CAQH’s Post

New blog!    As the largest healthcare payer in the US, Centers for Medicare & Medicaid Services sets the bar for health equity data collection.   However, with changing guidance and a constantly evolving landscape, measuring health equity continues to challenge health care leaders.   Read our latest blog on collecting quality data in hospitals > https://lnkd.in/dB8WPmPA   Curious how TKG can help retool your health equity strategy? Contact inquiries@thekinetixgroup.com    #healthequity #hospitals #CMS

As we look ahead to the Centers for Medicare & Medicaid Services QIN-QIO 13th Statement of Work, Comagine Health is actively exploring the most effective approaches to address the diverse needs of providers and communities across Region 6 while supporting the QIN-QIO Program at the national level. That’s why, in collaboration with five partner organizations, we interviewed 68 health care leaders across 14 states to spot barriers and discover opportunities for quality improvement. A primary insight: It’s important to align the QIN-QIO Program’s goals with those of each health care system or medical group. Such alignment would not only simplify participation but could foster a sense of mutual support as opposed to the feeling of managing competing priorities. Want to know more? Get the full report at https://lnkd.in/gezfQHdC. Thank you to the following organizations that conducted interviews in support of this project: * Alliance for Health Outcomes and Performance Excellence (AHOPE) — a partnership between KFMC Health Improvement Partners and Kansas Healthcare Collaborative * Great Plains Quality Innovation Network * Iowa Healthcare Collaborative * Quality Health Associates of North Dakota * South Dakota Foundation for Medical Care #QIO #QualityImprovement

Transitioning to a value-based care (VBC) model offers numerous benefits for healthcare companies! These benefits include improved patient outcomes, reduced healthcare costs, and enhanced patient satisfaction. By focusing on delivering high-quality, patient-centered care, companies can also achieve better care coordination and increased patient engagement. To start implementing a value-based care model, companies can take several proactive steps. First and foremost, they should identify high-risk patient populations to design targeted interventions that emphasize prevention, wellness, and chronic disease management. Developing a care model that prioritizes patient outcomes and quality of care is essential, as is ensuring that healthcare teams are well-coordinated and trained to deliver high-quality care. Leveraging technology is another crucial step. Data analytics and robust IT infrastructure can monitor and improve care delivery, ensuring patients receive the right care at the right time. Collaborating with other healthcare providers, payers, and community organizations creates a supportive network that enhances the overall care experience. By embracing these strategies, healthcare companies can position themselves at the forefront of delivering high-quality, patient-centered care. This proactive approach not only facilitates a smooth transition to a value-based care model but also contributes to a more sustainable and efficient healthcare system. 🌟 You can read more about this much needed shift in this article from Commonwealth Fund: https://lnkd.in/g4UusZ_2 #ValueBasedCare #HealthEquity #PreventativeCare #ChronicDiseaseManagement

inVio Health Network and CVS Accountable Care Partner to Improve Medicare Patient Care in South Carolina - HIT Consultant #inVioHealthNetwork and #CVS Accountable Care have partnered to enhance Medicare patient care in South Carolina through an Accountable Care Organization (#ACO). The collaboration aims to improve patient outcomes, reduce costs, and enhance care coordination for Medicare beneficiaries in the state. The partnership will leverage technology and data analytics to identify high-risk patients, implement care management strategies, and drive better health outcomes. This initiative demonstrates the growing trend of healthcare organizations working together to deliver more efficient and effective care to patients, particularly those with complex healthcare needs. #MedicarePatientCare #SouthCarolina #HealthcareCollaboration #DataAnalytics #CareCoordination. ai.mediformatica.com #health #network #healthcare #medicare #accountablecare #collaboration #this #patientcare #medicarebeneficiaries #mssp #populationhealthmanagement #prisma #digitalhealth #healthit #healthtech #healthcaretechnology @MediFormatica (https://buff.ly/442fYPO)

News from First Report Managed Care: The current Medicare Physician Fee Schedule brought many significant changes to increase access to much needed virtual care management (VCM) services to underserved populations. Learn more about the potential implications of these fee changes from an expert in this interview with Brian Esterly. #FirstReportManagedCare #FRMC #medicarephysicianfeeschedule #medicare #virtualcaremanagement #VCM

I’m excited to share that I was featured in Becker's Healthcare Payer Issue article on the 12 opportunities payers can seize next year. It was an honor to contribute to this insightful discussion alongside other industry leaders. As I reflect on the many opportunities ahead for payers, I believe the biggest opportunity in the next 12 months lies in advancing health equity. As key stakeholders in the healthcare ecosystem, payers have a pivotal role in ensuring that all individuals, regardless of their background, have access to quality care. Prioritizing #health #equity not only improves outcomes but also builds #trust and strengthens #community relationships. This approach ensures targeted and effective interventions, leading to a more equitable healthcare system. Thank you to Becker’s Payer Issues for including me in this important discussion. #HealthEquity #ValueBasedCare #CommunityHealth #HealthcareLeadership #PayerOpportunities #EquitableCare #HealthcareTransformation

Since the beginning, we’ve committed ourselves to building on existing evidence around the benefits of addressing social drivers of health, including the impact on health and costs. What we’ve found has been truly remarkable. Last week, we shared new data showing companion care reduced medical costs by 9% and improved healthcare utilization, including reducing inpatient hospital admissions by 18%, in a broad Medicare Advantage (MA) population. This is in addition to prior claims analyses we and our partners have conducted, which show in-person social support significantly impacts costs and use of healthcare services across populations. For example: 💡 Among socially isolated MA members, Papa reduced medical costs by 19% and increased primary care visits by 19% as well. 🏥 In a Medicaid population of high emergency department (ED) utilizers, medical cost reductions came in at 33%, while ED visits decreased by 25%. Together, these findings validate our novel approach to meeting the health-related social needs that disproportionately drive health outcomes. Learn more about the undeniable impact of #CompanionCare, how we approach research and innovation at #Papa, and how we use these findings to propel our service—and our value—even further: https://bit.ly/4aEatss

APMs incentivize healthcare providers to deliver high-quality, coordinated care to patients. The CMS Innovation Center regularly tests new payment and delivery models to identify which strategies successfully improve care and lower costs. First, APMs should directly reward reductions in health disparities. Second, models should consider how upfront funding can be used for equity purposes, and third, payments should be adjusted for the social risks of the populations served. #healthequity #healthdisparities #primarycare #accountablecare https://lnkd.in/gCKdZ67u

Quality healthcare is the degree to which health service experiences consistently improve desired health outcomes. It is about doing the right thing, at the right time, in the right way, for the right person. Responsible for the total cost and #quality of care for approximately 90,000 Traditional Medicare beneficiaries in 2023, we at agilon health are doing it right. Our 8 full risk Accountable Care Organization's - Realizing Equity, Access, and Community Health (ACO REACH) model programs achieved $150 million in gross savings and a 95% quality score! Through a keen focus on empathetic listening to senior's wants and needs and collaboration with some of the most empathetic and psychologically aware physician leaders and partners in the nation, we continue to elevate the #humanexperience in #healthcare with sustainable, scalable, solutions. Together, as we reimagine care delivery, we outperformed the national average in the CMS ACO REACH Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience survey in 7 out of 8 domains, with 5 out of 8 in the 90th percentile! If you want to know the secret, simply ask any patient, "What does quality healthcare mean to you?" Then LISTEN... and ACT on that feedback. https://lnkd.in/efgQ_E-M

In his article in The American Journal of Accountable Care, Dr. Mohamed Diab, MBA, discusses the challenges facing the healthcare system. He highlights issues like a lack of care coordination, physician burnout, and misaligned incentives that contribute to inefficiencies and poor outcomes. To improve the system, Dr. Diab advocates for a shift towards value-based care, which focuses on improving patient outcomes and addressing health disparities. Dr. Diab points out that a significant portion of healthcare spending is wasted, and health inequities lead to additional costs. He emphasizes the need for a more efficient and effective system, especially as the population ages and requires more complex care. Dr. Diab believes that accountable care organizations (ACOs) can play a crucial role in this transformation by promoting care coordination, addressing social determinants of health, and leveraging data and analytics to improve care. In conclusion, Dr. Diab urges physicians to embrace value-based care and engage with organizations like ACOs to drive positive change in the healthcare system. He emphasizes the importance of staying informed and collaborating with colleagues to provide better care for patients. AJMC - The American Journal of Managed Care #ValueBasedCare #HealthcareTransformation #ACOs #PatientOutcomes https://lnkd.in/eA6AZYqg