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Articles by Margaret-Mary
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Our diverse population needs a diverse health care workforce
Our diverse population needs a diverse health care workforce
By Margaret-Mary Wilson MD, MBA, MRCP, FNMCP
Sep 19, 2022
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My ‘learning moment’ this weekend was listening to this TED talk by Leah Georges. I hope you find it as thought-provoking as I did.
My ‘learning moment’ this weekend was listening to this TED talk by Leah Georges. I hope you find it as thought-provoking as I did.
Liked by Margaret-Mary Wilson MD, MBA, MRCP, FNMCP
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This quick video could change your work life today, let’s end this work place battle 2 statements to listen for “people are people” “meet people…
This quick video could change your work life today, let’s end this work place battle 2 statements to listen for “people are people” “meet people…
Liked by Margaret-Mary Wilson MD, MBA, MRCP, FNMCP
Experience & Education
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UnitedHealth Group
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Explore more posts
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Shirlivia Parker MHA,RHIA,CDIP, BS
Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation
219 Comments -
Angelica Landers
☝ Don't Miss the Application Deadlines for the ACO Primary Care Flex Model! CMS is accepting applications for the ACOs Primary Care Flex Model until August 1, 2024. Interested organizations must apply as new or renewing ACOs to the Medicare Shared Savings Program (MSSP) by June 17, 2024. The ACO PC Flex Model will launch on January 1, 2025, and run for five years. Low-revenue ACOs participating in the Shared Savings Program can apply to the ACO PC Flex Model. This innovative model aims to increase the number of low-revenue ACOs and enhance primary care payment through a Prospective Primary Care Payment (PPCP) option, shifting payment from fee-for-service to a predictable, monthly payment. 💲 Enhance primary care payment and innovative care delivery 📉 Narrow Disparities in health care outcomes 🔻Reduce program expenditures while preserving the quality of care 💪 Strengthen participation incentives for new and low-revenue ACOs 💰 Base Rate and Payment Enhancements 💴 One-time Advanced Shared Savings Payment Health Equity Strategy to drive accountable care and advance health equity #ACOPrimaryCareFlexModel #HealthcareInnovation #PrimaryCare #AccountableCare #Medicare #HealthEquity #SustainableHealthcare #ValueBasedCare #VBC #RiskAdjustment #PPCP #SharedSavings #CMS https://lnkd.in/gmiKZsHM
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Melissa Newton Smith
Earlier today, #CMS issued a Final Rule to bolster non-discrimination regulations in federally-funded programs including #MedicareAdvantage, Exchange, and #Medicaid. Before you brush this off as a routine #Compliance update, let’s explore these new rules a little more deeply. This FR strengthens rules requiring equal access for all, including language, literacy, race, color, nationality, sex, age, and disability to ensure beneficiaries access the benefits, services, health programs and activities they are rightfully entitled to. This applies to providers and payers, and tackles decision support tools, web content and mobile app accessibility, including for disabled persons, non-english speakers and no/low-literacy members. Every department is impacted by this rule, as is every vendor providing services to plans. CMS acknowledges compliance may be costly, will require fundamental changes to processes/activities and may result in insurors exiting the market. This FR builds on the 2024 FR requiring plans to communicate with members in their preferred language and alternate formats upon learning of them and the 2025 FR requiring plans to provide Notice of Availability in the 15 most common languages in members' state. Among other things, covered entities must now: - Designate a Section 1557 Coordinator - Develop, tailor and implement written P&Ps - Provide required notices and assurances - Train employees on their role to ensure nondiscrimination - Modify/remediate any discriminatory practices What can you do right now? Begin by examining current state to help prioritize next steps: 1. Are internal programs/processes compliant with these rules? Are your providers compliant? If not, how much will compliance cost? 2. Is #HEDIS & #PartD #Star measure noncompliance indicative of discriminatory practices? Are #CAHPS, #HOS & #memberexperience surveys highlighting issues where discriminatory activities are masked as #StarRatings weakness? 3. Is every vendor, FDR & supplier compliant with these rules? Are they using any black box algorithms, intervention targeting logic, predictive models, hardware/software, etc which could be discriminatory? If not currently compliant, can they become compliant? Can you wait on their timeline to become compliant? How much will compliance cost? 4. Where can you reduce costs to pay for the increased health expenses which will result from expanded access to benefits and services as equal access for all is operationalized? 5. Are #VBC and risk-contracts masking discriminatory practices by passing decision-making to a different legal org? Is your FDR oversight adequate to find and remediate discrimination by delegates? 6. If your operations are not product-tailored, are any processes or activities “quietly discriminatory” by letting low-literacy, non-english speakers or disabled persons look like they are non-responsive, un-/under-engaged or opt-outs? #ThisIsCahps. #ThisIsHOS. This is #HealthEquity & #HEI. ⭐
568 Comments -
Michael Ruiz de Somocurcio
Very interesting article. It compares hospital and health plan consolidation in specific markets. Indiana is a market that is deemed a high cost market (7th highest in nation for hospital costs) because of hospital consolidation per studies, yet when you look at the market, plans have more leverage as the top 3 represent 91% of the large group market. A few thoughts: 1) you can look at number of hospitals, but it would be better to compare commercial spend for these systems as I would imagine a lot higher than the counts indicate. Some hospitals may have a higher proportion of governmental business and that needs to be considered. 2) Based on plan leverage, one would think plans would say no to continued commercial price increases. It's important though that employers support plans in these discussions. I have seen many times over the years that employers want access above everything else, which means the plan has little leverage with the hospital to take hard line stands or risk losing large national employers who will just switch to another plan creating a vicious cycle of continued cost increases. 3) Under this environment, there is little incentive to move to VBC like arrangements vs. fee for service. 7. For example, in Indiana, the systems with the largest share of total hospitals are St. Louis-based Ascension (13.9%), Indianapolis-based IU Health (11.3%), Mishawaka-based Franciscan Health (8.7%) and Franklin, Tenn.-based Community Health Systems (8.7%). These four systems own 42.6% of all the hospitals in Indiana combined 8. On the other hand, the three largest payers in Indiana — Elevance Health (68.9%), UnitedHealth Group (17.1%) and Physicians Health Plan of Northern Indiana (5.3%) — represent 91.2% of all privately insured patients with insurance from the large-group market.
367 Comments -
Melissa Newton Smith
Earlier today, #CMS issued a #Medicaid Final Rule codifying existential Quality, Access and Accountability requirements. Among other things, these new rules improve #AccessToCare and #HealthEquity by: ⏩ Creating a mandatory MCD Quality Ratings System (#QRS) containing 18 required #HEDIS & #CAHPS measures which mirrors #MedicareAdvantage & #Exchange #StarRatings programs and requires public display of ratings online ⏩ Requiring 10- or 15-day maximum wait time standards for routine appts for OP MH/SUD, #primarycare, OB/GYN & 1 add’l state-chosen service ⏩ Requiring MLR reporting, and minimum 85% MLR if states set a minimum MLR target ⏩ Expanding/encouraging #VBP, #VBC and #APMs and codifies Provider Incentive requirements ⏩ Adding guardrails and clarity for use of ILOS, including enrollee rights/access and oversight (the MCD version of #SupplementalBenefits in #MA) ⏩ Codifying #QualityImprovement expense criteria ⏩ Expanding/strengthening network adequacy and benefit/service availability requirements These rules require Medicaid MCOs to ensure actual access exists for the care and services beneficiaries are entitled to. Just as we've seen recently with CMS changes to #MA, #PartD and #Stars, today’s FR change the game. Especially in combination with the 2027/2030 #DSNP Alignment rules in the 2025 MA FinalRule, these new requirements represent the most change in MCD accountability in decades. Here are 3 practical things Medicaid plans can do immediately for success: 1️⃣ Identify a silo-buster. CMS is aligning programs to minimize burden. It will be hard, if not impossible, to be profitable and highly rated if MA and MCD use separate processes, vendors, provider incentives, etc. It will be even harder to pass along product-specific provider accountability via risk/VBC without cross-program synergy/alignment. #Silobust relentlessly! 2️⃣ Educate, re-educate, re-skill & up-skill. These 284 pages, combined with the 182 in this week’s Nondiscrimination FR and last month’s 1,327 page MA FR can’t be understood or operationalized in your team’s ‘spare time.’ Every person in every team needs to understand the #NewNeedsOfFederalFunding so daily decisions meet new regulatory requirements. 3️⃣ Know your communities, know your providers and know your members. #NextGen solutions in both MA and MCD will require us to know and understand the communities and patients we have the privilege of serving. CMS understands the seismic impact of these rules, and is giving multiple years to come into compliance with the #NewNeedsOfMedicaid. Adaptation will require every bit of the long runways, though it will be tempting to slow-roll transformation since the timeline is long. #WhatGotYouHereWontGetYouThere #Transformation > #TinyTweaks #LetsRoll ⭐ ⭐ ⭐ ⭐ ⭐
11514 Comments -
John Whyte
I recently had the privilege of conversing with Joe Kiani, a trailblazer in the healthcare industry and a visionary leader. Our discussion centered around his innovative approach to making healthcare more accessible and efficient for everyone. Joe Kiani emphasized the importance of leveraging technology to provide high-quality care -- including in the comfort of patients' homes. This not only improves patient outcomes but also reduces the burden on our healthcare system. His work is a testament to how technological advancements can bridge gaps in care delivery and bring about transformative change. One key takeaway from our conversation was Joe's commitment to patient-centered care. By focusing on continuous monitoring and early intervention, we can significantly enhance patient experiences and outcomes. His vision aligns perfectly with the growing trend of personalized medicine and the need for more flexible healthcare solutions – including when it comes to addiction. I love talking to leaders – especially in healthcare – and learning more about their style. Take a listen to how he talks about microfixing and his need to tackle big problems, while at the same time, speaking up when he sees injustice. Let's keep pushing the boundaries and working towards a more inclusive and efficient healthcare system! #HealthcareInnovation #HomeBasedCare #PatientCenteredCare #TechInHealthcare #HealthcareLeaders #Inspiration
2614 Comments -
Cesar M. Limjoco, M.D.
An Outpatient Clinical Documentation Improvement (CDI) program offers substantial advantages to healthcare organizations by elevating patient care and operational efficiency. By integrating risk stratification with chronic conditions, enhancing quality measures, addressing social determinants of health, and establishing a collaborative team empowered by technology, such strategic initiatives result in improved patient outcomes and streamlined operations.
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Jim Pittman
Giuliana Grossi, writing for the AJMC - The American Journal of Managed Care, summarized key insights from the "Implementing Health Equity Through Value-Based Care for People in Medicare" session at the CMS Health Equity conference. Experts discussed innovative strategies to enhance health equity, particularly in postacute care and fee-for-service Medicare. Cindy Massuda and Chris Palmer presented groundbreaking work on health equity in postacute care, focusing on data collection and feedback reports to address disparities. Palmer outlined efforts to integrate health equity into the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program, including the Health Equity Adjustment (HEA) to reward facilities serving dual eligible residents. Maya Peterson provided updates on care management services within the Physician Fee Schedule (PFS), emphasizing social determinants of health (SDOH) risk assessment, community health integration, and principal illness navigation (PIN). Lucy Bertocci discussed the Medicare Shared Savings Program's (MSSP) Advance Investment Payments (AIP), aimed at supporting accountable care organizations (ACOs) with upfront costs. The session highlighted the importance of addressing health-related social needs, stratifying data to understand disparities, and supporting ACOs through innovative payment models. Centers for Medicare & Medicaid Services #HealthEquity #Medicare #ValueBasedCare #InnovationInHealthcare https://lnkd.in/gQPHhKUG
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Hammad Haider-Shah
A few weeks ago, as a healthcare leader, I had the opportunity to listen to Democratic and Republican politicians discuss healthcare at Wisconsin Hospital Association's Advocacy Day. It was a thought-provoking experience highlighting our healthcare system's complexities and challenges. One key takeaway from the discussion was the urgent need for bipartisan collaboration and innovative solutions to improve healthcare delivery and outcomes for all Wisconsinites. Both sides emphasized the importance of accessible, affordable, and high-quality healthcare for everyone, regardless of their background or socioeconomic status, though with very different approaches. In light of this discussion, I believe this where healthcare leadership can focus on driving positive change: 1. Patient-centered care: We as healthcare leaders must prioritize patient-centered care by putting patients at the forefront of decision-making processes. This involves listening to patient feedback, addressing their needs and concerns, and ensuring that healthcare services are tailored to meet individual preferences and requirements. 2. Collaborative partnerships: Building strong partnerships with stakeholders across the healthcare ecosystem is crucial. This includes collaboration with government agencies, insurance providers, healthcare providers, community organizations, and patient advocacy groups. By working together, we can create comprehensive solutions that address the diverse needs of our population. 3. Innovation and technology: Embracing innovation and leveraging technology can significantly improve healthcare delivery. From telemedicine and digital health solutions to data analytics and artificial intelligence, numerous opportunities exist to enhance efficiency, accuracy, and accessibility in healthcare services. 4. Health Equity: Addressing health disparities and promoting health equity should be top priorities. Healthcare leaders must strive to eliminate barriers to care, reduce inequalities in health outcomes, and ensure that all individuals have equal access to essential healthcare services. 5. Workforce Development: Investing in the development and support of healthcare professionals is essential for delivering high-quality care. This includes training programs, continuing education opportunities, mentorship initiatives, and promoting a culture of collaboration and respect within healthcare teams. 6. Financial Sustainability: Healthcare leaders need to navigate the complex landscape of healthcare financing while maintaining financial sustainability. This involves responsible resource allocation, cost-effective practices, and exploring alternative payment models that prioritize value-based care. By focusing on patient-centered care, collaborative partnerships, innovation, health equity, workforce development, and financial sustainability, healthcare leaders can contribute to a healthier, more equitable future for our communities. #WHAAdvocacyDay
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Melissa Newton Smith
As another week of #TukeyGate drama wraps up in #MedicareAdvantage, I’m surprised and saddened by the number of plans not submitting revised bids to capture the newfound revenues they earned through last week's CMS adjustments. Thursday’s #HPMS memo is a stark reminder to plan leaders: any plan receiving an upward adjustment to their overall #StarRating through the June 13 #Tukey recalculations will not reap the benefit of their increased rating unless they submit a revised bid. If you ended last week thinking you'll skip submission of a revised bid, I strongly encourage you to reconsider that this weekend. Choosing not to submit a revised bid under these circumstances in order to collect the money your organization is legally entitled to is perhaps one of the highest-stakes business decisions I can recall in MA. Many plan leaders don’t realize that “Quality Bonus Payments” are not a transactional “bonus” payment paid directly by #CMS to #MA plans – rather, #QBP is ‘disbursed’ to plans through an adjustment to the benchmarked rate submitted in bids. Yes, I know. Submitting a revised bid on a super short timeline (now down to just 1 more week) is hard. Requires an all-hands on deck fire drill. Potentially using vendors or consultants who you have to ask to work “off paper” with a promise to get contracts and payment in place after submission. The sheer volume of analytical work done by #Stars teams and Stars-centric vendors in the last 10 days is enormous and hard to quantify. Every MA plan is trying to reverse engineer the math to figure out whose ratings increased. With immense effort being asked of Stars teams. But many of those plans that were impacted are choosing not to submit new bids and will forego the newfound funding. While I understand this is the easiest pathway for plan personnel (especially during the summer slowdown), it harms your members and providers, since 85% of revenue has to flow back out as MLR. Monday is the deadline to notify CMS if you plan to resubmit your bid to leverage the increased revenue associated with Tukey-related changes. If your plan was impacted and you are reading this over the weekend, please don’t miss your opportunity. There is still time to add relatively simple, yet impactful adjustments, to your bid through a rapid revision before next week’s deadline to use the incremental revenue CMS’ adjustment provided to your contract(s). Please don't miss your chance. Trust me. This IS your commitment to the best possible #MemberExperience. And since benefit erosion will hit on 1/1, this is your most critical MY2024 #CAHPS decision. Your beneficiaries will thank you. Your providers will thank you. Your Board will thank you. ⭐ ❤️
12526 Comments -
Robert Bowman
"However, these savings—as much as $50 billion annually1—are unreported and not shown to improve care access for patients without adequate insurance.2,3" ---Well, the financial design is so bad that it has closed over 600 hospitals since DRG and the era of cost cutting. The financial design is the reason for closures and compromises. The 50 billion distributed to hospitals serving vulnerable populations (40 - 50% of US pop) would be some help due to the Era of Cost Cutting 1983 to 2030 or longer. "Per CMS’s budget neutrality principle in the Outpatient Prospective Payment System (OPPS), the $9 billion repayment must be offset by $7.8 billion of cuts to nondrug reimbursements." ---Budget neutrality and regulatory capture prevent any true reform to add support to the hospitals and practices serving most Americans most behind. Once again CMS is not accountable and must be reigned in even if it takes 50 years as it did for physician accountability over the last half of the 19th century and for human subject researchers over the last half of the 20th century. Medicare and Medicaid have failed for 2621 counties (40% of US) most behind and has primary care and basic health access except 1965 to 1978. What about the Belmont Principles and numerous violations? What about protection of vulnerable populations, informed consent (which requires prior study of consequences poorly done by CMS), or beneficent intent - especially with all three lining up consistently against the majority of the nation most behind time after time! Strike 1 for ethical and moral violations - CMS has demonstrated time and again the inability to protect their charges - vulnerable Americans. CMS most fails where there are concentrations of elderly, poor, disabled, and their worst public plans. Strike 2 - CMS has failed to do adequate studies of consequences prior to the implementations of policies since 1983 and including Medicaid Waivers which will steal more from team member support and give more for team members to do - with worst impacts on Community Health Centers with 50% Medicaid and in the most vulnerable populations highest in concentrations of Medicare, Medicaid, and Dual plans. Studies are done more to justify what CMS is doing rather than to protect most Americans most behind from consequences such as their providers rated poorly or penalized just for caring for these populations inherently lower in outcomes and drivers of outcomes (Readmissions, ACO shared savings, Star Ratings, others) Strike 3 - CMS fails for beneficent intent. The intent is cost cutting. CMS harms tens of millions with designs that have killed hundreds of hospitals and countless practices, delivery team members, and local leaders in health and other community areas. We know about some economic and access impacts from these losses, but the full impact and cascades of impacts are never studied. See comments for losses of jobs, income, leadership, and better health insurance
3 Comments -
Jonathan Goldfinger
Even incremental primary care progress in Congress is progress. I’m with Lonnie - these bills focused on primary care finance reform for low-income families and seniors are likely a step in the right direction. At the same time, I hope for even more focus on funding integrated care both directly and through outcomes-based payment. And for integration of integrations across siloes, like merging SAMHSA CCBHC’s vs. HRSA FQHC’s. Does a person in a crisis really need a new medical home or is this a sign we failed them in their first one? Come on feds! Let’s get together and model healthcare that does the same! If not, siloed funding risks further workforce #burnout from greater complexity. #mentalhealthishealth #traumainformedcare
23 Comments -
Damian Rasch, DO, MBA
As a cardiologist and aspiring economist focused on healthcare policy, I'm deeply concerned by the rise of Medicare Advantage plans. On the surface, these plans promise to deliver Medicare benefits more efficiently through private insurers. But a closer look reveals how prior authorization requirements in Medicare Advantage often restrict medically necessary care, to the detriment of patients and the healthcare system. The numbers tell a very scary story: In 2021, Medicare Advantage plans denied 6% of over 35 million prior authorization requests, frequently overruled on appeal. 82% of prior auth denials are overturned when appealed, suggesting many should not have been denied to begin with. Only 11% of patients appeal denials, often unaware of their rights or daunted by the complex process. The economics are clear - plans have a financial incentive to restrict expensive care via prior authorization, as they are paid a fixed amount per patient. Denying care boosts their bottom line. The human costs are also apparent, as patients face delayed or foregone treatment, worse health outcomes, and surprise bills for denied services. Doctors and hospitals must divert resources to fighting denials. Medicare Advantage has strayed from its promise, prioritizing profits over patients. Healthcare leaders and policymakers must scrutinize these practices and enact reforms. Protecting access to care should be the priority. Our system fails when it rewards insurers for saying "no" to patients in need. The new rules are a start, but robust enforcement will be key. Patients deserve a system that provides fair, timely access to quality care - not one that rations it to pad corporate profits. It's time we rethink the trajectory of Medicare Advantage, before it does irrevocable damage to Medicare and the patients it serves.
7912 Comments -
Fernanda Bigolin, Ph.D
What makes a children's hospital a true unicorn in healthcare? Cincinnati Children's Hospital is a model of excellence in healthcare. This hospital stands out for its quality pediatric care and its adherence to the principles of #HighReliability Organizations (#HRO). How is this achieved? ➡ Excellence in Child Care: The hospital is recognized for its high-quality pediatric care. ➡ Constant Innovation: Investments in innovative technology and processes to improve patient outcomes. ➡ Governance Model: Effective organizational structure that promotes security and efficiency. ➡ Community Impact: Active engagement in the community to promote children's health and well-being. ➡ Adherence to HRO Principles: Cincinnati Children's commitment to the principles of HROs has resulted in significant improvements in patient safety and operational efficiency, making it a true example for healthcare to follow. Do you know how your organization can benefit from implementing HRO principles? #patientsafety #healthcare #hro #highreliability
33 Comments -
Matthew Simpson
#AHRQ's National Center for Excellence in Primary Care Research just released a report highlighting AHRQ's investments in primary care research for fiscal years 2021 and 2022. Over these two years, AHRQ dedicated funds for 128 grants/cooperative agreements and 12 contracts. Specific areas of focus included digital healthcare, practice improvements, person-centered care, health equity, and behavioral health.
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Tiya LaCroix
Keep our rurals open but if you really want to help get the foreign equity owned GPO that sets the pricing for our hospitals BANNED from our state. Economies of scale are used by Vizient against Oklahoma rural hospitals. If you have 13 tiers, hidden tiers, and tier maxes…that’s not a contract, that a free for all nightmare of a scam we all fell for. Their awful written tiered agreements force our rurals to pay more for the exact same items that our large hospitals pay less for. Example box of gloves a large hospital system in the state will pay 6-8 bucks for a box of 250 exam gloves. That same box for a rural EMT? 24 bucks. There is no price transparency and you are forcing patients who live in rural areas to pay more because of the lack of infrastructure by the corporations serving them to effectively and economically get goods and services to these hospitals. And distributors who whine about the cost of delivering to rural hospitals all while posting BILLIONS in profit every quarter are the first on my 💩 list. Let’s keep our rurals open but let’s make them more profitable so that they can continue to add much needed services and gainfully employ more community members.
61 Comment -
Philip M. Alberti
✴ CALL FOR ABSTRACTS ✴ Building data capacity to study health equity in patient-centered outcomes research The Office of the Assistant Secretary for Planning and Evaluation (ASPE) is sponsoring a special issue in the journal Medical Care focusing on patient-centered outcomes research (PCOR). The special issue will feature papers that highlight opportunities focused on how data can be collected, linked, analyzed to support PCOR studies that incorporate a health equity lens to address questions important to patients, caregivers, and communities; clinicians; and policymakers. ✴ Abstract Submission Due Date: 7/1/2024 ✴ Submit here: https://lnkd.in/eJgaHyZJ #healthequity #healthcareequity #PCOR #patientengagement #communityengagement #opportunity #research #data RAND
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Lakshmi “Deepa” Yerram MD MHA
Empowering FQHCs, RHCs & Small Primary Care Practices on the Path to Value-Based Care (VBC) Considering a move towards VBC? ACOs and MSSPs offer a rewarding path for FQHCs, RHCs, and small primary care practices to deliver high-quality, coordinated care while achieving financial stability. This table provides a helpful comparison of various ACO and MSSP models, highlighting their benefits, challenges, and suitability for your practice. Start Your VBC Journey with Less Risk: MSSP (Basic & Enhanced Tracks): These tracks offer a solid entry point with shared savings incentives for meeting quality and cost-saving goals. Track 1+ Enhanced Model: This variation provides similar advantages to the Basic Track MSSP but with a lower risk profile and reporting burden, making it ideal for ACOs new to VBC. Explore the table (link to your table) to find the model that best aligns with your practice's needs and resources. Ready to discuss your options? Share your thoughts in the comments below, and let's connect to explore how VBC can benefit your patients and practice! #VBC #ACO #MSSP #HealthcareInnovation #PrimaryCare
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Thomas Culhane, MD, MMM, MS
Interesting intrigue around the 4-star to 3.5 star 5% PMPM (HUGE for #healthplans) quality bonus #Obamacare cliff. Proposed #CMS changes may help the perennial 3.5 star plans (the #Centene's and #Molina's of the world) and hurt the 4.0 and 4.5 star plans (the nonprofits #Kaiser's, #UPMC's, #Providence's, etc). $20B in bonuses is in play over 10 years. Looks to be best to attain and maintain 5-Stars whenever possible (consistently demonstrate the absolute best care for the population served, demonstrate the best taxpayer value and the Obamacare-granted power to market for new membership the year around). #Darwinianism rules! #SDOH #HealthEquity #HealthcareReform #HealthcareTransformation #PrimaryCare #PopulationHealth #PatientCenteredCare #PatientCenteredHealthcare #HealthcareQuality #ValueBasedCare #ValuebasedHealthcare
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