A significant number of Medicaid beneficiaries — one in five — have a behavioral health diagnosis (mental health and/or substance use disorder). However, many of these individuals are served in fragmented systems of care with little to no coordination across providers, often resulting in poor health care quality and high costs. Read More →
The National Committee for Quality Assurance (NCQA) is proud to announce NCQA’s eMeasure testing laboratory is now approved by the Office of the National Coordinator for Health Information Technology (ONC). As an ONC-Authorized Testing Lab (ONC-ATL), NCQA can perform health IT tests as part of the ONC Health IT Certification program.
NCQA is the only approved alternative to this government-based electronic quality measure testing procedure. With this approval, health IT and data vendors can use the NCQA generated test decks for two certifications; ONC HIT Certification for use in reporting electronic clinical quality measures (eCQMs) to CMS for the Quality Payment Program; as well as NCQA eMeasure certification for use in NCQA’s recognition for Patient-Centered Medical Home (PCMH) and as a standard supplemental dataset in support of HEDIS reporting. Read More →
Collaborating with public health and community organizations to foster informed decision-making can help Medicaid entities better address the social determinants of health (SDOHs), says new guidance issued by the National Quality Forum (NQF).
An expert panel assembled by NQF found that Medicaid programs are well positioned to positively impact food insecurity and housing-related SDOH among their beneficiary populations, but only if they work closely with other organizations in their communities. Read More →
Cost measures are a growing part of Medicare’s value-based payment programs. Medicare Spending per Beneficiary (MSPB) is the cost measure included in Medicare’s Hospital Value-Based Purchasing (VBP) Program. Beneficiaries who are dually enrolled in Medicare and Medicaid are known to have higher spending on care, but it is unknown whether spending on the MSPB measure varies based on dual enrollment and whether this has implications for the performance of safety-net hospitals. Read More →
Medication synchronization programs based in pharmacies simplify the refill process by enabling patients to pick up all of their medications on a single visit. This can be especially important for improving medication adherence in patients with complex chronic diseases. Read More →
On January 11, 2018 the Trump Administration released a long-anticipated solicitation to states in the form of a State Medicaid Directors Letter. The letter invites proposals to undertake demonstrations to test the effects of threatening to withdraw or reduce Medicaid – or actually doing so -- from people who fail to meet work requirements. Eleven states currently have applications in the pipeline, and in recent days two more states appear to have at least preliminarily raised their hands as well. Read More →
Sudden Unexplained Infant Death, or ‘SIDS’ is the leading cause of death of babies under the age of one in the United States. Current recommendations call for infants to be placed to sleep on their back at all times to lessen the risk of SIDS. However, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC), many babies are still placed in unsafe sleep environments. Read More →
The stories of these three children share one similarity: The U.S. health-care system has failed them in spectacular fashion even as it has put their parents under severe emotional and financial strain. All for the lack of home-care nurses. Read More →
This article evaluates the differences in the quality of skilled nursing facilities (SNFs) that Medicare Advantage and FFS beneficiaries entered in the period 2012–14. After we controlled for patients’ clinical, demographic, and residential neighborhood effects, we found that FFS Medicare patients have substantially higher probabilities of entering higher-quality SNFs (those rated four or five stars by Nursing Home Compare) and those with lower readmission rates, compared to MA enrollees. The difference between MA and FFS Medicare SNF selections was less for enrollees in higher-quality MA plans than those in lower-quality plans, but Medicare Advantage still guided patients to lower-quality facilities. Read More →
A study that tasked pharmacy staff members—rather than doctors or nurses—with taking medication histories in the ED resulted a more than 80% drop in medication errors.
Those findings prompted a change at Los Angeles-based Cedars-Sinai: Now, pharmacy staffers take medication histories for certain high-risk patients who are admitted through the ED. Read More →
As the FDA continues to approve generic drugs at a record clip, patients see the potential for reducing costs while nonprofits hope for increased availability of generics during a nationwide shortage.
FDA Commissioner Scott Gottlieb, MD, released the latest data last week on approvals of generic prescription drugs. Through November, the FDA has granted 929 approvals or tentative approvals for generic drugs, at an average rate of 84.5 per month this year. This past month saw 107 generics earn approval, besting the previous all-time high of 101, a record the FDA had just set one month prior. Read More →
This toolkit, developed with support from The SCAN Foundation and the Milbank Memorial Fund, provides a targeted menu of LTSS reform strategies adopted by state innovators that may be replicated by other states. It identifies concrete policy strategies, operational steps, and federal and state authorities that states have used to advance their LTSS reforms. It also highlights opportunities and challenges that states faced in designing and implementing reforms. Read More →
Surveyors will measure quality based on feedback from short-stay SNF residents in 2018. Read More →
Telehealth has moved from a novelty to a mainstream access point. But questions remain about the limits of its reach and effectiveness, and, most problematically, its reimbursement. Read More →
CMS may appear to be slowing the path to value-based care by ditching some bundled payment models, but a new program could revitalize the effort. The new initiative will draw in more physicians who were not attracted to the earlier versions. Read More →
A recent survey shows that more than half of consumers determine the price before receiving healthcare. Physicians and health systems will need to respond to the movement toward price-based decisions in healthcare. Read More →
Using such data as a source of social determinants of health information can boost the accuracy of population risk predictions.
It’s no surprise when your mailbox is full of credit card offers or coupons and catalogues from your favorite stores. After all, it’s fairly common knowledge that credit reporting agencies like Experian and Equifax (which recently made headlines for a massive data breach) provide your purchasing data to companies for direct marketing purposes.
But what if healthcare providers could tap into that data too? How might it be added to claims and clinical data to better predict population health risk? Read More →
Newly released guidelines from the American Heart Association and the American College of Cardiology lower the blood pressure (BP) cutoff for hypertension diagnosis from 140/90 mm Hg to 130/80 mm Hg.
The term prehypertension is no longer recommended. Instead, stage 1 hypertension will refer to levels of 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic pressure; 120 to 129 mm Hg systolic and diastolic less than 80 is considered “elevated.” By lowering the cutoff, nearly half of American adults, particularly the younger individuals, will now be considered hypertensive. Read More →
Community pharmacists who work directly with patients in a patient-centered medical home (PCMH) can help improve rates of influenza vaccination and improve outcomes in diabetes and hypertension management, according to a study published online in the Journal of the American Pharmacists Association. In the study, researchers describe a collaboration between Kroger Pharmacy and a medical practice that consisted of seven physicians, a registered dietician, and a medical home coordinator.
Between January 2013 and January 2014, a community pharmacist worked in the medical practice for 8 hours per week, divided into two 4-hour shifts. While in the office, the pharmacist provided one-on-one appointments with patients, built relationships with office staff, and answered patient and prescriber questions. Appointments with patients included medication therapy management, diabetes education, and weight loss education, as needed. The pharmacist also offered follow-up services in the office or the pharmacy as patients wished. Kroger Pharmacy received a fixed fee per patient per month for high-risk patients. Read More →
Psychiatric collaborative care management (PCCM) as described by Current Procedural Terminology (CPT) 2018 reflects behavioral health services delivered via a specific evidence-based model. Care is managed by a behavioral health care manager (BHCM), who has master’s/doctoral-level education or specialized training in behavioral health, under direction of a treating physician or qualified health care professional (QHP) in consultation with a medical professional trained in psychiatry or behavioral health and qualified to prescribe the full range of medications. Read More →
Today, the Centers for Medicare & Medicaid Services (CMS) announced a new policy to allow states to design demonstration projects that increase access to treatment for opioid use disorder (OUD) and other substance use disorders (SUD). CMS’s new demonstration policy responds to the President’s directive and provides states with greater flexibility to design programs that improve access to high quality, clinically appropriate treatment. In addition, CMS is announcing the immediate approval of both New Jersey and Utah’s demonstration waivers under the new policy.
Through this updated policy, states will be able to pay for a fuller continuum of care to treat SUD, including critical treatment in residential treatment facilities that Medicaid is unable to pay for without a waiver. Read More →
Whether you are delivering primary care through a multi-state integrated system or a rural independent practice, benefits abound in optimizing this fully reimbursed Medicare service.
Despite primary care providers' celebration when the Centers for Medicare & Medicaid Services began paying for the preventive service now known as the Annual Wellness Visit (AWV) in 2011, the majority of PCPs continue to forgo those dollars.
But according to organizations that have made a concerted effort to promote and perfect the service, revenue is far from the only benefit of a strong AWV strategy. Read More →
As recognition of the critical role that social determinants play in health and quality of life has grown, partnerships between health care and human service organizations to address them are proliferating. Little is known, however, about the factors that contribute to the success of those partnerships, or their prevailing challenges — important insights for organizations considering whether and how to collaborate.
With support from the Robert Wood Johnson Foundation, the Partnership for Healthy Outcomes: Bridging Community-Based Human Services and Health Care is shedding light on this area of opportunity. Led by Nonprofit Finance Fund, the Center for Health Care Strategies (CHCS), and the Alliance for Strong Families and Communities, this initiative examined lessons from 200 cross-sector collaborations that serve low-income and other vulnerable populations, identified through a national Request for Information. Read More →
When Vickie Nieto digested the news Monday morning that at least 58 people died in a mass shooting in Las Vegas, the first thing she thought about was what she would tell her two daughters, ages 10 and 14.
“My 10 year-old heard about it on the TV before school,” Nieto, of Land O’ Lakes, Florida, told ABC News. “I didn’t want to tell her about it because I didn’t want to scare her.”
Nieto said her fifth grade daughter is “already scared about school shootings because they have to practice for them at school.” Read More →
by Northwest Community Care Network with Community Collaboration
Students entering North Carolina public schools must have documentation of a health assessment and immunizations by the 30th day of class, or they are excluded from attending school until they submit documentation. A community collaborative was essential in decreasing the number of students excluded from school for noncompliant documentation in the Winston-Salem Forsyth County school district. Read more →