CDPHP, 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
For more information on our Payer & Provider Roundtable Summit:
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.
Otros episodios de "Bright Spots in Healthcare"
Can Your Social Care Strategy Drive You to Five Stars?
hace 5 horas
59:46Leaders from Network Health, UPMC Health Plan, Healthmine and Benelynk explore how Medicare Advantage plans can attain 5-Stars and share bright spots on improving outcomes for members with social risk factors. Learn how closing gaps in care and reducing health disparities can help your plan reach 5 Stars! Topics include: CMS Health Equity Index Product Enhancement Member Activation and Engagement Payer/Provider Collaboration Social Care Strategy Blueprint Panelists: Andre Bliss, Ph.D., MBA, Director, Medicare STARs, UPMC Health Plan Mallory Mueller, (she/her/hers) Director Quality Health Integration, Network Health Cherie Shortridge, Senior Advisor, Healthmine Sean Libby, President, BeneLynk Bios: https://www.brightspotsinhealthcare.com/events/evolution-of-sdoh-2024-and-beyond/ BeneLynk sponsors this episode BeneLynk is a national provider of Social Care solutions for Medicare Advantage and Managed Medicaid health plans. We serve plans and their members by creating a human-to-human connection and providing the assistance a member needs to get the benefits they deserve. We build stronger human connections supported by innovative technology by employing one dynamic conversation that flows organically to meet Social Determinants of Health challenges. All of our services are customized to the specific geography, where we provide the members with the specific information they need to keep their benefits in place. Our mission is to improve lives and positively impact Social Determinants of Health barriers by providing our healthcare partners with the information they need and people with the advocacy they deserve.
The Future of Senior Health: Equitable Access & Open Enrollment
59:12Healthcare leaders from Humana, myPlace Health, Mom’s Meals, and SCAN explore the latest product and benefit design trends for the aging population. Our expert panel shares strategies and best practices your plan can implement to bridge the social and clinical care gap and empower seniors to create a lifetime of healthy habits. Topics include: Product Segmentation SDOH/Supplemental Benefits Care Models Payer and Provider Collaboration Panelists: Catherine Macpherson, MS, RDN, Senior Vice President of Healthcare Strategy & Development, Mom’s Meals Erika Pabo, MD, MBA, Chief Transformation Officer & Central Operations, Centerwell & Conviva, Humana Lena Perelman, Senior Director, Product Development, Market Expansion, SCAN Health Plan Robert Schreiber, MD, AGSF, Vice President and National Medical Director, myPlace Health Bios: https://www.brightspotsinhealthcare.com/events/the-future-of-senior-health-equitable-access-open-enrollment/ The Episode is Sponsored by Mom’s Meals Getting the right nutrition is essential to achieving and maintaining good health – yet accessing balanced meals that also support health challenges and fulfill personal tastes is not always as easy as it should be. At Mom’s Meals, our passion is to provide nourishment and deliver wholesome meals to the homes of those who need better nutrition to support their health and wellness, no matter where they live. It’s the reason we’ve built our business from our own personal roots, caring for our clients as we do our own family and loved ones. Our menus are designed by professional chefs and registered dieticians to taste great and support the nutritional needs of common chronic conditions. Clients get to choose every meal, every order. Meals are delivered to any address, no matter how remote. To learn more visit momsmeals.com.
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Last-Minute Gaps in Care Strategies
1:01:51Senior healthcare leaders from AmeriHealth Caritas, AvMed, HealthTeam Advantage, and ReferWell share strategies health plans can use to understand gaps in care throughout the member journey. For health plans participating in risk-based agreements, gaps in care have severe implications for members' health outcomes and their ability to attain higher quality scores necessary to receive financial bonuses and drive member enrollment. Hear how plans leverage data and real-time analytics to effectively and efficiently close time-sensitive care gaps to improve HEDIS, Stars and other quality scores. Topics covered include: Provider Plan Partnerships Building a Relationship with Members Identification & Targeting Systems & Incentives Confirmed Panelists Marsha Barlocker, RN, BSN, MS, Senior Director, Quality & Case Management, HealthTeam Advantage Chad Baugh, Chief Strategy Officer, ReferWell Vandna Bhrany, Vice President, HEDIS Strategy & Analytics, AmeriHealth Caritas Frank Izquierdo, Senior Vice President Provider Solutions and Strategic Alliances, AvMed Bios: https://www.brightspotsinhealthcare.com/events/last-minute-gaps-in-care-strategies/ This episode is sponsored by ReferWell Health plans must be acutely aware of their progress towards achieving their Care Gap Closure targets. Their most significant obstacle is to directly impact those specific areas, even though they have limited capabilities to do so. ReferWell helps health plans improve access to care by efficiently scheduling members for the care they need. ReferWell care navigators find the "Perfect Match" provider right at the referable moment when the member is saying yes to their care). They then seamlessly schedule the member's appointment while still on the call. It’s a proven process that provides better access, experience and outcomes for members and better quality performance, which affects the health plan’s bottom line.
Driving Innovation at Nashville General Hospital
48:10Nashville General Hospital CEO Joseph Webb,D.Sc., MSHA, FACHE, joins Eric to discuss how the hospital is using innovation to fulfill its mission and vision to improve the health and wellness of Nashville – one neighbor at a time. During the conversation, Dr. Webb shares details on two innovative initiatives Nashville General implemented to address health equity and transform care delivery. Food Pharmacy - In 2018, Nashville General launched the Food Pharmacy to provide access to food for individuals living with food insecurity and to educate those individuals about which foods best fit within the care plan based on their chronic conditions. Congregational Health and Education Network (CHEN) - Launched in 2017, CHEN is a 501(c)(3) faith-based initiative with local churches and educational institutions with a primary focus on reducing health disparities for communities of color through education attainment, access to healthcare, and health literacy. Currently, CHEN includes 100 faith-based organizations of all denominations throughout Nashville. In addition, Dr. Webb provides a blueprint to help other health organizations implement similar, innovative programs to promote healthy communities and reduce health disparities. About Dr. Webb Since joining Nashville General in 2015, Dr. Webb has successfully led efforts to improve patient outcomes, enhance the patient experience and grow revenues. Before joining Nashville General Hospital, Dr. Webb served as chief operating officer for Common Table Health Alliance in Memphis, Tennessee. As a former chief executive operating officer for Methodist Le Bonheur South Hospital in Memphis, Tennessee, he held additional chief executive roles for Healthcare Services of America at Coastal Carolina Hospital and Northwest Mississippi Regional Medical Center. Dr. Webb is board certified in Healthcare Management and is a Fellow of the American College of Healthcare Executives. Nationally, he serves as a board member of America’s Essential Hospitals and as chairman of the Governance Committee. He serves on the board of the Nashville chapter of the American Heart Association and as a board member of NashvilleHealth. Dr. Webb is a member of Omega Psi Phi, Incorporated. Dr. Webb earned a Doctorate of Science in Health Services Administration and a Master of Science in Hospital and Health Services Administration from the University of Alabama at Birmingham. He also holds a Bachelor of Science and Master of Science in Health and Physical Education from Tennessee State University. About Nashville General Hospital A leading safety net hospital with 150 beds and more than 22 clinics. Nashville General Hospital serves as the index teaching hospital for the historic Meharry Medical College. Nashville General has earned multiple accreditations for its evidence-based measures and practices that provide quality healthcare. These include The Joint Commission’s Gold Seal of Approval accreditation, NCQA PatientCentered Medical Home accreditation, the NCQA Diabetes Recognition Program, accreditation by the Commission on Cancer for Nashville General’s Robert E. Hardy Cancer Center, and Level 3 TNCPE Performance Excellence Award. The hospital also has increased its revenue sources through expanded healthcare services and launched initiatives to attract new commercially insured patients. These efforts ensure that every patient receives high-quality care at Nashville General Hospital regardless of their ability to pay.
AI is Advancing The Member Journey and Improving Lives TODAY
1:01:25Healthcare leaders from Geisinger, Intermountain Health, UNC Health and TytoCare join Eric to discuss how AI and machine learning transform the member journey and empower members to take a more active role in their health. Our experts share successful strategies and best practices your healthcare organization can implement to change the member experience. Hear the following case studies and learn how: Intermountain Health physicians use AI to diagnose pneumonia Geisinger leverages AI and machine learning to identify patients at higher risk for colon cancer to ensure they go for a colonoscopy UNC Health determines which patients are best suited for home health care vs. the hospital with AI and machine learning TytoCare drives better patient adoption of virtual care technologies with AI Panelists: Nathan Dean, MD, Section Chief of Pulmonary and Critical Care Medicine, Intermountain Medical Center Rachini Moosavi, Chief Analytics Officer, UNC Health Karen M. Murphy, PhD, RN, EVP/Chief Innovation and Digital Transformation Officer, Geisinger Ohad Pollak, Chief Marketing Officer, TytoCare Bios: https://www.brightspotsinhealthcare.com/events/how-ai-is-changing-patient-engagement This episode is sponsored by TytoCare TytoCare is a virtual healthcare company that enables leading health plans and providers to deliver remote healthcare to the whole family through its Home Smart Clinic. Combining a cutting-edge, easy-to-use, FDA-cleared device with AI-powered guidance and diagnostic support, the Home Smart Clinic enables the whole family to conduct remote physical exams with a doctor, replicating in-clinic exams for immediate answers from home. TytoCare drives utilization rates that are five times higher than traditional telehealth services; reduces the total cost of care by an average of five percent; diverts ED visits by an average of 10.8%; and has a high average NPS of 83. The Home Smart Clinic includes Tyto Engagement Labs™, a proven framework of engagement journeys designed for successfully deploying and adopting the solution. To complete its offering, TytoCare also provides the Pro Smart Clinic, for professional settings outside the home to serve rural clinics, schools, workplaces, and more. TytoCare serves over 220 major health systems and health plans in the U.S., Europe, Asia, Latin America, and the Middle East. For more information, visit us at tytocare.com.
The Disenrollment Tsunami: How to Enhance Your Medicaid Redetermination
59:57Healthcare leaders from Health Net, Horizon Blue Cross Blue Shield of New Jersey and Socially Determined shared successful Medicaid Redetermination strategies and best practices to help ensure your plans’ most vulnerable populations do not lose essential health coverage. With the end of the Public Health Emergency and the Medicaid continuous coverage provision in April, Redetermination could cause 18M Americans to lose health coverage, creating care gaps for the most vulnerable & widening health disparities. Our expert panel provides you with important information about navigating the disenrollment storms ahead. Mildred Menos, Director, Medicaid Product Administration, Horizon Blue Cross and Blue Shield of New Jersey Darrel Ng, Vice President, Communications & Marketing, Health Net Trenor Williams, MD, Co-Founder & CEO, Socially Determined Bios: https://www.brightspotsinhealthcare.com/events/the-disenrollment-tsunami-how-to-fix-your-medicaid-redetermination-strategy/ This episode is sponsored by Socially Determined Socially Determined is leading the transformation of health care 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 better manage risk, 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: www.sociallydetermined.com
How Blue Cross Blue Shield of Arizona is Reinventing the Member Journey
42:00Phylicia Schroeder, Manager, Provider Engagement and Quality Analytics at Blue Cross Blue Shield of Arizona Medicare Advantage and Janine Wakim, Head of Operations at ReferWell, join Eric to discuss how the plan is transforming the member journey by instituting a cultural shift putting the member’s needs above the plan’s needs, adding that to accomplish this goal, the plan uses data and predictive analytics to learn about what makes its members unique. Topics covered during the episode include: - Member journey mindset - Navigation and physician scheduling - Data integration, risk mitigation (as it relates to CAHPS) and - Provider engagement. Phylicia and Janine share many bright spots your plan can implement to provide a tailored experience for your members! About Phylicia Phylicia is a highly skilled Medicare Stars quality (HEDIS, CAHPS, HOS) analyst and strategist who specializes in data analysis, extrapolation and visualization through building dashboards in Power BI, technology implementation, provider engagement and clinical workflows, project management, process improvement and documentation. She is a true innovator who never says “No” and sees obstacles as opportunities to apply creative problem-solving to find a solution. About Janine As Head of Client Operations, Janine Wakim is keenly focused on the success and satisfaction of ReferWell’s customers. Janine leads the team that works with some of the largest healthcare systems and payers in the United States from onboarding to growth to ongoing support. She is an operations leader with over 20 years of experience in strategic planning and process improvement, leading client experience and business analytics teams. At Gartner, she served as the lead in building the offshore center of excellence for Business Analysis to provide insights into the Research and Advisory business to grow its footprint and retain its client base. She also served in leadership roles at Datto and Potoo Solutions. Janine earned a Bachelor of Science in Finance from Lehigh University, an MBA from Columbia Business School, and an MPH in Hospital Administration from Columbia University Mailman School of Public Health. This episode is sponsored by ReferWell Health plans are acutely aware that they are measured and graded on quality, experience and health equity more so than ever before. Their biggest challenge is to impact those areas directly. ReferWell helps health plans advance health equity by scheduling underserved members for the care they need, be it medical, care gap appointments or — through your community partnerships — appointments for transportation assistance, nutritional counseling, mental health services and other community-based organization offerings. Data shows that ReferWell’s solution directly impacts the members who need it most. ReferWell care navigators find the Perfect Match right at the referable moment (when the member is leaning into their care) and schedule the member while on the phone. It’s a proven process that provides better access, experience and outcomes for members, and better quality performance, which affects the health plan’s bottom line. For more information, visit www.referwell.com.
How Psychedelics Can Bend the Mental Health Cost Curve
37:20Psychedelic Researcher and Psychologist Alex Belser, PhD, joins Eric to discuss the efficacy and safety of psychedelics, how they are being applied in practice and the potential pharmacoeconomic and business impact this category of medications can have on patients with severe mental illness. Alex shares information on the latest research and developments in psychedelics and dispels some of the myths around usage. He also discusses how psychedelics may be more cost-effective than conventional drug treatments for mental health issues and how the medications could change mental health care as we know it. About Alex Dr. Alex Belser is a licensed psychologist and researcher focused on psilocybin, MDMA, and DMT therapies. At Yale, Dr. Belser is investigating a psychedelic treatment for OCD. He is the Chief Clinical Officer of Cybin, where he is the co-creator of a new model of psychedelic-assisted psychotherapy called EMBARK.
Equity, Engagement & Nutrition: Innovations Empowering the Underserved
1:00:59Leaders from Humana, SCAN and NourishedRx discuss the link between food, nutrition security and health and the idea that food and nutrition programs can improve health. Many Americans lack access to nutritious food due to food insecurity, contributing to high rates of chronic disease, poor health outcomes and health disparities, especially among underserved communities. Our expert panel will share solutions and strategies health plans can adopt to improve health equity, reduce healthcare costs and alleviate the adverse impact of limited access to healthy food among your most vulnerable populations. Panelists Romilla Batra, MD, MBA, Chief Medical Officer, SCAN Leah Brucchieri, Director of Medicare Growth and Innovation at Humana Lauren Driscoll, Founder and CEO of NourishedRx Bios: https://www.brightspotsinhealthcare.com/events/equity-engagement-nutrition-innovations-empowering-the-underserved/ This Episode is sponsored by NourishedRx NourishedRx aims to eradicate poor diet and nutrition insecurity as top drivers of death, disease, and disparities. Founded in 2019 by Lauren Driscoll, NourishedRx is a digital health and nutrition company that helps people live healthier lives and supports health equity. Leveraging the healing and connective power of food, NourishedRx partners with healthcare organizations nationally to nourish their most vulnerable members, build healthy relationships, and support health equity. NourishedRx delivers highly personalized, culturally relevant meals and groceries to members, along with wrap-around whole health support and nutrition education. The NourishedRx solution delights and engages members and promotes connection that enables NourishedRx not only to support dietary health and glean actionable insights regarding gaps in care and health-related social needs. Through this solution, NourishedRx can drive better health outcomes and lower overall costs at scale. Visit the website at nourishedrx.com
How Digital Mental Health is Making an Impact
1:01:15Healthcare leaders from AmeriHealth Caritas, Cigna Healthcare, Highmark, Reliant Medical Group and Corporate Insight share innovations in mental health, including how their organizations are incorporating and maximizing digital mental health tools and platforms. Learn strategies and approaches you can implement in your organization. Panelists Yavar Moghimi, MD, Chief Psychiatric Medical Officer, AmeriHealth Caritas Sam Nordberg, PhD, Chief of Behavioral Health, Reliant Medical Group Demetrios C. Marousis, MA, MBA, LPC, Director, Behavioral Health, Highmark William M. Lopez, MD, CPE, National Medical Director-Virtual Care, Senior Medical Director-Behavioral Health, Cigna Healthcare Lauren Roncevic, Senior Director of Healthcare Research, Corporate Insight Bios: https://www.brightspotsinhealthcare.com/events/how-digital-mental-health-is-making-an-impact/ This episode is sponsored by Corporate Insight. Corporate Insight delivers competitive intelligence, user experience research and consulting services to the nation’s leading healthcare, financial services and insurance institutions. As the recognized industry leader in customer experience research for over 30 years, Corporate Insight has been the trusted partner to corporations seeking to improve their digital capabilities and user experience. Their best-in-class research platform and unique approach of analyzing the actual customer experience helps corporations advance their competitive position in the marketplace. Visit their website at: www.corporateinsight.com