Tag Archives: Medicaid

High-tech guided meditation eases burn pain

Parkland Hospital in Dallas County, Texas, is one of America’s “most wired,” as recognized by Hospitals & Health Networks® Magazine. Its careful integration of user-friendly tech extends from handy kiosks in the lobby to patient rooms with an array of digital devices that help both patients and staff. While much of the technology is focused […]
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Analytics provides “one report card” for physicians

In today’s health care, there are a lot of players – and a lot of payers, each with their own standards for evaluating physicians and the care they provide. As Greg Kile, CEO of the analytics firm Populytics, explains in an Optum® video, his company’s top 10 payers have 176 different metrics. Being washed over […]
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Modernizing Medicaid: Mega-Reg implications health plans should know

Payers manage a multitude of responsibilities as it relates to their Medicaid membership. From regulatory adherence, and payment integrity optimization to enrollment management, the current, and sometimes, complex canvas of Medicaid oversight is now growing.   The Department of Health and Human Services (HHS) issued a new ruling earlier this year with the intention to […]
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Preventive care: Gauge potential to drive revenue

Say your patient population is the size of Cincinnati and Toledo combined, you might be able to fill up my beloved Buckeyes’ Ohio Stadium with patients who’ve skipped two years of well visits. I’m talking about 18 percent of your patients missing out on preventive care. What would closing that gap in care mean to […]
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Calculating the incalculable

We often hear from state program integrity units that the work they do goes unrecognized. Yet when quizzed on how they promote their efforts — which could result in millions of dollars in savings and recoveries over just one year — they often reveal a limited understanding of how to calculate these savings. After all, […]
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Getting behind the science: Program integrity, predictive analytics and best practices

Whether you pluck the petals from a daisy or gaze into a crystal ball, the traditional means of predicting and influencing future events has always carried a high degree of risk. Fortunately, when it comes to analyzing claims data, there are proven methodologies —predictive analytics — that states can use to help assess the validity […]
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A healthy partnership: Medicaid managed care organizations and federally qualified health centers

“Triple Aim” has become recognized as the methods designed to put our health care system on the path to long-term sustainability. Stakeholders recognize the triple aim as simultaneously lowering population health costs, increasing quality and improving the health care experience for patients. Critical to improving the patient experience is measuring the performance of health providers, […]
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Excessive incarceration of individuals with mental health and substance use disorders: Jail diversion programs may be the answer

The number of individuals with mental illness and substance use disorders in U.S. jails and prisons is troubling, with estimates ranging from 360,0001 to more than a million.2 At least 30 percent of incarcerated adults have a serious mental illness, and approximately 65 percent have a substance use disorder. Twenty-five percent have both.3 Now, an […]
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Suspend Medicaid benefits of the incarcerated rather than terminating them

When individuals are incarcerated, most states terminate Medicaid benefits. Problems arise, however, as prisoners are about to be released. Administrative delays and state regulations often result in a gap of several weeks before coverage resumes — a critical period of time for former inmates struggling with mental illness, addiction or a host of high-level chronic […]
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Engaging in risk-based contracts? Get an actuary’s opinion

Health care providers across the country are looking at ways they can increase their clinical and financial risk exposure under value-based contracts. But if they’re not experienced with risk, they may enter into contracts that put them in difficult situations. The consequences of bad risk contracts could include poor cash flows, non-competitive rates resulting in […]
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