Catherine Anderson

I’m following Stabilize #Medicaid and #CHIP Coverage Act (H.R. 5434 and S. 3138) closely. Consistent, comprehensive coverage is critical for overall health and I’m curious to see what traction we’ll see this #Congress… https://lnkd.in/gvCWaqVC

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My Friday good news celebrates the heroes of value-based care: primary care physicians and teams. The most successful #Medicare ACOs, those delivering value for Medicare and Medicare beneficiaries and sharing in that value, are primary care-centric #ACOs. We know how they do it; the playbook often includes support from enablers like Aledade, Inc.. Dr. Menard and his colleagues didn't give up when success wasn't immediate. How do we grow more primary care-centric ACOs and generate more value for Medicare and more access and quality care for beneficiaries? There are some health system ACOs investing in primary care and integrated teams. But it might take more forceful nudges from Medicare to get big health systems participating in total cost-of-care risk models. Or, we might need payment policies to give primary care more independence to practice comprehensive care. Congress could also consider restructuring the APM bonus to reward primary care "centricity". #primarycare #valuebasedcare Primary Care Collaborative David Raths David Muhlestein AAFP Foundation Thomas Culhane, MD, MMM, MS Darrin Menard, M.D. Stacey Richter https://lnkd.in/dThMvJrQ

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It's thrilling to have Thomas Novak, the whisperer of all things related to #Medicaid systems interoperability, mention #Consent Management services, not once, but TWICE in a single post. For those who missed it, state Medicaid agencies can receive enhanced federal matching funds to provide supportive health IT services that improve care coordination for individuals being treated for behavioral health and/or substance use disorders (SUDs). Electronic Consent Management (ECM), for those new to the concept, means offering an accessible source-of-truth database for the data-sharing preferences (consents) of individuals with sensitive information in their health records to be stored and made known, with role-based access controls. The ECM does not store medical records; rather it serves as a traffic cop for organizations that need to share specially-protected information for the purpose of care coordination, or for other purposes as individuals choose to allow, based on consent forms in the system (e.g., eligibility and enrollment, research studies, notification of clinical trials, and others). Care coordination for behavioral health and SUD treatment is highlighted in the announcement, but this service will be valuable for reproductive and gender-related healthcare services as well. There will be a roadmap available soon to state Medicaid agencies that are interested in implementing an ECM, because this is exactly what Washington State Health Care Authority is doing with Midato Health's ShareApprove electronic consent management registry service! Washington's service will be called ConsentLink, and the first SUD clinics in Washington are slated to go-live on ConsentLink on August 13th. Stay tuned! A partial list of people and organizations instrumental to Midato Health: Laura Nixon Pete Robinson Mike Bertrand Cindy Throop Brett Johnson Mohammad Jafari Don Ross, BS, ACHE John Barranco Bren Shipley Dawn Bonder Vatsala Kapur Vani Kapur Douglas Jenkins Laura Kreofsky, MHA, MBA, PMP, CDH-E Preston Dodd Tresa Thomas Massiongale Mary-Sara Jones Jerry Carleton Yan Cui Graham Baradoy Fred Hong Lucy Wightwick Ayaka Yoshida Danni Zhang Jing Yan (Jennifer) Dai Waleola Akinsanmi Kyle Bacon Catherine Veraghen @360 Social Impact Studios Newfire Global Partners Toptal Delap LLP Immix Law Amazon Web Services (AWS) Olio https://lnkd.in/gGSSp7ju

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2025 MA star ratings released last week—and not all health plans fared well. Stakeholders across the country are now poring through the data to understand trends and implications. Fierce Healthcare shared some key takeaways from our preliminary analysis here: https://bit.ly/3BIrrtX

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I love to see Medicare Advantage plans subject their results to rigorous peer review, and Humana has consistently done this. This study looks at "senior-focused primary care practices" and outcomes of their MA enrollees. Cut-to-the-chase--more primary care is associated with fewer ED visits, hospitalizations, and readmissions, and other quality outcomes are quite strong compared to a similar set of beneficiaries in TM. These outcomes are consistent with other findings, such as from the MSSP ACO program. These results don't mean that current MA payment methods are accurate, but it does mean that some MA plans have a business model that aligns with beneficiary interests and are partnering with physician groups well and paying for better outcomes. Would be great to see more MA plans do this kind of research! #MedicareAdvantage #primarycare Humana Kate Goodrich Emily Boudreau Health Affairs Better Medicare Alliance https://lnkd.in/dSgQ96RD

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Fiscal and demographic challenges threaten the financial sustainability of #Medicare, requiring a broad effort to modernize the program. Our new Solutions Brief recommends several policy reforms for decreasing the cost of Medicare and other Federal health programs while increasing the quality of care for patients: https://lnkd.in/eKbbQiiv

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🗣 HealthSherpa's FFM Reintegration The Centers for Medicare & Medicaid Services (CMS) has issued new guidance on correctly integrating FFM accounts with HealthSherpa for Agents. If you haven't received these instructions, please follow the steps below. 👇 1) Ensure you are logged out of the CMS Enterprise portal. https://lnkd.in/et64YmKf 2) Log in to your HealthSherpa for Agents account. https://lnkd.in/ebsnswFv 3)Navigate to your Settings page and select ‘Remove My FFM Account’ (refer to the screenshot below). 4) Reintegrate your FFM account. For more information on how to reintegrate your FFM account with HealthSherpa, visit this help page.https://https://lnkd.in/eQBJxh5R

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A new Health Affairs article authored by Centene, with support from Manatt Health, discusses continuous coverage for youth enrolled in #Medicaid and #CHIP, particularly the causes and consequences of coverage gaps, the benefits of stable coverage, and current state activity on continuous enrollment policies. Learn more and read the article here: https://lnkd.in/eeZhrX2Z

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Eric Parmenter Quantum Health Vice President of Health Systems, and Brent McDonald Sr. Vice President & Chief Strategy Officer for Vanderbilt University Office of Population Health spoke at the Iscebs Symposium to discuss the future of value-based care, a model evolving since the Affordable Care Act (ACA) of 2010. With healthcare costs rising by 7% in 2024, employers face significant challenges including unsustainable benefit expenses, stagnant wage growth and the financial burden of Medicare and Medicaid underpayments. As traditional models strain business resources, the need for employers to adopt next-generation value-based care is more urgent than ever. Learn more about how value-based care is revolutionizing employee benefits at https://hubs.ly/Q02P-X8t0. #24symp #HealthcareNavigation

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A new #EBHC scoping review explores how health service and delivery systems in high-income countries define and operationalise #HealthEquity. 👉 https://ow.ly/ZxaY50ShGWU

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A historic and monumental win for #healthcare providers in the battle against big #healthinsurance! On October 14th, providers reached a $2.8 billion #antitrust settlement with Blue Cross Blue Shield (BCBS) entities across the country and Blue Cross Blue Shield Association, to resolve BCBS’s long-standing underpayments and anticompetitive practices.  This includes a $2.8 billion cash payment into a settlement fund, as well as investments by the Blues of hundreds of millions of dollars in system improvements for the benefit of providers. Providers must now decide whether to participate or pursue independent claims. Legal consultation is recommended for providers evaluating their options. Allia Group finances litigation on behalf of providers to recover fair payment and address insurers' unfair business actions. Contact us for a consultation. https://lnkd.in/eH8r-xtd

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📢 COMING TOMORROW: Our June 2024 report includes recommendations to Congress on improving the transparency of financing the non-federal share of #Medicaid and #CHIP and recommendations to states that address integrated care for people who are dually eligible for Medicaid and #Medicare, and more!

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UnitedHealthcare is anticipating a potential disruption in its #Medicaid business as millions lose coverage after the COVID-19 public health emergency ends. Investor concerns about Medicaid disenrollment caused a drop in UnitedHealth's stock price, impacting other major insurers as well. Andrew Witty, UnitedHealth CEO, acknowledged the "prolonged redetermination cycle" in Medicaid and the challenge of maintaining "perfect synchrony" between utilization and rates. UnitedHealth assured investors that recent cyberattacks won't impact their upcoming Medicaid program bids. Despite the Medicaid challenges, UnitedHealth outlined its investment strategy, highlighting areas like value-based care, pharmacy benefits management, and technology. Learn more: https://hubs.ly/Q02zxKM00

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Another section of the #FinalRule has been released by #CMS aimed at enhancing #access to and #transparency of #Medicaid services, including #HCBS. This rule pairs with two other final rules published in April 2024 that focus on improving Medicaid #eligibility and access to Medicaid services. This rule is focused on an #FFS system, but the impact could involve changes to underlying FFS rates in base #data for #ratesetting and program #oversight in #MLTSS. Dianne Heffron and Meredith Mayer of Mercer US Government have conducted a review of the proposed and finalized rules. https://bit.ly/3QuGRXe

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#SDPSeptember kicks off with the release of our new brief, “Better Care Access and Outcomes with Medicaid State Directed Payments.” Learn more about how #EssentialHospitals are using state directed payments (SDPs) to improve care in communities. https://bit.ly/47t3sdN

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