Spring Issue

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    07-Mar-2016
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Medicaid news

Transcript of Spring Issue

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    T h e M e d i c a i d B i g P i c t u r e Y o u N e e d . I n U n d e r 5 M i n u t e s.

    M o s t ly M e d i c a i d

    HEALTH REFORM

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  • 4th Annual

    Medicaid Medicaid Medicaid Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Medicare Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Marketing Medicare Medicare Medicare Marketing Marketing Marketing

    Medicare Toolkit Receive Key Updates on Healthcare Reform and its

    Impact on Marketing to Increase Plan Compliance

    Integrate Marketing Across Di erent Media Channels to Grow Age-In and Current Enrollee Market Share

    Create Compliant Customer Service Approaches to Identify and Respond to Todays Senior Population

    Understand the Evolving Medicare Sales Strategy to Prepare for a Post-Reform Environment

    Explore Innovative Marketing and Retention Strategies for Medicare SNP Plan Growth

    Leverage Best Practices to Maintain Quality and Boost Enrollment During Peak Periods

    Medicaid Toolkit Drive Creative Partnerships with Advocacy Groups to

    Expand Outreach Dollars under Limited Budgets

    Maximize ROI on Marketing Initiatives in Tight Budgets

    Master Meeting EPSDT Well Visit Goals Th rough Innovative Checkup Outreach Programs

    Improve Member Retention and Quality Outcomes For Better Regulatory and Financial Outcomes

    Grow Maternal Post-Partum Visit Rates through Overcoming Barriers to Improve HEDIS Scores

    Understand the changing demographics of your plan and community to provide culturally competent services and give providers to the tools to make necessary changes

    Advanced strategies to optimize enrollment, maximize retention and ensure compliance in an era of change

    &

    Enrollment Congress&

    March 22-23, 2010 Hilton Baltimore Baltimore, MDMention priority code XP1514MMad when registering

    www.iirusa.com/mmo

    Actionable Insights from the Plans & Thought Leaders You Admire MostAetna Amerigroup Amerihealth Mercy Blue Cross Blue Shield of AL Blue Cross Blue Shield of MN Blue Cross Blue Shield of SC Boston Medical Center Healthnet Health Plan CareSource Community Partners Louisiana Dept of Health & Hospitals Medica Health Plans Molina Healthcare of Ohio Neighborhood Health Plan Oklahoma Healthcare Authority/SoonerCare OmniCare Passport Health Plan Priority Health State of Maryland UCare UC Berkeley UPMC Health Plan

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    QUALITYANDINNOVATIONNEWS VeryfewdoctorsseeenoughMedicarepatientstoreportreliablequalitymetrics CMSreleasesmeaningfuluseregsforEHRs

    KristinPattersonandMMStaff

    Samplesizedoesnotcompute

    The whole world may be abuzz with using

    quality metrics to reform payment there's

    just one big problem. According to a study

    published in JAMA inDecember 2009,most

    primary care physicians don't even see

    enough Medicare patients to calculate the

    current Medicare quality measures with

    statisticalvalidity.Put simply, theirMedicare

    patient traffic is too low to tell if they are

    improvingqualityorcost.The lowestsamplesizeneeded is328patients (formammography)andthe

    highestneededismorethan19,000patients(forhospitalprevention).Mostphysiciansseelessthan180

    Medicarepatientseachyear.IfMedicarequalityandcostmeasurementaretobethestandardsmoving

    forward,thisain'tlookinggood.1

    RegulationsDefiningMeaningfulUseofElectronicHealthRecordsReleased

    When theAmericanRecoveryandReinvestmentActof2009wassigned, the law included theHealth

    InformationTechnologyforEconomicandClinicalHealthAct(HITECH).HITECHgivesCMStheauthority

    to establish criteria for the utilization of EHR technology within the healthcare system. Under the

    proposedregulation,meaningfuluseisdefinedbyCMSandONCasaneligibleprofessionaloreligible

    Calculating Medicare Quality Metrics - Not Enough Patients Seen to be Accurate

    180

    328

    Average Seen by Physicians Mammography Sample Size Needed

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    hospital that, during the specified reporting period, demonstratesmeaningful use of certified EHR

    technology inamannerthat improvesquality,safety,andefficiencyofhealthcaredelivery,reduces

    health care disparities, engages patients and families, improves care coordination, improves

    population and public health, and ensures adequate privacy and security protections for personal

    healthinformation.2

    During the first year of participation in

    the program both eligible professionals

    and hospitals must demonstrate they

    have performed one or all of the

    following criteria: 1) acquired and

    installedanEHRsystem2)trainedstaff,

    deployedtoolsandexchangeddataor3)

    upgraded a certified EHR system by

    expanding its functionality and

    interoperability.3

    Furthermore, participants must also

    satisfy additional annual requirements

    suchas30percentMedicaidpatientvolume (forprofessionals),average lengthof stayof25daysor

    fewerand10percentMedicaidpatientvolume(forhospitals).4

    At first glance, the initial costof implementing anEHR systemmightbe tooexpensive foroperating

    budgets;however,eligibleprofessionalscanreceiveupto$63,750overasixyearperiodwhilehospital

    paymentsaredeterminedbyaformulathatbenefitsthosewithahighMedicaidpatientvolume.Ifthe

    proposed regulation is passed, providers should consider this an opportunity to implement an EHR

    systemata lowercost.Moreover, incentivepaymentscouldbeginasearlyasOctober2010toeligible

    hospitalsand January2011 tootherproviderswhichwouldhelpease the immediate costburdenof

    implementingorupgradingasystem.5

    Theproposed regulation containsmany incentives toaccelerateand facilitate theadoptionofhealth

    information technology by individual providers and organizations throughout the healthcare system.

    MorenewsoverattheMostlyMedicaidBlogs

    blog.mostlymedicaid.comwherethebestMedicaidmindsmingle.

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    Participantswillseethatthecostsof implementationwillbeoffsetby improvementstopatientsafety

    andquality,reductionofmedicalerrorsandacquisitionofaloyalpatientbase.

    HEALTHREFORMNEWS Updatesonthemadness States that have already broadened health care coverage say that the Senate overhaul bill

    unfairlypenalizesthem

    Lookingatmanagedcarefirmsandincentivesforreform MedicaidexpansionbyhavingMedicarepickupthefulltabforduallies

    BrendanStern,ClayFarris,andKristinPatterson

    Giventhedirectionofcurrentpoliticalwinds,theGreatHealthReformDebatemaybeoversoonsowethoughtwedtalkaboutitonemoretime.

    Updatesonthemadness

    Ithastrulybeenheadspinningtotrytokeepupwiththehealthreformchanges/ideasproposedeach

    day.InDecember,somesenatorsweretryingtolowertheMedicareeligibleageto55aswellasextend

    mandatoryMedicaid coverage to familieswith incomes up to $33,075. Thosewacky politicians also

    proposed requiring insurance companies to spend 90%ofpremiumson services,building in aprofit

    limit.Sortoflikeonlygivingtocharitieswhohaveloweradmincosts?

    Oh,beforeweforgetHarryReid(who'sadmittedlyon

    ournaughtylistforhisshamefulporkslingingseelast"Weare, ina sense,beingpunished for our owncharity."

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    issue)comparedopposition topassinghishealth

    reformopustooppositiontoabolition.Weknow

    thatall'sfair in love,warandUSpoliticsbutthat

    lowblowisjustdownrightdisgusting.