Category Archives: dual eligibles

Pioneer ACO Results Year 2: Inpatient Utilization Down; Medicare Saves More Than $384 Million

The Pioneer Accountable Care Organization (ACO) Model has generated over $384 million in savings to Medicare over its first two years — an average of approximately $300 per participating beneficiary per year — and significantly decreased inpatient care, while continuing … finish reading Pioneer ACO Results Year 2: Inpatient Utilization Down; Medicare Saves More Than $384 Million

Posted in Accountable Care Organizations, affordable care act, Alternative Healthcare Coverage, Avoidable Hospitalization, Care Coordination, Care Transitions, Disease Management, dual eligibles, Elderly Care, Improving Patient Care, Medicare | Tagged , , , , , | Leave a comment

‘Next Generation’ ACO Encourages Telehealth, Post-Discharge Home Services: CMS

In another step towards advancing models of care that reward value over volume, HHS announced the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery. A new initiative from CMS’s Innovation Center, the model is part of … finish reading ‘Next Generation’ ACO Encourages Telehealth, Post-Discharge Home Services: CMS

Posted in Accountable Care Organizations, affordable care act, Alternative Healthcare Coverage, Care Coordination, Care Transitions, Disease Management, dual eligibles, Elderly Care, Healthcare Costs, Healthcare Utilization, Home Healthcare, Medicare/Medicaid EHR Incentive, Skilled Nursing Facilities, Telehealth | Tagged , , , , | Leave a comment

CMS 2015 Impact Assessment of Quality Measures: Healthcare’s Triple Aim Improved

Results from the 2015 National Impact Assessment of Quality Measures Report (2015 Impact Report) demonstrate progress in improving healthcare’s Triple Aim, and impacts populations beyond Medicare, according to the CMS. The report is a comprehensive assessment of quality measures used … finish reading CMS 2015 Impact Assessment of Quality Measures: Healthcare’s Triple Aim Improved

Posted in affordable care act, Avoidable Hospitalization, CMS Acute Care Episode, Disease Management, dual eligibles, Elderly Care, Healthcare Costs, Healthcare Utilization, Population Health Management | Leave a comment

Cultural Competency Between Case Manager and Patient Breeds Engagement, Retention

Communicating with vulnerable patients effectively, whether it’s about medication non-adherence, or simply what is or isn’t working, requires a certain level of cultural competency between the case manager and patient, says Jay Hale, LPC, CEAP, director of quality improvement and … finish reading Cultural Competency Between Case Manager and Patient Breeds Engagement, Retention

Posted in affordable care act, Avoidable Hospitalization, Behavioral Health, Care Coordination, Care Transitions, Case Managers, Case Managers and the Patient Experience, Diabetes, Disease Management, dual eligibles, Elderly Care | Tagged , , , | Leave a comment

Overcoming 3 Roadblocks to Duals Care Coordination

Assuring adequate revenue for a duals care coordination program is critical to its success, says Julie Faulhaber, Health Care Services Corporation’s (HCSC) vice president of enterprise. Being sure that care planning and risk assessment components adequately and appropriately document the … finish reading Overcoming 3 Roadblocks to Duals Care Coordination

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Duals Geriatric Care Management: Melding the Medical, Social and Behavioral

When developing a geriatric care management program for the dually eligible, coordinating social and medical components is key, says Timothy C. Schwab, MD, FACP, former chief medical officer of SCAN Health Plan and president and CEO of Tim Schwab Healthcare … finish reading Duals Geriatric Care Management: Melding the Medical, Social and Behavioral

Posted in Behavioral Health, Care Coordination, dual eligibles, Medicaid, Medicare | Leave a comment

Strategies for Finding, Engaging Dual Eligibles

To locate, stratify and engage dual eligibles, Health Care Services Corporation (HCSC) starts with state-supplied information to reach this largely older adult and disabled population, explains Julie Faulhaber, HCSC’s vice president of enterprise Medicaid. If that information is inaccurate, HCSC … finish reading Strategies for Finding, Engaging Dual Eligibles

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Improving the Health of Dual Eligibles with HRAs

A local approach—the integration of public health with managed car—is what a lot of states and CMS are starting to look for in care coordination of Medicare-Medicaid beneficiaries, explains Pamme Taylor, vice president of advocacy and community-based programs for WellCare … finish reading Improving the Health of Dual Eligibles with HRAs

Posted in Disease Management, dual eligibles, Health Risk Assessment and Stratification, Healthcare Costs | Tagged , , | Leave a comment

Data Dive Uncovers Socioeconomics Driving ER Visits, Readmissions

By diving deep into existing data, officials at John C. Lincoln Network accountable care organization (ACO) realized the primary cause of readmissions for a subset of patients wasn’t inaccessible primary care, but lack of food. Patients were going to the … finish reading Data Dive Uncovers Socioeconomics Driving ER Visits, Readmissions

Posted in Avoidable Hospitalization, Cardiac Care, Care Coordination, dual eligibles, Elderly Care, Hospital Readmissions | Tagged , , | Leave a comment

3 Opportunities to Cut Medication Non-Adherence Costs

Healthcare organizations are increasing their efforts to contain medication non-adherence costs by concentrating on care transitions in complex patients, according to the results of HIN’s third annual Medication Adherence e-survey. More than half of responding organizations said they are targeting … finish reading 3 Opportunities to Cut Medication Non-Adherence Costs

Posted in Avoidable Hospitalization, Care Coordination, Care Transitions, Disease Management, dual eligibles, Elderly Care, Medication Adherence | Tagged , , , , | Leave a comment