David Ford

What does calling my cable company have to do with Medicaid? I had to call a certain notorious cable/internet provider recently. The one with customer service so bad that it was skewered in a classic South Park episode. I blocked out an hour and braced for my inevitable PCOM aneurysm rupture. Shockingly, it was a breeze. The rep was friendly, and my issue vanished in minutes—a far cry from their usual 'dial-one-to-scream-into-the-void' reputation. So, what changed? Competition happened. A decade ago, our choices for cable and internet were as limited as the soda options in a health spa. Now, thanks to a buffet of streaming services—even including live local TV—the old cable giants had to step up their game or step aside. Turns out, competition is more effective than caffeine at improving service quality. Why can't Medicaid beneficiaries get the same treatment? Currently, most Medicaid coverage is through Managed Care Organizations (MCOs), where the state pays a fixed monthly rate per patient. This model should spur cost-efficiency, but it often just limits the scope of care. Low payments to doctors, restricted access to necessary services—who does that help? Could strict government regulations guarantee better service? Maybe, but FA Hayek (and a basic reading of history) prove that bureaucracy alone can't engineer excellence. And choice for Medicaid patients? Virtually non-existent. Many areas offer just one MCO. If you're dissatisfied, too bad—there's no alternative. It's like being stuck with dial-up in the era of fiber optics. Long wait times for basic procedures, no freedom to seek better coverage... It's eerily reminiscent of the old cable monopoly days. In the private sector, at least there's a semblance of choice: HMOs, PPOs, HSAs... But for Medicaid recipients? Sorry, the state chooses for you. Hope you like it. Our Medicaid system desperately needs a dose of competition. Isn't it time we offer Medicaid patients the luxury of choice that drives quality up and costs down? https://t.co/C7XE6CpIIP Joe Grogan Lisa Grabert Joanne Spetz Cheerag Upadhyaya, MD, MBA, MSc, FAANS, FACS Brian R. Gantwerker, MD, FAANS, FACS Sanjay Dhall Larry Bucshon, M.D.

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Millions are losing Medicaid coverage due to procedural issues — learn effective strategies to mitigate this challenge. At the California Association of Health Plans (CAHP) session, industry leaders showcased how California's robust Medicaid unwinding plan and partnerships with health plans significantly contributed to their success in curbing coverage loss during Medicaid redeterminations. Key strategies include: 1️⃣ Collaboration with Health Plans: Partnering with health plans and community organizations to reach vulnerable members. 2️⃣ Improving Contact Data Accuracy: Enhancing electronic data-sharing systems to streamline changes to individual eligibility. 3️⃣ Transitioning to Alternative Coverage: Supporting the transition to Marketplace coverage for those who no longer qualify for Medicaid. Dive in for further insights: https://bit.ly/49vww3W #CAHP2023 #MedicaidUnwinding #Healthcare

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Remember to tune in to Blue Shield of California's webinar on primary care delivery in California today at 12 PM PT. Learn from our CEO, Khanh Gia Nguyen, and other industry leaders on steps being taken to improve primary care service delivery in California and the launch of a value-based payment pilot. Register here: https://lnkd.in/eqwr4RH6 #primarycare #valuebasedcare #healthcareinnovation

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According to this article in Modern Healthcare, discussing a report from the Center for Healthcare Quality and Payment Reform, we have 16 rural hospitals at risk of closing in Washington State, and another 8 in Oregon. It’s disheartening but not surprising when reimbursement rates don’t cover the cost to provide care and hospitals have been operating at a loss for much too long. Make no mistake, it is an issue of health equity when our neighbors in rural and underserved communities face hospital closure and risk further losing access to care.  #healthequity #healthcare #healthcareaccess https://lnkd.in/gHr4Qz-j

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The Future Organization LLC has been accepted as a state-approved vendor for the California Department of Health Care Services (DHCS) Providing Access and Transforming Health (PATH) Technical Assistance (TA) Marketplace! The following categories of organizations can apply to receive DHCS PATH TA funding to engage The Future Organization at no direct cost, for customized consulting services across the domain of building data capacity, including data collection, management, sharing, and use: ·      County, city, and local government agencies, including public health departments ·      Providers (including, but not limited to, public hospitals and provider organizations) ·      Community-based organizations (CBO) ·      Other ECM and Community Supports providers ·      Correctional agencies and other justice-involved stakeholders ·      Medi-Cal Tribal and Designees of Indian Health Programs The PATH TA Marketplace also has a range of approved providers to serve a variety of organizational and service improvement needs across other domains.  If your organization belongs to one of the above categories and is in need of technical assistance or consultancy support, please visit the PATH TA Marketplace link below to learn more and get access to helpful tools and resources!

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The Association of Healthcare Value Analysis Professionals (AHVAP) celebrates Elizabeth Eisenberg, MSN, RN, CVAHP from Scripps Health for commitment to excellence in the specialty of healthcare value analysis! Liz has signified this commitment by signing the official Association of Healthcare Value Analysis Professionals (AHVAP) healthcare value analysis pledge. To learn more about the Association of Healthcare Value Analysis Professionals (AHVAP) Commitment pledge: https://lnkd.in/gqEWPBue. #AHVAP #valuebasedcare #excellenceincare #valueanalysis

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In a recent PCC interview, Blue Shield of California's Peter Long urged policymakers to set clear outcome measures for defining health care success and ensure health plans allow flexibility to support improvement. Hear more from this primary care champion: https://lnkd.in/dYYsGwAD

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New #ManattOnHealth Insight by Lora Kim and Nina Punukollu: The Centers for Medicare & Medicaid Services (#CMS) just approved a historic #Medicaid expansion in Arizona, California, New Mexico and Oregon, marking the first time traditional #HealthCare practices will be covered under Medicaid and #CHIP. This landmark decision opens doors to culturally appropriate health care—aimed at tackling longstanding health disparities affecting American Indian and Alaska Native communities. Learn more: https://lnkd.in/ehsvJpMk

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The Centers for Medicare & Medicaid Services released its annual health spending assessment in Health Affairs, revealing concerning trends: - Medicare spending is spiraling out of control with little political will to reduce costs. - Health spending is projected to reach 20% of GDP soon, outpacing wage growth and decreasing affordability. - Private healthcare costs grow slower than government spending, emphasizing the importance of private coverage. COVID and IRA policy are major drivers of these issues: - Post-COVID pent-up demand is increasing costs across hospitals and doctors. - Prices and aging are having a major impact as well. - Medicare spending is expected to grow significantly, reaching historic rates, putting pressure on taxpayers. - Unsustainable cost growth is looming, with the average family projected to spend 40% of their income on healthcare within five years. Transformative changes in Medicare policies are crucial for long-term sustainability: - Using the successful Part D model in Medicare Advantage and fee-for-service. Part D leverages competition and incentives hold down costs. - Deploying new (and real) incentives to deliver value should be incorporated while reducing regulatory/reporting burdens on providers. Fee-for-service is uncoordinated and drives waste and overutilization of services that may harm patients. - Addressing $51 billion in annual Medicare improper payments (fraud) and ensuring payments structures are vital. The program's trajectory towards $2 trillion in 2032 demands thoughtful planning and strategic reforms to ensure the program's future viability and alleviate the burden on taxpayers. Learn more about the assessment here: https://lnkd.in/etpJWRdr Council for Affordable Health Coverage

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📣  Are you headed to Southern California State of Reform Health Policy Conference? 📣 We are excited to engage with industry leaders, gain valuable insights, and contribute to the ongoing dialogue about the future of healthcare in the state of California. If you'd like to learn more about Stellar Health and our approach to value based care delivery, then send Nick Melrose a DM or a quick note to connect: [email protected] #healthcare #healthpolicy #StateofReform #valuebasedcare

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CDI2 is transforming health care through data science. This annual report highlights the work that’s improving outcomes, especially for marginalized communities, and shaping care far beyond California. 📖 Read it here: https://bit.ly/3BWT7LV #DataDrivenInnovation Cora Han Atul Butte

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Stakeholder engagement is paramount to health systems change at all levels and intersections—- and there are many and they are dynamic, vast, and often entrenched, but the basic tenets still withstand the tests of time. Read about how our LA Collaborative is creating space to make space Alexis Taylor, MPA, MSL Rana Suliman Ahana Singh, MPH Dania Wasongarz Victor Garibay 👏🏼#healthpolicy #systemschange #DHCS #CalAIM #CBOs #StakeholderEngagement

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The Oregon Health Authority and Washington State Auditor's Office collaborated on a audit with the HHS Office of Inspector General in this report outlining significant #waste and #improperpayments in #Medicaid. Findings include: - #DuplicateParticipation: $445 million in Medicaid payments from 2019-2022 went to recipients also enrolled in other states, with $29 million deemed improper. - Gross #Waste Easily Prevented: #California and #Washington accounted for $134 million and $65 million in overlapping benefits in just Oregon. - Errors in #Eligibility Data: Limited staffing reviews only 20% of quarterly cases, leaving over 26,000 unreviewed. - Federal Data Gaps: Lack of real-time, accurate data-sharing prevents timely detection of duplicate enrollments. With #PARIS down all year (due to a lapsed federal data sharing agreement), the antiquated solution was unable to address duplicate participation POST-COVID. (We're pretty sure it wasn't intentional.) The timeframe for this audit was also during the Pandemic Health Emergency. Congress prohibited States from disenrolling people during the #PHE. This shows the cost of that decision - and it's just ONE STATE. Kudos to Oregon for United Council on Welfare Fraud has repeatedly called for updates to a duplicate participation oversights. So far, no program has done it well under Federal control. This shows the cost. Let's hope this gets fixed in the new Congress and Administration! https://lnkd.in/ew9JbHtz #welfarereform #FNS #NationalAccuracyClearinghouse #PublicAssistanceReportingInformationSystem #ACF #HHS #fraudwasteabuse #taxpayerfunded California Welfare Fraud Investigators Association

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Webinar Rescheduled! Calling All Health Information Exchanges (HIEs)... Don’t miss our webinar on November 14, 2024, from 12 PM - 1 PM: HIE Sustainability and EMS - How Your HIE Can Facilitate Exchange of Pre-Hospital Data. Join San Diego Health Connect as we delve into the essential role HIEs play in enabling the smooth transfer of pre-hospital data from EMS providers to hospitals. Discover how this data exchange boosts care coordination, enhances patient outcomes, and contributes to the sustainability of HIEs. Key Topics We’ll Cover: • Integrating EMS data into the healthcare system via HIEs • Real-time data sharing between EMS and emergency departments • Strengthening partnerships between EMS agencies, hospitals, and HIEs • Case studies of successful EMS data-sharing efforts • How SDHC’s hosted solution supports seamless integration of pre-hospital data Secure your spot today: https://zurl.co/SaXt #EMS #HIE #PreHospitalData #HealthcareIntegration #SDHC #CareCoordination

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Do you need to know what is happening with MEDICARE coverage of telehealth coverage starting January 1, 2025? Stay-tuned! This helpful post from CTRC provides the current state of play. In addition to telehealth, there were several important MEDICARE updates related to remote therapeutic monitoring. For details, please check out the CTRC website with links to two 30 minute webinars and slide decks.

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The integration of data across government programs is pivotal in addressing the social drivers of health. California Department of Health Care Services and California Cradle-to-Career Data System are collaborating on an innovative endeavor to connect data to improve outcomes for all Californians. This interconnectedness paints a holistic picture, allowing for the identification of patterns and trends that may not be visible when data is siloed. Learn more on how cross-sector collaboration can bridge sectors and create a seamless information ecosystem. https://lnkd.in/giEJJfuB

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As California's largest nonprofit health data network, Manifest MedEx is integral to the state's health data infrastructure, combining and delivering crucial health information to help Medi-Cal managed care plans (MCPs) succeed under CalAIM. Learn what Medi-Cal MCPs can do with MX. https://lnkd.in/dqCsmBkz

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How can Medi-Cal improve its transportation benefit? In 2020, the California Health Care Foundation released a study of the Medicaid benefit, calling out several ways the state and managed care plans could make it better for members, providers, and California. Have those recommendations been implemented? Read our latest blog to find out. https://hubs.li/Q02B9_780

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California's Office of Health Care Affordability entertains its first-ever material change transaction notice, less than a year after releasing the draft of its intensive healthcare transaction review regulations. In the latest Health Law Update Blog, Counsel Sarah Browning and Associate Nicole K. discuss why the MCN is important, as well as takeaways. #OHCA #Healthcare #BHBlog

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