Giving birth in the United States is dangerous, and even more so if you are Black or Indigenous, live in a rural area, or have a low income. Maternal deaths continue to rise, even though the vast majority are preventable. The rate of people experiencing severe maternal morbidity is climbing, and perinatal anxiety and depression…
Download Slides Download Handout Learn about innovative and unconventional approaches to Medicare Advantage HEDIS strategy from real-world experiences. It’s a new year! And now is a great time to evaluate last year’s performance, review your current strategy, develop a plan, and set new goals to close gaps in care. Make 2024 the year you…
As we move into 2024, health care is experiencing unprecedented digital innovation and transformation. New technologies and capabilities are emerging to enable organizations – including payers, providers, and self-funded employers – to confidently take on risk in value-based care (VBC) programs. The American Academy of Family Physicians reports that 49% of practices are participating in some form…
Large language models, a form of artificial intelligence, are generating a lot of hype in healthcare circles, primarily because of their potential to transform and improve various aspects of healthcare delivery and management. The buzz also is driven by rapid advancements in AI and machine learning. But while there’s significant potential, challenges and ethical considerations…
Risk Adjustment Factor and CMS-HCC Model The Centers for Medicare & Medicaid Services (CMS) utilize Hierarchical Condition Category (HCC) risk adjustment models to predict forthcoming healthcare costs for Medicare Advantage patients, considering health status and demographic factors. The Risk Adjustment Factor (RAF) score determines CMS payments to health plans per patient. Medicare Advantage Organizations (MAOs)…
Chicago-based Medical Home Network (MHN), a nonprofit organization focused on transforming care in the safety net, is partnering this year with 64 federally qualified health centers (FQHCs) in seven states to participate in two CMS value-based programs: ACO REACH and the Medicare Shared Savings Program (MSSP). MHN provider partners participating in the NeueHealth Premier ACO…
ABSTRACT Objectives: To assess in a Medicare Advantage population (1) whether discharge to home health, compared with discharge to home, following an inpatient stay subject to CMS postacute care transfer (PACT) regulations, is associated with better outcomes or lower expenditures and (2) whether the impact differs among subpopulations. Study Design: Claims-based retrospective cohort study. Methods:…
Payers, health systems, and health professionals will experience expanded accountability for performance in closing health disparity gaps in 2024. With advances in public health research, many modern health challenges have been attributed to how social and ecological factors, commonly referred to as social determinants of health (SDOH), can influence health outcomes. To measure the progress…
As the healthcare landscape continues to evolve, there’s a clear trend towards value-based care (VBC). This significant shift, which places a premium on patient health outcomes, diverges from the traditional fee-for-service approach. The aftermath of the COVID-19 pandemic has mainly catalyzed the adoption of VBC models, highlighting the importance of care quality and effectiveness rather…
With the push towards health equity and away from a fee-for-service model of healthcare, risk-bearing organizations have an opportunity to join the ACO REACH (Realizing Equity, Access, and Community Health) program. In the program, Centers for Medicare & Medicaid Services (CMS) encourages ACO REACH participants to work with underserved communities. Further, the program guidelines mandate…