Posts Tagged ‘Medicaid’

Infographic: Medicaid’s Role in Behavioral Healthcare

May 19th, 2017 by Melanie Matthews

Medicaid restructuring as proposed in the American Health Care Act could limit states' ability to care for people with behavioral health conditions, according to a new infographic by the Kaiser Family Foundation.

The infographic details how Medicaid currently enables people with behavioral health needs to access care and how reduced federal spending could limit behavioral health coverage and services.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve OutcomesAs the critical role of an engaged, activated healthcare consumer becomes more apparent in a value-based healthcare system, healthcare organizations are focusing on patient engagement and activation programs.

In a recent industry survey on trends in patient engagement, healthcare organizations reported that behavioral health conditions presented a particular challenge to patient engagement initiatives. However, there is robust evidence that motivational interviewing is a powerful approach for treating substance abuse, anxiety and depression.

Behavioral Health Patient Engagement: Using Motivational Interviewing Techniques and Strategies To Improve Outcomes, a 45-minute webinar now available for replay, Mia Croyle with the University of Wisconsin School of Medicine and Public Health shares key learnings from patient engagement initiatives targeted at patients with behavioral health conditions.

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Infographic: Physician Appointment Wait Times; Medicare and Medicaid Acceptance Rates

May 5th, 2017 by Melanie Matthews

The average wait time for a physician appointment in 15 mid-sized metropolitan areas was nearly 8 days longer than in l5 major metropolitan areas, according to a new infographic by Merritt Hawkins.

The infographic also examined rates of Medicare and Medicaid acceptance by physicians in these markets.

No matter which level of participation physician practices choose for the first Quality Payment Program performance period beginning January 1, 2017, CMS's "Pick Your Pace" announcement means practices should proactively prepare for the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on physician quality reporting and reimbursement.

MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System delivers a veritable MACRA toolkit for physician practices, with dozens of tips and strategies that lay the groundwork for reimbursement under Medicare's Merit-based Incentive Payment System (MIPS), expected to begin in 2017 and one of two payment paths Medicare will offer to practices.

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Infographic: Economic Impact of the Medicaid Expansion in Michigan

February 6th, 2017 by Melanie Matthews

Economic Impact of the Medicaid Expansion in MichiganUnder its Medicaid expansion program, the Michigan state government will end up with more money than it spends, even as costs rise, according to a new infographic by the Institute for Healthcare Policy & Innovation at the University of Michigan.

The infographic looks at the impact of Michigan's Medicaid expansion on job creation, tax revenue on increased economic activity and cost avoidance from other safety net programs.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex PopulationsAsked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team.

Having demonstrated the team's bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed's four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

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Infographic: Medicaid Expansion in Pennsylvania

August 19th, 2016 by Melanie Matthews

The Medicaid expansion has made it possible for more Pennsylvanians to access healthcare than ever before, according to a new infographic released by the Pennsylvania Department of Human Services. As of April 2016, the expansion had reached 625,970 newly eligible Pennsylvanians, ages 18 to 64.

The infographic provides a demographic snapshot of the newly insured.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex PopulationsAsked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team.

Having demonstrated the team's bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed's four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

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Infographic: Medicaid Managed Care

August 5th, 2015 by Melanie Matthews

Medicaid health plans now serve more than 43.5 million low income individuals – nearly 66 percent of total Medicaid enrollment–and a growing body of research finds the tools and techniques they use show great promise in achieving better outcomes for Medicaid beneficiaries and cost savings for states.

A new AHIP infographic examines how Medicaid managed care plans are improving quality and promoting value as well as the type of cost savings these plans are delivering to states.

Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid PopulationTo locate, stratify and engage dual eligibles, Health Care Services Corporation (HCSC) takes a creative approach, employing everything from home visits to 'street case management' to coordinate care for Medicare-Medicaid beneficiaries.

Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid Population describes HCSC's innovative tactics to engage this largely older adult and disabled population in population health management with support from a range of community partners and services.

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Infographic: The Challenge of Serving Dual Eligibles

December 24th, 2014 by Melanie Matthews

Individuals dually eligible for Medicare and Medicaid are among the sickest and poorest individuals covered by healthcare in the United States. They are also likely to have mental health needs and live in nursing homes.

A new infographic by HealthX examines dual eligible healthcare spending, the challenges of serving dual eligibles and strategies for best serving this market.

Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid Population To locate, stratify and engage dual eligibles, Health Care Services Corporation (HCSC) takes a creative approach, employing everything from home visits to 'street case management' to coordinate care for Medicare-Medicaid beneficiaries.

Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid Population describes HCSC's innovative tactics to engage this largely older adult and disabled population in population health management with support from a range of community partners and services.

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Infographic: How Will the November Election Impact Medicaid Expansion?

October 13th, 2014 by Melanie Matthews

Some of the November governors’ races could impact the number of states with Medicaid expansion programs, according to a new infographic by Families USA.

There are currently 23 states that have not chosen not to expand Medicaid. Of those, 15 have gubernatorial races in November, setting the stage for potential Medicaid expansion in 2015. The infographic looks at the governors’ races likely to have the greatest impact on whether the state expands Medicaid.

Governors' Races and Medicaid Expansion

Medicaid Expansion: Mid-Year 2014 Results Medicaid Expansion: Mid-Year 2014 Results includes enrollment statistics by state, company and county, plus details of financial results and market strategies for major Medicaid players. Packed with the latest available data, the report provides a thorough picture of how the Medicaid market is shaping up right now. Medicaid expansion continues to provide tremendous new opportunities for health plans, states and the uninsured.

Medicaid Expansion: Mid-Year 2014 Results will provide your management team with a quick, thorough and accurate reading of the results to date, and a window into the opportunities ahead.

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5 Ways to Reach, Engage Dual Eligibles

May 15th, 2014 by Cheryl Miller

It takes a village — and more — to locate, stratify and engage dual eligibles, says Julie Faulhaber, vice president of enterprise Medicaid at Health Care Service Corporation (HCSC), especially when they can range from school-aged children to elderly Native Americans. Here, she discusses how to best engage the company's diverse population.

Here’s an example of a Centennial Care outreach plan, which includes our dual eligibles. It has our Medicaid adults and children. There are not very many school-based children that are dual eligibles, but there are some, so working with the school-based clinics, the nurses’ association, etc., helps us engage.

In the New Mexico market, working with the Native American community is very important in engagement and sometimes actually for locating our members. Working with the tribal government and their leadership, some of the urban health centers, Indian health organizations, and other community organizations under the Native American groups can be extremely helpful. And some of our populations work with our behavioral health groups so again, those community mental health centers and other community organizations serving those with mental health and behavioral health concerns are of value to us.

We also work with community and public health outreach in this market. Promotoras or community health workers are critical elements for us to not only engage, but then also to maintain our relationship with members. With some of these outside agencies, we often have contractual relationships, and are able to share personal health information back and forth. That makes it much easier for us to locate members, and also have some of the staff in these organizations be part of our interdisciplinary care team.

Excerpted from Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid Population.

5 Considerations for Developing a Dual Eligibles Program

February 5th, 2014 by Jessica Fornarotto

Congress has responded to the differences and unique needs of the dual population, states Dr. Timothy Schwab, former CMO of SCAN Health Plan, creating the Office of the Duals and the Innovation Center.

Dr. Schwab stresses the importance of defining the goals and the population when developing or participating in a dual eligible program.

If you're developing or participating, you need to define your goals, which will ultimately lead to how you develop the care management program and the metrics. Everything relates back to the Triple Aim of better health, better care and better cost.

It's important to get as much information about the population you're going to serve as possible. You need to look at the age bands, which is relatively easy for most states. You need to also look at how many people are in each age band, and what the program is going to serve.

Third, it's important to understand the functional status of this population. This may be a little bit harder to get from the state because they probably only have information available for the population currently being served by the long-term supports and services programs in the community. And we know that there are people who aren't being served that the state is not aware of.

When it comes to the medical status, the state has very little information on this because Medicare is the primary payor and the state only secondarily gets any information on medical status.

Fifth, the social status is also critical: Where do they live? What is their caregiver status? What percent of them have caregivers? What percent live in their own home? Then, you must consider issues such as language, literacy, and culture: What percent of them are non-English speaking? What cultural improvements must you consider when serving certain parts of the population?

Excerpted from: Population Health Management for Dual Eligibles: Blueprint for Care Coordination

Healthcare Business Week in Review: Children’s Health Coverage, ACOs, Reducing ED Visits

January 10th, 2014 by Cheryl Miller

Some good news to welcome in the new year: nearly two-thirds of the nation’s leading healthcare executives believe the healthcare system will be somewhat or significantly better by 2020 than it is today as a result of national healthcare reform, according to a study published in the Health Affairs blog.

Additionally, 93 percent believe that the quality of care provided by their own hospital or health system will improve during that time period. The findings, based on research by the University of Pennsylvania and the Children’s Hospital of Philadelphia, includes responses from 74 senior executives from large hospitals and health systems across the United States.

More good news: doctors, hospitals and other healthcare providers have formed 123 new Medicare ACOs, providing approximately 1.5 million more Medicare beneficiaries with access to high-quality coordinated care across the United States.

According to a CMS announcement, the new ACOs include a diverse cross-section of healthcare providers across the country, including providers delivering care in underserved areas. More than half of ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. Approximately one in five ACOs include community health centers, rural health clinics, and critical access hospitals that serve low-income and rural communities, CMS said.

Good news extends to low-income children as well, with our report that 23 states received over $307 million in bonuses for improving access to children’s health coverage and successfully enrolling eligible children in Medicaid, according to CMS.

States that met at least five out of eight specific features to streamline enrollment, including using data-matching to reduce paperwork and eliminating face-to-face interview requirements, received performance bonuses, designed to offset the costs of insuring this demographic, and initiated by The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Some news to ponder: contrary to the idea that convenience prompts many privately insured people to seek care in emergency departments (EDs), those most likely to use EDs believe they urgently need medical attention, according to a new study by the Center for Studying Health System Change (HSC).

Only rarely did respondents cite convenience as a reason for choosing ED care. About one in four people (24.8 percent) reported their doctor’s office was closed when they needed help, and close to a quarter (24.1 percent) indicated their physician instructed them to go to an ED.

Wondering what healthcare industry areas are ripest for expansion in 2014? Check out our latest HINfographic: 7 Value-Based Priorities for Healthcare’s Smart Money, based on the latest HIN market research.