CareMount Health Solutions, VillageMD and Socially Determined leaders discuss the incentives and requirements laid out by the new ACO REACH model and how organizations can develop action plans to identify differences or disparities in their members' health status.
CMS replaced the Global and Professional Direct Contracting (GPDC) Model with the redesigned ACO Realizing Equity, Access, and Community Health (REACH) Model in 2023. ACO REACH is the first accountable care model to directly address health equity and access to care, with a specific directive to meet the needs of patients from marginalized and underserved communities. Whether you participate in ACO REACH, the model provides vital insights into the future of value-based care and care collaboration.
Panelists: Gary Jacobs, Executive Director, Center for Government Relations and Public Policy, VillageMD; Kate Casaday, MPH, Director of Market Operations, CareMount Health Solutions; Ashley Perry, MPH, Chief Solutions Officer, Socially Determined
This episode is sponsored by Socially Determined
Socially Determined is leading the transformation of healthcare delivery and payment through social risk analytics and solutions. Our SocialScapeⓇ SaaS platform, data and industry-leading expertise empower health systems, plans and other risk-bearing organizations to manage risk better, improve outcomes and advance equity at scale. Recently named by Fierce Healthcare as one of the 15 most promising healthcare companies, Socially Determined is headquartered in Washington, DC. Visit the website at www.sociallydetermined.com.
Otros episodios de "Bright Spots in Healthcare"
How Healthfirst is Partnering with a Health System to Make Providers’ Jobs Easier
43:24G.T. Sweeney, Chief Information Officer, Healthfirst and Sami Boshut, Chief Information Officer, MediSys Health Network, Inc., join Eric to discuss how their organizations collaborated with a technology company to create a cloud-based platform that enables seamless sharing of patient data across the care continuum. The platform connects longitudinal data from claims, quality measures and electronic health records (EHRs) to identify gaps in care, making it easier for providers to address patient needs in real-time. The two discuss how the platform supports the next phase of value-based care by ensuring providers have the right information at the right time to address the needs of patients. Sweeney and Boshut also provide a blueprint to help other organizations implement similar provider-centric technology systems. About Our Guests: G.T. Sweeney has been Healthfirst’s Chief Information Officer since 2014, leading the Information Services department to help transform the insurer's business and tightly integrate information systems to further strategic goals. Sami Bosurt has a demonstrated history of working in the hospital & healthcare industry with a proven track record and expertise in Healthcare Consulting, Infrastructure Installations, Software Implementation and Vendor Management.
The Next Wave of Benefits Navigation for Government Programs
38:26John Petito, Corporate Vice President, Transformation, SCAN Health and Ashish V. Shah, CEO, Dina, discuss the power of benefits navigation in attracting and retaining members for Medicare Advantage plans and other government programs. The average Medicare beneficiary has access to over 43 Medicare Advantage plans, and offering supplemental benefits such as home-centered care enables plans to compete and differentiate in the marketplace. But plans must ensure members understand the benefits and that the navigation experience is seamless – and painless. John and Ashish share successful strategies and best practices plans can implement to improve member experience and ensure members receive the care they need. Topics include: How the Medicare Advantage market is shifting New opportunities for risk-bearing entities Why navigation is so hard and how to enhance it Measuring navigation strategy Improving CAHPS and STAR Ratings through enhanced benefit navigation This episode is sponsored by Dina Dina provides benefits and care coordination solutions to support health plans and providers as they extend care management into the home. Customers use our SaaS technology to digitize their network of community and home-centered providers; transform coordination workflows so they spend less time with phone calls and faxes; collect performance data to improve their network continuously; and capture meaningful data directly from home. Last year, Dina was named to the Inc. 5000 list of fastest-growing companies and CB Insights Digital Health 150 list of companies transforming healthcare with digital technology.
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Reduce Total Cost of Care: Innovative Whole Person Models for High-Cost Conditions
1:00:41Healthcare leaders from Blue Shield of California, CareSource, UT Health Austin and Vori Health discuss the importance of adopting a whole-person approach across the broader healthcare experience to maximize value, drive healthy behavior change and ensure more equitable care. Learn how to develop an integrated whole-person solution framework and implement strategies to support members with chronic and high-risk conditions. Topics include: Adopting self-service digital tools and applications to engage members Providing access to resources, health coaches, medication, and mental/behavioral health support Leveraging medical and SDoH data to determine unique needs, tailor care, and sustain healthy behavior change Panelists: Judith Davis, Vice President Clinical Operations, Ohio Market, CareSource, Angie Kalousek Ebrahimi, Senior Director, Lifestyle Medicine, Blue Shield of California, Karl Koenig, M.D., M.S., Executive Director, Musculoskeletal Institute; Division Chief of Orthopaedic Surgery, Associate Professor of Surgery and Perioperative Care, Dell Medical School, Ryan A. Grant, MD, MBA, FAANS, Founder and Chief Executive Officer, Vori Health Bios: https://www.brightspotsinhealthcare.com/events/reduce-total-cost-of-care-innovative-whole-person-models-for-high-cost-conditions/ Request discount code for our Payer & Provider Summit: https://www.brightspotsinhealthcare.com/summit-promo/ This episode is sponsored by Vori Health Vori Health is a specialty medical practice delivering a virtual-first musculoskeletal (MSK) solution to help members return to their lives faster. As the only nationwide MSK practice with doctor-led care teams, Vori Health is the most convenient way to access appropriate care for back, neck, and joint pain without bouncing around the healthcare system. Whether members need a diagnosis, non-opioid prescription, personalized physical therapy, or health coaching, they can turn to Vori Health for evidence-based care and effective end-to-end support. This holistic model reduces unnecessary surgeries, enables faster recoveries, and lowers MSK spending with up to a 4:1 ROI, for more information, visit www.vorihealth.com.
Boosting Plan Performance: Improving Provider-Centric Risk Adjustment & Staying Compliant
1:00:06CDPHP, Johns Hopkins Medicine, Priority Health, ATRIO Health Plans and Vatica Health share successful strategies and best practices for provider-centric risk adjustment programs, which enable health plans to enjoy higher compliance, enhanced quality of care, improved risk score accuracy, higher Star and quality ratings and better financial performance. Learn how your plan can empower physicians to close care gaps, avoid common pitfalls and maintain compliant record documentation proactively. Panelists: Gregg Kimmer, President & CEO, ATRIO Health Plans; Michelle Ilitch, MPH, Vice President, Vice President of Network Solutions and Value-Based Programming, Priority Health,; Colleen Gianatasio MHS, CPC, CPC-P, CPMA, CRC, CPCO, CDEO, CPPM, CCDS-0, CCS, and AAPC Approved Instructor, Director Clinical Documentation Integrity and Coding Compliance, Capital District Physician’s Health Plan (CDPHP); Frank Shipp, FACHE, MBA, Executive Director, Johns Hopkins Clinical Alliance, Johns Hopkins Medicine; Hassan Rifaat, MD, CEO, Vatica https://www.sharedpurposeconnect.com/events/boosting-plan-performance-improving-provider-centric-risk-adjustment-staying-compliant/ For more information on our Payer & Provider Roundtable Summit: https://brightspotssummit.eventbrite.com This episode is sponsored by Vatica Health Vatica Health is the #1 rated risk adjustment and quality of care solution for health plans and health systems. By pairing expert clinical teams with cutting-edge technology, Vatica increases patient engagement and improves coding accuracy and completeness. It helps identify and facilitate closure of care gaps and enhances communication and collaboration between providers and health plans. The company’s unique provider-centric solution helps payers, providers and patients achieve better outcomes, together. Vatica is trusted by many leading health plans and thousands of providers nationwide. Healthcare research firm KLAS named Vatica “Best in KLAS” for risk adjustment in 2023. KLAS also named Vatica to its Emerging Solutions Top 20 list for innovative companies that have the greatest potential to impact and disrupt the healthcare market. For more information, visit VaticaHealth.com.
Unique Approaches to Building Trust with Dual Eligible Members
1:00:22AmeriHealth Caritas, Blue Cross Blue Shield, Optum at Home & Reema Health share bright spots and novel tactics for engaging dual eligible beneficiaries. Discussion topics include: building a foundation of trust through a community approach, engaging hard-to-reach or historically unreachable members, and addressing health-related social needs to improve clinical outcomes Panelists Include: Christopher McDade, Vice President, Medicare Integrated Health Plans and Revenue Management, AmeriHealth Caritas, Leanna Moran, Managing Director of the Duals Market, Blue Cross Blue Shield of Rhode Island Catherine Mitchell, Chief Strategy Officer, Optum at Home Melissa Kjolsing, Head of Engagement Strategy, Reema Health Bios: https://www.sharedpurposeconnect.com/events/unique-approaches-to-building-trust-with-dual-eligible-members/ This episode is sponsored by Reema Health Reema is transforming how people navigate the gaps between health care and social care using technology and Community Guides who share their identity with the members they serve. Reema’s approach improves healthcare experiences, leading to higher member engagement and reduced costs. Reema’s breakthrough health platform uses proprietary technology and predictive data modeling to identify people with the highest level of unmet social needs, power Community Guides with the right information to engage them meaningfully, connect them with the most relevant resources, and improve their health and lives. Because they believe in guiding all members to better health. Learn more at reemahealth.com
How Banner|Aetna is Rethinking Whole Person Care
55:16Joanne Mizell, Chief Operating Officer, Banner|Aetna – a joint venture between CVS Health’s insurance arm, Aetna, and health system Banner Health – joins Eric to discuss what makes Banner|Aetna unique from other health insurers and its approach to whole person care. She shared how the company uses MultiDisciplinary Care Teams to provide high-risk patients with a localized, high-touch, intensive care management strategy with a unique care approach to meet patients face-to-face. In addition to sharing numerous bright spots, including a Type 2 Diabetes Reversal program, Joanne lays out a blueprint for building innovative, whole person care programs. About Joanne Joanne joined Banner|Aetna in February 2018 with over 20 years of Aetna experience and nearly 30 years in the Employee Benefits industry. In this role, and as a member of the executive leadership team, Joanne oversees the organization's operations. She supports the execution of the strategic goals set by Banner|Aetna’s Board of Directors and Chief Executive Officer. Bright Spots in Healthcare has a new website! Please visit: https://www.brightspotsinhealthcare.com/ Register for our Payer & Provider Executive Summit on August 24 & 25 in Boston.: https://www.eventbrite.com/e/469644799237
Improve CAHPS through Enhanced Benefits Navigation
1:01:13Healthcare leaders from Alignment Health, SCAN, ATI Advisory and Dina discuss the importance of MA plans to ensure members understand available non-medical benefits. Making the experience painless is essential to attracting and retaining members – and improving CAHPS and Star Ratings. Learn successful strategies and best practices your plan can implement to improve member experience and ensure members receive the care they need. Topics include: Humanizing the navigation process; creating a culture of customer service; using technology to streamline benefit navigation, and leveraging home-centered care Panel: Dawn Maroney, CEO of Alignment Health Plan and President, Markets of Alignment Health John Petito, Corporate Vice President of Strategy & Transformation, SCAN Health Plan Ashish V. Shah, CEO, Dina Anne Tumlinson, CEO, ATI Advisory Bios: https://www.sharedpurposeconnect.com/events/maximizing-the-impact-of-supplemental-benefits-to-increase-star-ratings/ Payer & Provider Executive Roundtable Summit Registration: https://www.eventbrite.com/e/payer-provider-roundtable-summit-engagement-clinical-bright-spots-registration-469644799237 This episode is sponsored by Dina Dina provides benefits and care coordination solutions to support health plans and providers as they extend care management into the home. Customers use our SaaS technology to digitize their network of community and home-centered providers; transform coordination workflows so they spend less time with phone calls and faxes; collect performance data to improve their network continuously; and capture meaningful data directly from home. Last year, Dina was named to the Inc. 5000 list of fastest-growing companies and CB Insights Digital Health 150 list of companies transforming healthcare with digital technology.
Success Stories in Virtual Care Enrollment & Engagement
1:01:03Healthcare leaders from United Health Group, Blue Shield of California, Highmark, Oklahoma Complete Health (Centene) and TytoCare share real-world, virtual care success stories. Gain insight into how virtual care boosts outcomes improves equity and reduces costs. Hear case studies, lessons learned, and best practices you can implement in your organization. Topics include: Engagement, Experience and Equity Plan Design Local as a Strategy and Hybrid Care Industry Experts: Nina Birnbaum, Medical Director, Innovation Acceleration, Blue Shield of California; Barbara Koch, Senior Vice President, Office of Health Equity, UnitedHealth Group; Timothy Law, DO, Chief Medical Officer, Highmark; Douglas Olivo, Director of Rural Care and Telehealth Services, Oklahoma Complete Health, a subsidiary of Centene; Si Yahav Tirosh, Director of Engagement Labs, TytoCare Bios: https://www.sharedpurposeconnect.com/events/success-stories-in-virtual-care-enrollment-engagement/ This episode is sponsored by TytoCare TytoCare allows users to access quality medical care anytime, anywhere, enabling providers to conduct a comprehensive examination of the ears, lungs, heart, throat, heart rate, temperature, skin, abdomen, and more ..all remotely. TytoCare’s handheld exam kit and app connect users with a clinician or specialist for a medical exam and telehealth visit no matter where they are. Clinicians can access clinical-quality exam data to help ensure patients receive the best remote diagnosis and treatment possible. Health providers, insurers, hospitals, clinics, businesses, and schools worldwide are leveraging TytoCare’s remote exam system to deliver on the full promise of telehealth. And when it comes to product design and the consumer experience, no one has them beat. Companies who are already leveraging their knowledge and platform include Kaiser, Elevance, Amazon and the NHS to name a few. TytoCare is fully compliant and cleared with regulatory bodies, including FDA, CE, HealthCanada, ISO medical, HIPAA, HITRUST, and GDPR. Visit: www.tytocare.com
Mitigating Social Risk to Achieve Higher Star Ratings
1:01:07Senior leaders from Cigna, Independent Health, Regence, and Socially Determined join Eric to discuss how minimizing social risk helps plans garner higher quality and performance scores. Learn successful strategies for identifying, engaging, and addressing members with elevated social risks to drive gap closure and member retention. The session is full of bright spots you can implement in your organization! Panel: Kathleen Faulk, Senior Vice President & General Manager, Government Programs, Regence; Angela Kloepfer-Shapiro, MD, MBA, Regional Medical Executive, Northeast and West Regions, Cigna Medicare Advantage;Dawn Odzywolski, Vice President, Medicare Programs, Independent Health; Ashley Perry, MPH, Chief Strategy & Solutions Officer, Socially Determined Bios: https://www.sharedpurposeconnect.com/events/mitigating-social-risk-to-achieve-higher-star-ratings/ Summit Registration: https://www.eventbrite.com/e/469644799237 This episode is sponsored by Socially Determined Socially Determined is leading the transformation of healthcare delivery and payment through social risk analytics and solutions. Our SocialScapeⓇ SaaS platform, data and industry-leading expertise empower health systems, plans and other risk-bearing organizations to manage risk better, improve outcomes and advance equity at scale. Recently named by Fierce Healthcare as one of the 15 most promising healthcare companies, Socially Determined is headquartered in Washington, DC. Visit the website at www.sociallydetermined.com.
Sell with a Story in Healthcare with Paul Smith
56:16A well-crafted story can pack the emotional punch to turn routine presentations into productive relationships. Organizational storytelling expert and author Paul Smith joins Eric to share his popular and proven formula for telling a story. Paul discusses the following: What is the optimal structure of a story? What different types of stories should we all have at our fingertips for our meetings with health plans and provider organizations? How do we leverage these stories to make a sales pitch? How do we use storytelling to close a sale? At the end of the episode, you’ll have a blueprint for a new storytelling strategy for their sales organization! About Paul Paul Smith is one of the world’s leading experts on organizational storytelling. He’s one of Inc. Magazine’s “Top 100 Leadership Speakers of 2018” and the author of three Amazon #1 bestsellers: Lead with a Story (now in its 11th printing, and published in 7 languages around the world), Sell with a Story, and The 10 Stories Great Leaders Tell; in addition to Parenting with a Story and his newest work, Four Days with Kenny Tedford. He’s a former executive at The Procter & Gamble Company and a consultant with Accenture before that. Buy Paul’s book, Sell with a Story: https://www.amazon.com/Sell-Story-Capture-Attention-Build/dp/0814437117 Paul’s website: https://leadwithastory.com/