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

NASHP

MARCH 24, 2025

Introduction Within the nursing home landscape, a primary role of state agencies is to oversee Medicaid payments and regulate nursing homes. Research has shown that increased staffing often correlates with higher quality of care. 1 At current levels of staffing, incentives total 14.4

Medicaid 52

Medicaid Nursing Quality of Care Accountability 52

Home Health Care

MAY 19, 2022

“If we do well under HHVBP, that should help prove the value of home health care,” one executive recently told me. 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. Medicare Advantage [plans] can see all of that information.”.

Medicare 111

Medicare Regulations Quality Improvement Quality of Care 111

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 130

Integration Healthcare Quality of Care Regulations 130

HIT Consultant

AUGUST 17, 2023

Healthcare decision-makers must identify the solutions that address today’s most crucial needs — variability in care, budgets (and clinicians) stretched too thin, and slow, reactive, outdated quality improvement methodologies — while recognizing the difference between legitimate concern and unfounded panic.

Healthcare 98

Healthcare Quality Improvement Regulations Hospitals 98

Briggs Healthcare

APRIL 7, 2022

“Nursing homes play a unique dual role in the long-term care continuum, serving as a place where people receive needed health care and a place they call home. The 1986 Institute of Medicine report Improving the Quality of Care in Nursing Homes identified a range of challenges to the quality of care in nursing homes.

Nursing 52

Nursing Quality of Care Quality Assurance Home Care 52

NCQA

JUNE 27, 2023

LTSS Distinction, for MCOs, and Case-Management for LTSS (CM-LTSS), for community-based organizations (CBO)— increase oversight of care for this vulnerable population. In July, NCQA will update these programs to further align with best practices and federal regulations.

Medicaid 52

Medicaid Care Transition Quality Improvement Regulations 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 76

Integration Healthcare Quality of Care Regulations 76

HIT Consultant

MARCH 17, 2024

As more plans, providers and members enter VBC arrangements, substantial volumes of clinical data will need to be managed effectively to oversee patient risk and care quality. Arming providers with a longitudinal patient summary for conducting comprehensive risk assessments improves patient outcomes while lowering the cost of care.

Quality Improvement 64

Quality Improvement Medicare Quality of Care Regulations 64

Briggs Healthcare

MARCH 9, 2023

The program will be funded with CMS’ Civil Money Penalty (CMP) funds, which come from collected CMPs that are imposed against nursing homes and other long-term care facilities when they are not in substantial compliance with one or more Medicare and Medicaid program participation requirements for long-term care facilities.

Nursing 52

Nursing Prevention Medicaid Performance improvement 52

NASHP

OCTOBER 20, 2022

High-quality, integrated care requires strong system-level partnerships, information and data sharing, and family-centered practices. In spite of these barriers, and to help address them, states have implemented innovations to improve integrated care coordination for CYSHCN. Leveraging Data and Technology.

Medicaid 98

Medicaid Integration Accountability Quality Improvement 98

NASHP

JULY 24, 2023

Evidence suggests that vertical integration and growing consolidation in health care leads to higher hospital and provider prices and higher total spending — all while having little to no impact on improving quality of care for patients, reducing utilization, or improving efficiency.

Hospitals 52

Hospitals Prevention Quality Improvement Quality of Care 52

NASHP

MARCH 22, 2024

North Carolina’s InCK program , led by Duke University and the University of North Carolina at Chapel Hill, brings together partners from Medicaid, behavioral health, child welfare, juvenile justice, education, Title V, mobile crisis, and more to coordinate care and address the health and social needs of children in five counties.

Medicaid 52

Medicaid Integration Primary Care Nursing 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. HHSC Uniform Managed Care Manual.” [30]

Medicaid 124

Medicaid Quality of Care Quality Assurance Nursing 124

NASHP

JUNE 22, 2022

This section of the guide outlines considerations, examples, and resources for: Identifying stakeholders and establishing partnerships across care coordination and child-serving systems. Assessing care coordination system capacity, gaps, and process improvements. Financing care coordination systems. Academic institutions.

Care Transition 52

Care Transition Medicaid Doctors Regulations 52

NASHP

MAY 8, 2023

29 State health policy leaders may consider regulation a barrier to collecting race and ethnicity data in their health equity program development. 31 The Patient Protection and Affordable Care Act of 2010 (ACA) also prohibits discrimination against protected persons in health care.

Medicaid 52

Medicaid Regulations Prevention Medicare 52

NASHP

DECEMBER 23, 2022

Monitor and evaluate quality improvement and outcomes and address barriers to care. The licensure and certification of midwives is administered by the Illinois Department of Financial and Professional Regulation. Monitor and Evaluate Quality Improvement and Outcomes and Address Barriers to Care.

Medicaid 59

Medicaid Nursing Hospitals Regulations 59

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. Tennessee operates a VBP program called the Quality Improvement in Long Term Services and Supports initiative (QuILTSS ).

Medicaid 52

Medicaid Nursing Quality Improvement Accountability 52

Sheppard Health Law

NOVEMBER 13, 2023

Enhance Guardrails for Agent and Broker Compensation Over the last few years, CMS has issued new regulations and subregulatory guidance intended to address abusive marketing practices by third party marketing organizations (“TPMOs”) that sell MA and Part D plans.

Medicare 59

Medicare Medicaid Regulations Integration 59

Patient Safety Movement

FEBRUARY 27, 2024

We are a young science which has emerged through a passion by many to improve the quality of care that we offer our patients and their families. Therefore, addressing price transparency is not only a matter of financial equity but also a critical component of ensuring patient safety and quality of care.

Patient Safety 52

Patient Safety Prevention Hospitals Healthcare 52