Hal Wolf

Epic Systems’ recent move to back the TEFCA medical records exchange is interesting. On the surface, it’s all about creating a seamless flow of patient data across hospitals, QHINs, and all relevant stakeholders. But let’s be real—data is the oil of the new economy, and interoperability is the pipeline that delivers this precious resource to all the right stakeholders. By aligning with TEFCA, Epic might just be positioning itself as the refinery. All in all, this is a welcoming move by Epic Systems—especially if it really is as straightforward as they make it sound. But given the lack of details, one has to wonder if there are any hidden catches. After all, when it comes to something as valuable as healthcare data, it’s wise to look out for the fine print. Let’s hope this is genuinely about improving patient care. https://lnkd.in/gDdDCcmj

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Health literacy is vital for advancing Medicaid equity. Center for Health Care Strategies latest resource equips healthcare professionals with practical strategies to improve how they communicate with Medicaid members, ensuring patients understand and access the care they deserve. Strengthening these communication efforts helps break down barriers, fosters trust, and leads to more equitable health outcomes. Explore these insights to enhance patient engagement and drive better results in your community.

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New for 2025, CMS is rolling out a geographically based targeting option for Medicare Advantage organizations based on an Area Deprivation Index. If these orgs get things right, this could mean opportunities with new enrollees (especially in Midwest and Southern states) with potential rewards, incentives, and reduced cost sharing. This is in addition to CMS’ 2025 proposal to draw from ACO REACH and its geographic adjustments (which saw some big winners). If finalized, savvy ACOs would have additional capabilities through prepaid shared savings. tl;dr, CMS continues to push geographic considerations for beneficiaries. #sdoh #healthequity #medicare #medicaid .Variate Health

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Interesting perspective on #TechnologicalDebt in health care by Dave Lamar focused on the provider market, but we seem the same issues within state depts and payers. While good data governance practices are key, there must be a better way to solve this common - if not universal - challenge in health care, if only by offloading some of the administrative responsibilities that require the individual management and administration of no-value-add administrative functions. #healthdata

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Navigating healthcare government affairs is key to improving patient outcomes. Success relies on building strong relationships with policymakers, staying updated on legislation, and engaging in policy discussions. https://hubs.la/Q02PR5Mt0

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How can #Medicaid policymakers advance the adoption of value-based arrangements by Federally Qualified Health Centers? 1.     Through the Return of Shared Savings to #FQHCS. – Participating FQHC networks should be eligible to share in a substantial portion (50% or more) of the savings realized when the actual total costs incurred for their attributed population are below the benchmark or goal set for average Total Cost Of Care (TCOC). 2.     Adjust the Payment Model for the FQHC Patient Population. – The benchmark costs used to set rates should be based on the average #TCOC in the market, or the average amount the Managed Care Organization gets paid per enrollee, rather than using the FQHC networks’ own historical low reimbursement as a starting point. Learn more in this report authored by our Kim Prendergast, Aditya Mahalingam-Dhingra, and Vikki Wachino for the Milbank Memorial Fund - https://lnkd.in/eCGMECd2 #Valuebasedcare ##FQHC #ACO #TCOC #Medicare #ProspectivePaymentSystem #ManagedCare #Managedcareorganizations #VBP #Healthcarequality #CMS #healthequity #Communityhealthcenters #Communityhealth Massachusetts League of Community Health Centers National Association of Community Health Centers (NACHC)

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Next up, the Practice Management Committee session lead by Mark R. Jones and Alan Eisman at Emergency Department Practice Management Association (EDPMA) Solutions Summit! Powerful content on Contracting and Partner Relations (Bing Pao), Machine Learning AI (Dave Friedenson, MD, FACEP) and IDR Best Practices (Ed Gaines)! #EDPMA #SolutionsSummit24

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In #healthcare #interoperability news, The U.S. Department of Health and Human Services (HHS), through the Office of the National Coordinator for Health Information Technology (ONC) and its Recognized Coordinating Entity (RCE), The Sequoia Project, announced that the Trusted Exchange Framework and Common Agreement #TEFCA Version 2.0 (CA v2.0) has been released! "These enhancements and updates mark a huge step forward for TEFCA as it meets the promise of seamless nationwide exchange at scale." 🌐 What Is It? The U.S. Department of Health and Human Services (HHS) has released Common Agreement Version 2.0 (CA v2.0). This agreement sets the rules for securely sharing health information across different networks 🔑 Key Points: 🔸 TEFCA Exchange via FHIR: CA v2.0 now requires support for Fast Healthcare Interoperability Resources (FHIR). This means easier information exchange between health networks and better access to personal health data via apps. 🔸 Qualified Health Information Networks (QHINs): Seven designated QHINs can adopt and implement this new version. 🔸 Terms of Participation: Participants and Subparticipants must comply with specific requirements to join TEFCA. 🔸 Big Step Forward: CA v2.0 brings us closer to seamless nationwide health data exchange. 🚀 Why It Matters: This release enhances healthcare connectivity, making it easier for everyone to access and share vital health information. 🌟 Read more in this press release from ONC! 🔗 https://lnkd.in/eZPczt8e

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🚀 CMS Unveils Strategic Initiatives to Enhance Healthcare Services and Accessibility 🏥 The Centers for Medicare & Medicaid Services (CMS) has announced a groundbreaking series of initiatives aimed at improving healthcare quality and expanding access for beneficiaries. Key highlights include: 🌟 Nursing Home Staffing Campaign: Addressing staffing shortages to elevate care standards in long-term facilities. 🧠 Innovation in Behavioral Health Model: Selected states will focus on enhancing care for adults with mental health conditions and substance use disorders. 💰 Healthcare Spending Insights: The 2023 National Health Expenditures Report reveals a significant rise in healthcare spending, emphasizing the need for sustainable funding strategies. 🏡 Acute Hospital Care at Home Program: Demonstrating the feasibility of delivering inpatient-level care in home settings while maintaining quality and reducing costs. 🌍 Health Equity Conference 2025: A platform to discuss advancements in health equity, encouraging community involvement and research contributions. 💡 CMS is also focusing on maternal health, rural healthcare support, hospice quality improvement, and updated hospital price transparency requirements. These initiatives are set to create a more efficient, equitable, and resilient healthcare system that benefits all stakeholders. 👉 Click the link to learn more about these transformative efforts! #CMSInitiatives #General #HealthEquity #HealthcareInnovation #MedicareMedicaid #RegulatoryAgencies #MarketAccess #MarketAccessToday

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Participants in the Value-Based Care Learning Collaborative’s Care of Acute and Chronic Conditions track. Twenty-three DC Medicaid provider practice teams are testing changes to address gaps and improve care during the second learning cycle of Integrated Care DC’s Value-Based Care Learning Collaborative.

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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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If you have started a new GME program in the last seven years you should reciew these and comment.

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Today the Centers for Medicare & Medicaid Services (CMS) published the request for applications (RFA) for the ACO Primary Care Flex (PC Flex) Model, which will test #primarycare hybrid payments within MSSP beginning January 1, 2025. (https://lnkd.in/epgeV9ie) The application portal is open now (https://lnkd.in/erZPbmGq). To apply, ACOs must submit an MSSP application (as an initial, re-entering, or renewing/early renewing applicant) and a supplemental PC Flex application questionnaire. The MSSP application is open now through June 17 at 12:00pm (noon) ET. The PC Flex supplemental application must be submitted by August 1, 2024. CMS will host a model applications webinar on June 6 at 2-3:30pm ET. (https://lnkd.in/eVJJKrrP) Considerations for applying to PC Flex were discussed during NAACOS' MSSP 2025 Application Insights webinar yesterday, the slides and recording will be available on-demand shortly (https://lnkd.in/ejizaatZ). Stay tuned for additional NAACOS resources on the PC Flex model. Key model details: > The model will run January 1, 2025 – December 31, 2029. > Eligible participants are low revenue ACOs using prospective assignment that begin a new MSSP agreement starting Jan. 1, 2025; ACOs cannot simultaneously participate in Advance Investment Payments (AIP). > Participation is at the ACO level and all ACO participants and their primary care providers will be required to participate; fee reductions will be applied at the TIN/NPI level. > In addition to the MSSP application and PC Flex questionnaire, applicants must submit a spend plan, roster of non-physician practitioner data, and assurance of ability to repay; applicants may withdraw the PC Flex application at any time prior to signing the Participation Agreement (December 6 – 12, 2024), and may withdraw the PC Flex application without impacting the MSSP application. > Participants will be required to submit a health equity plan, collect and report health equity data, and secure a repayment mechanism (separate from MSSP repayment mechanism for 2-sided tracks). > ACOs will distribute the Prospective Primary Care Payment (PPCP) to their participant primary care providers, FQHCs and RHCs. CMS will require ACOs to publicly report information on the distribution of the PPCP. #valuebasedcare #accountablecare #healthcareinnovation

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Enhancing Quality Improvement in Hospitals with ORControl™ Quality Improvement (QI) in healthcare isn’t just about outcomes—it’s about creating smoother, safer, and more efficient processes. ORControl™ empowers hospitals with minute-by-minute coordination, optimized OR utilization, and instant day-of-surgery insights, helping clinical teams stay aligned and proactive. By addressing challenges as they happen, ORControl supports a more streamlined, patient-centered approach to perioperative operations and day-of-surgery workflows. Learn more about how ORControl is transforming QI initiatives and advancing healthcare standards in this article by Becker's Health. View full article below ⬇

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The Medicaid Leadership Exchange podcast shares insights on how states are working to achieve better outcomes for individuals served by Medicaid, and creative approaches used to address #healthdisparities. Via CHCS and NAMD - https://hubs.la/Q02DVp3g0

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PicassoMD and Eventus WholeHealth Announce Partnership to set a new standard in healthcare innovation and patient-centered services for individuals in long-term care settings PicassoMD, Inc., a platform that connects healthcare providers for real-time clinical decision support, referrals, and care coordination, and Eventus WholeHealth, the country’s leading provider of primary care and mental health services for medically vulnerable adults, are proud to announce a new partnership that will enable their strategic clinical care teams to connect with local and remote specialists in real-time. PicassoMD and Eventus WholeHealth share a common goal of making access to healthcare available to those who are medically vulnerable. Co-founded by a cardiologist, PicassoMD has revolutionized the way Primary Care Providers (PCPs) deliver care. The platform enables PCPs to access real-time clinical consultations with specialists across more than 30 specialties in under 30 seconds, significantly improving patient outcomes and reducing costs. Additionally, if a referral is necessary, PicassoMD helps seamlessly transition the patient from the PCP to a local specialist, ensuring continuity of care and enhancing patient satisfaction. This partnership has already shown impressive results for Eventus patients: * 70% of Emergency Department (ED) visits were avoided. * 77% of specialist referrals were avoided. * 70% of cases saw a change in clinical behavior based on real-time specialist input. * The average time to connect with a specialist was just 12 seconds. "Through our strategic partnership, Eventus WholeHealth and PicassoMD are setting a new standard in healthcare innovation for individuals in long-term care," said Dr. Reza Sanai, founder and Co-CEO of PicassoMD. "We are dedicated to enhancing patient outcomes and streamlining care coordination, demonstrating our commitment to transforming healthcare with compassion and excellence." “Eventus’ partnership with PicassoMD has been amazing! It allows our clinicians to securely message specialty providers for consultation about difficult cases. I’ve personally connected with various specialists and within minutes had a plan of care to implement the same day. This app enables real-time patient treatment instead of waiting months for an appointment,” said Cathy Parker, NP, VP of Value Based Care Outcomes at Eventus WholeHealth. “These curbside consults directly affect value-based care by providing real-time solutions, coordinating care, and decreasing ER transfers, leading to better quality and cost-effective care for our patients.”

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