden-Harris Administration is taking to increase accountability of bad actors in the nursing home industry, improve the quality of nursing homes and make them safer. and face increasingly severe enforcement actions if improvement is not demonstrated.

Nursing 40

Nursing Accountability Quality Improvement Quality of Care 40

Briggs Healthcare

MARCH 1, 2022

million people live in over 15,500 Medicare- and Medicaid-certified nursing homes across the nation. Research also suggests that, despite depriving residents of quality care, private equity-owned nursing homes actually led to an uptick in Medicare costs , too. More than 1.4 Establish a Minimum Nursing Home Staffing Requirement.

Quality of Care 40

Quality of Care Nursing Accountability Medicaid 40