As of May 2022, nearly 89,000,000 people were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), according to government data. To effectively manage care for these populations, payers and providers must do the following: Streamline delivery of preventive, holistic care Broaden access to resources for enrollees Boost patient/member engagement Improve coordination of care Knowing where to start executing or improving upon these initiatives can be the hardest part. Fortunately, data points to five critical areas to address for Medicaid populations. Pediatric health Access to food Behavioral health Telehealth access Hospital readmissions In this blog, we look at important...
How Can Virtual Visits Address SDOH and Improve Member Outcomes?
Virtual visits and telehealth solutions are here to stay. COVID-19 may have fast-tracked telemedicine (March 2020 saw a 154% increase in telehealth visits as compared to March 2019.), but in fact, the evolution of virtual care has only just begun. 38% of patients have received care via virtual visits in 2022 research shows 76% of patients who had a telehealth visitwould prefer to continue using telehealth in the future And that’s a good thing – for payers, healthcare providers, and patients. Why? Because in addition to the obvious benefits of convenience and cost, virtual health visits can help providers and payers better address health inequities by...
11 Ways HELIOS Can Help Payers with Complex Medicare Populations
Improving health outcomes and reducing costs of care for Medicare populations may seem like an overwhelming challenge with chronic conditions costing billions each year. After all, these populations are typically older, and with age comes the onset of some of the most common (and expensive to manage) chronic conditions, such as cardiovascular disease, heart failure, hypertension, diabetes, osteoarthritis, and Alzheimer’s disease. The high cost to manage these patients is very much on CMS’ radar, however, and has prompted CMS and many Medicare plans to adopt value-based care models that focus on preventive care and reducing the associated issues related to chronic conditions...
6 Ways to Enhance Chronic Care Management for Medicare & Medicare Advantage Populations
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,...