Innovista Health’s Post

Better primary care and pay for value continues to progress in Medicare thanks to Purva Rawal, Meena Seshamani, Liz F. and team. Nice status check here. What about care for people who carrying insurance through their employer? Slower progress. Given the goal articulated here of having 100% of Medicare in accountable care by 2030, it will be critical for HHS to engage employers as a partner in health system evolution. Put differently, think about a practice that cares for 90% commercial patients ... why would they play in these demos? Changing the delivery system will ultimately require engaging employer sponsored healthcare, so we need to be thinking about this together now. There are many elements to this from a policy perspective - including ensuring that programs such as FEHB are as engaged as Medicare and better connectivity through TEFCA. But maybe most important, creating a locus point within the Federal government where employers can engage to drive more consistency. We're working on all of these questions at Morgan Health, and always looking for like minded organization - let us know what you think.

Medicaid covers nearly one-fifth of our population—yet it has long been overshadowed when it comes to healthcare innovation. That’s changing fast. By giving states greater flexibility and focusing on social factors that shape health, Medicaid is becoming a trailblazer for more holistic, technology-driven models of care. Here’s how diapers, data, and digital tools are redefining what it means to deliver value. https://lnkd.in/edTsdSEC

Medicaid covers nearly one-fifth of our population—yet it has long been overshadowed when it comes to healthcare innovation. That’s changing fast. By giving states greater flexibility and focusing on social factors that shape health, Medicaid is becoming a trailblazer for more holistic, technology-driven models of care. Here’s how diapers, data, and digital tools are redefining what it means to deliver value. https://lnkd.in/e3HfgArv

Better integration between Medicare and Medicaid supports better outcomes for dually eligible individuals. Hear more on how ACAP D-SNPs are improving health: https://bit.ly/3Reixci    #Medicare #Medicaid #DualEligible 

In the last decade, value-based care has grown from almost nothing to undeniably significant aspect of our health system,” including accountable care organizations making up 20% of Medicare. This iteration of the playbook synthesizes what we’ve learned over the last decade plus, so that payers, physicians, hospitals, and ACOs can implement payment and delivery models that improve outcomes and lowers costs. Getting important aspects of value-based payment right is crucial for continuing to advance physicians’ success in helping their patients achieve good health outcomes in these models. This playbook reflects input from physicians in an array of practice settings on their lessons learned for patient attribution and financial risk and benchmarking. It will be a valuable resource for both those with experience in value-based care and those who are just getting started. #valuebasedcare #healthcare https://lnkd.in/e8VR5XHJ

Research in JAMA Health Forum underscores the benefits of better integration between Medicare and Medicaid for people who are dually eligible.     People whose Medicare and Medicaid plans were more highly integrated reported higher levels of satisfaction with their health plans, were more likely to report being treated respectfully by customer service, were more likely to know how to obtain information related to their health and healthcare, and reported less out-of-pocket spending.    These findings add to the growing body of knowledge on improving health for dually eligible individuals and are yet another reason I am proud to be working with the Association for Community Affiliated Plans (ACAP) and Medicare-Medicaid Integration Alliance to advance policy solutions.    More on the research findings in McKnight's Home Care: https://bit.ly/3zmVyG7     #Medicare #Medicaid #DualEligible  

From Harvard to Medicaid: Why Even Healthcare Insiders Struggle with the System In a revealing look at the complexities of our healthcare system, two industry insiders share their unexpected personal struggles. Here's why their stories matter: 🔹 Unexpected Challenges: A Harvard-educated physician and a healthcare leader both faced healthcare access issues they thought they'd be immune to. 🔹 Hidden Struggles: These experiences highlight how health-related social needs and system navigation difficulties can affect anyone. 🔹 Systemic Flaws: Our healthcare system often fails to account for the complex realities of individuals' lives. 🔹 Call for Change: The authors advocate for a new approach that anticipates unexpected needs and closes systemic gaps. 🔹 Promising Solutions: Auto-enrollment, payment reform, and data sharing are highlighted as potential game-changers. 🔹 Collaboration is Key: The article emphasizes the importance of 'co-opetition' and cross-sector partnerships in driving meaningful change. Key Takeaway: To truly improve healthcare, we must embrace the complexity of lived experiences and build a more connected, holistic system of care. Have you or someone you know faced unexpected challenges in navigating the healthcare system? How can we better design our systems to serve everyone? #HealthcareReform #PatientExperience #HealthEquity #SystemicChange

From 2019 to 2023, there were 84 #Medicaid managed care RFPs released, including 68 for Medicaid health plans, 6 for Medicaid pharmacy benefit management plans, and 10 for dental benefits. A list of those RFPs can be found in our recent report, Medicaid Health Plan Request For Proposals (RFPs): An OPEN MINDS Market Intelligence Report. Read now: https://lnkd.in/edwwx8yv #MedicaidAwarenessMonth #ManagedCare

📈 "Value-based care models have already seen a 25% increase in health care provider participation from 2023 to 2024, based on data from the Centers for Medicare & Medicaid Services. However, these models can be challenging for health care practices, and success (i.e., operating at a profit while providing quality care to patients) requires an understanding of the reimbursement model, significant investment in infrastructure and expertise, and possible changes in the way medicine is practiced." I'm proud to be at Stellar Health, where we simplify, enable, and reward the delivery of value-based care to all Americans, making it not just easier but even enjoyable for care teams. 👇 Comment below or DM me to learn more about how we partner with health plans and systems. I'll send you a recent KLAS Research study titled: "Improving Patient Outcomes and Coding Accuracy by Incentivizing Non-Provider Staff." #valuebasedcare #vbc #stellarhealth #qualityimprovement #healthcare #healthcaretechnology #healthplan #primarycare #medicare #medicaid #populationhealth

Fiscal rationing of physician reimbursement by insurers augments prior authorization rationing of physician recommended care to enhance profits for health insurers with no evidence that this improves access, outcomes or costs for patients. The quantity or consequences of this rationing is never revealed or transparent. #tripleaim #medicareadvantage #healthcare #hmo #publicprivatepartnership