Improve Health Outcomes, Drive Member Engagement, and Reduce Costs Complex and chronic conditions are commonplace among Medicare populations, and one of the most expensive drivers of healthcare spending. In 2017, an estimated 66 percent of all non-dual-eligible Medicare beneficiaries were living with two or more chronic conditions. In 2020, data from the Chronic Conditions Data Warehouse (CCW) found that 31,860,990 Medicare beneficiaries had a chronic condition. Annually, chronic conditions are multibillion-dollar expenditures. For example, in 2017, heart disease and strokes cost the U.S. $363 billion per year, diabetes: $327 billion, and arthritis: $304 billion. Each was split between direct medical costs...
How Does Managed Care Reduce Healthcare Disparities?
Over the past few decades, health programs such as Medicare and Medicaid have increasingly turned their attention to solving the social and economic inequalities that contribute to health disparities. As they continue to strategize on the best ways to address health disparities, many plans and states are gradually shifting to managed care models in response. Ahead, we break down the challenges surrounding health disparities and care inequities and look at the ways managed care can help alleviate both issues and provide greater health equity for all. Key takeaways will include: Social and economic inequalities lead to health disparities that result...
How Can HELIOS Improve Medicare Advantage Plan Member Experiences?
Medicare Advantage (MA) plans have fully embraced whole-person, integrated care and are designed to provide members with much more than traditional clinical healthcare. Many provide additional value-added benefits and services such as dental, vision and hearing coverage, wellness rewards, and transportation to medical appointments. From traditional Medicare Advantage plans to Medicare Advantage plans with prescription drug coverage (MAPD), to those that are specifically set up for dual-eligible individuals or persons with specific healthcare and/or financial needs (i.e., Dual Special Needs Plans or Chronic Care Special Needs Plans). All Medicare Advantage plans seek to provide a comprehensive suite of healthcare services...
Track 2 of the Making Care Primary Model: Integrating & Expanding Care Services
Track 2: Implementing Advanced Primary Care CMS’ recently announced Making Care Primary (MCP) model advances the agency’s drive to shift from a fee-for-service model to a value-based care model. The MCP model takes a tiered approach, with three tracks of participation. This progressive structure is intended to enhance coordination of care and unlock better health outcomes through improved data, tools, communication, and payment, eventually facilitating patient co-management between primary and specialty care. As suggested in our blog post covering Track 1, even organizations that don’t plan to participate can stay at the forefront of value-based care by working toward the...
How to Get Started with the Making Care Primary Model
Track 1: Building the Infrastructure for Better Value-Based Primary Care CMS recently announced its new Making Care Primary (MCP) model, a voluntary initiative set to launch in July 2024 among selected participants in eight states. As of September 2023: “CMS is working with State Medicaid Agencies in eight states – Colorado, North Carolina, New Jersey, New Mexico, New York, Minnesota, Massachusetts and Washington – to engage in full care transformation across payers, with plans to engage private payers in the coming months.” Source: CMS Key Objectives of the MCP Model Continue paving the way for organizations to move from fee-for-service...
Future of Care Chat – Episode 6: Resources & the Challenge in Achieving Healthcare Data Interoperability
Why is healthcare data interoperability so difficult to achieve? The technical staff currently needed to manage healthcare data exchange to meet interoperability standards and requirements is extensive, burdensome, and costly. A streamlined FHIR® data solution could significantly reduce all three and help organizations overcome critical data challenges. In the final episode of our data interoperability series, Episode 6, Marcus Caraballo, VP of Product Management, and Huthaifa Khan, Director, Solutions Architecture, discuss why the HL7® FHIR® standard matters so much in the modern healthcare data exchange. If you missed past episodes, watch them below: Episode 5 Episode 4 Episode 3...
Future of Care Chat – Episode 5: Reasons Why FHIR® Matters in the Modern Healthcare Data Exchange
Why does FHIR® matter so much in the modern healthcare data exchange? A conversation with VirtualHealth product team leaders about the different reasons why FHIR®matters in the modern healthcare data exchange. There are a number of reasons why the HL7® FHIR® standard matters in the modern healthcare data exchange. From improved access for payers, providers, and patients to access medical and clinical records, to easier data sharing across care teams, FHIR® makes it possible to support a patient-centric coordinated-care approach to help improve care coordination overall. Next up from our last data interoperability series episode, In Episode 5, Marcus Caraballo,...
Future of Care Chat – Episode 3 – Diving into FHIR®
What is FHIR? Why does FHIR matter in healthcare data management? The HL7 FHIR (Fast Healthcare Interoperability Resources 1) standard defines how healthcare information can be exchanged between different computer systems regardless of how it is stored in those systems. And for healthcare payers and organizations today, it’s an important standard for sharing and exchanging clinical records across the care continuum so as to enable cost-efficient care, and the standard by which healthcare organizations are held accountable. This includes those under the banner of CMS for data related to healthcare services, prior authorizations, and more. In Episode 3, Marcus Caraballo,...
How Can Accountable Care Organizations Address the Data Silo Challenge?
Nearly a decade ago, a Forbes contributor referred to data silos as “a medical tragedy.” Jump forward 10 years and we still have data silos. And the very real human consequences they create such as suboptimal health outcomes related to missed or delayed diagnoses, medical errors, and missed opportunities to provide the right care at the right time. Although data sharing presents significant challenges for accountable care organizations (ACOs), there are strategies that can help address data silos, including instilling a collaborative work culture and adopting technology that enables seamless data integration across ACOs. Why ACOs Need to De-Silo Their...
6 Things Accountable Care Organizations Should Look for in a Medical Management Platform
Medical management platforms can help accountable care organizations (ACOs) meet core goals related to providing highly coordinated, value-based care. For example, software with automated workflows and data centralization capabilities helped ACOs increase primary care services and wellness rates among members while reducing emergency department visits, hospital readmissions, and overall costs, according to a 2017 report in Healthcare IT News. But, with many medical management platforms in the market now, which is right for your organization? Medical Management Software for ACOs: 6 Critical Considerations An ACO should look for a medical management platform that provides the tools and resources to cost-effectively...