Podcasts about mcos

This is the third and final part of our multi-club ownership series. We've learned how multi-club operations work and provided some practical examples from the world of football.Today - we answer your questions on the effectiveness and future of MCOs.So, can we say for certain multi-club ownership is here to stay?Host: Ayo AkinwolereWith: Matt Slater Executive Producer: Adey MoorheadProducer: Mike StavrouWe want to hear about your podcast habits. Go to theathletic.com/athletic/survey25 to fill out a short survey and be in with the chance of winning £/$100 Amazon vouchers Hosted on Acast. See acast.com/privacy for more information.

This is the third and final part of our multi-club ownership series.  We've learned how multi-club operations work and provided some practical examples from the world of football. Today - we answer your questions on the effectiveness and future of MCOs. So, can we say for certain multi-club ownership is here to stay? Host: Ayo Akinwolere With: Matt Slater  Executive Producer: Adey Moorhead Producer: Mike Stavrou Learn more about your ad choices. Visit megaphone.fm/adchoices

Yesterday we heard part one of our multi-club ownership eries, as we learned about how MCOs work - and their purpose.Today, we get some real-world examples, hearing from inside the operations whose clubs include sides from the Premier League and Major League Soccer.So what is it like to own and manage multiple clubs in different leagues and sometimes in different sports?Host: Ayo AkinwolereWith: Matt Slater, Tim Bezbatchenko & Larry BergExecutive Producer: Adey MoorheadProducer: Mike Stavrou & Nick Thomson Hosted on Acast. See acast.com/privacy for more information.

Yesterday we heard part one of our multi-club ownership eries, as we learned about how MCOs work - and their purpose. Today, we get some real-world examples, hearing from inside the operations whose clubs include sides from the Premier League and Major League Soccer. So what is it like to own and manage multiple clubs in different leagues and sometimes in different sports? Host: Ayo Akinwolere With: Matt Slater, Tim Bezbatchenko & Larry Berg Executive Producer: Adey Moorhead Producer: Mike Stavrou & Nick Thomson Learn more about your ad choices. Visit megaphone.fm/adchoices

Whether it's Manchester City, Chelsea or even Bournemouth more and more Premier League clubs are sitting as part of multi-club ownership portfolios.But why?How do multi-club ownership groups work, are they purely about making money, or do they help guarantee success on-the-pitch?Ayo Akinwolere is joined by Matt Slater for the first of our three-part series in multi-club ownership including Matt speaking with AJ Swoboda, Managing Director in the Americas for consultancy firm Twenty First Group about the role of MCOs within the global game.Host: Ayo AkinwolereWith: Matt SlaterFeaturing: AJ SwobodaExecutive Producer: Adey MoorheadProducer: Guy Clarke Hosted on Acast. See acast.com/privacy for more information.

Whether it's Manchester City, Chelsea or even Bournemouth more and more Premier League clubs are sitting as part of multi-club ownership portfolios. But why? How do multi-club ownership groups work, are they purely about making money, or do they help guarantee success on-the-pitch? Ayo Akinwolere is joined by Matt Slater for the first of our three-part series in multi-club ownership including Matt speaking with AJ Swoboda, Managing Director in the Americas for consultancy firm Twenty First Group about the role of MCOs within the global game. Host: Ayo Akinwolere With: Matt Slater Featuring: AJ Swoboda Executive Producer: Adey Moorhead Producer: Guy Clarke Learn more about your ad choices. Visit megaphone.fm/adchoices

California Department of Health Care Services' Joanna Aalboe joins the show to share about the continued evolution of California Advancing and Innovating Medi-Cal (CalAIM)/Medi-Cal transformation as well as how managed care organizations (MCOs) will start to be measured in 2025 and beyond.

In today's episode, we revisit our episode with Josh Vire, Vice President of Value-based Operations at CHESS Health Solutions, where he discussed what has been learned during the move to managed Medicaid in North Carolina and what CHESS brings to the table with its all-patient solution.Josh Vire, welcome to the Move to Value podcast.Thank you, Thomas. Thanks for having me. Pleasure to be here.So, Josh, let's talk about managed Medicaid. First, can you tell me what is managed Medicaid?Sure. It may be easiest to start by sort of describing how traditional Medicaid works. In traditional Medicaid, typically this operates under what's called a fee for service payment model. This model is going to reimburse providers directly for every service that they provide to Medicaid beneficiaries. And generally the upside to this model is that it's going to allow for the flexibility and provider choice for the beneficiaries. But what we often see is that this leads to fragmented care and ultimately the incentives in this fee for service type model really incentivizes the volume of services over outcomes. So, in contrast to that, Managed Medicaid utilizes alternative payment models including capitation and what are called value-based payments. And the way that the capitation works is that a managed care organization or a MCO as they're referred to will receive a fixed monthly payment per Medicare beneficiary that's going to cover all their health care needs. And then that fixed payments are paid regardless the amount of services that are provided. And then those MCOs are going to use those funds to incentivize providers to be more cost effective in their care as well as incentivize sort of tighter coordination of the care. And then what they can layer on to those, as I mentioned, is the value-based care payments which are intended to reward providers based on the quality and outcomes of care rather than just the quantity of services provided. And so in theory, right, this would encourage more efficient, high-quality delivery of care. In addition, managed Medicaid may employ other payment models that are along that continuum of value based care payments, which could be like pay for performance or bundle payments. But really the goal there is to align the incentives to focus on driving down total cost of care as well as improving health outcomes for beneficiaries.Well last December North Carolina made the transition to managed Medicaid and Chess spent the year prior to that establish establishing the infrastructure and beginning to make preparations to offer this service. Can you tell me why this decision was made and a little bit of the story about how Chess built this service line.Absolutely. CHESS has a decades plus long history of working with providers to transform care delivery to value based care. And historically our focus has been on traditional Medicare, Medicare Advantage and commercial contracts. But as we went through our engagements with our value partners and then as we began to have discussions with providers across the state, we heard consistently that one of their pain points was the need to work with of having to work with multiple enablement companies to serve all their patients. So some enablement companies only work with MA or maybe the traditional Medicare options or commercial. But no one was really acting as sort of a one stop shop in in serving the entire patient population for these providers. So our decision to expand our services to include Medicaid was really driven by our desire to be what we call an all-patient solution, which essentially just means we want to be able to align incentives across the provider's entire patient population. And really that's because we believe this is how true transformation can and will occur, not in certain segments, but by treating all patients with an...

We spend a lot of time griping about the insidious power of corporate health insurance in our healthcare system here. But you would expect that taxpayer funded public programs for our most vulnerable friends and neighbors are free from profiteering right?  Sadly, no. Medicaid - the public program that serves the lowest income Americans, plus some people with disabilities, and a lot of the country's long-term care - has been extensively privatized in most states. Hoping to trim budgets, most states have outsourced Medicaid recipients to “Medicaid Managed Care Organizations,” which are actually private insurance companies. And with private insurance comes the barriers to care we know all too well, like prior authorizations, denial of claims, and narrow networks. These are all part of the private insurance/public programs business model: the more care they avoid paying for, the more money from those capitated payments they get to keep. But today we have a rare ray of sunshine: a state showing there's another way to provide care, not just coverage, to some of their most vulnerable residents. In 2012 Connecticut kicked the private insurance-run Managed Care Organizations out of their Medicaid program. They took on Big Insurance and won. Our guest today will walk us through how it went down. Sheldon Toubman has been a litigation attorney for Disability Rights Connecticut since 2021, and a leader of the efforts to remove Managed Care Organizations from the state's Medicaid program. Before that, he was a staff attorney with New Haven Legal Assistance Association (NHLAA), where he spent 30 years representing and working on behalf of Medicaid enrollees. He engages in a variety of strategies on behalf of people with disabilities, from litigation to legislative advocacy and public education through media, webinars and other means. https://www.youtube.com/watch?v=zM7dRzHkVu0&t=1804s Show Notes Sheldon tells us that before 2012, Connecticut's Medicaid program was bifurcarted: eligible kids, pregnant people, and families were in a capitated Managed Care Organization (MCO) model and people with disabilities were in a fee-for-service program. (Medicaid is funded with federal dollars, but unlike Medicare, states design the programs and make all the decisions about plans.) With a fee-for-service model, the state takes on the risk. With the MCO model, the MCO receives a per-person/per-month fee (a "capitated payment") from the state, and they have to provide the care; if the patient requires less care, the MCO keeps the money, but if the patient requires more care, the MCO has to pay for the amount above the per-person/per-month fee. MCOs had a financial incentive to deny care so they could recoup more money. Beginning in the late 1990s, Medicaid advocates began a campaign of lawsuits and lobbying to remove Managed Care from their Medicaid program. Hartford, Connecticut is known as the insurace capital of the US, so this was a tough fight. Insurance companies fought this campaign because public programs are a major profit center for insurers, often more profitable than private employer-sponsored insurance. The insurance industry claimed they provided excellent care for less money, and coordinated care in a way that's not possible with the fee-for-service model. The insurance industry also ran ads about all the jobs they provide, and legislators were afraid to tangle with them. When the state asked for data about how the MCOs spent public dollars, they refused to provide it. So advocates only had anecdotal information, and it was hard to refute the claims the MCOs made about how well they served patients. One of the anecdotal complaints they heard the most was the lack of access to providers. Advocates convinced the state to check the insurance company provider network lists, so the state instituted a Secret Shopper survey to analyze them. They found that patients could get an appointment with supposed in-netw...

Decoding Medicare Advantage and Medicaid MCOs: Understanding the CoverageYou may have heard (or even said) that Medicare Advantage is great if you're healthy but terrible if you're sick. But why is that? This week on The Amplify OT Podcast, I'm sharing what Medicare Advantage is, why it's popular, despite these claims, and how it has expanded into the Medicaid space with managed care organizations (MCOs).Join the Amplify OT MembershipAs an exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It's time to become your own best resource on Medicare and advocacy.In this episode, I cover:Benefits and barriers that come with Medicare Advantage plans.The difference between traditional Medicare and Medicare Advantage. Why managed care plans (MCOs) are popular, especially for governments. Current and proposed regulatory changes that affect these plans and us as practitioners. Thanks for listening! If you found this episode helpful, don't forget to follow, rate and review the show. To learn more about Amplify OT head to https://amplifyot.com/ Have a question or just want to say hello? Call or text +1 (919) 341-9289 to have your questions answered on the podcast! *Message and Data Rates May ApplyAmplify OT ResourcesWant to keep learning about how insurance and reimbursement impact you? Then head to AmplifyOT.com/Services to see what resources we have available!CLICK HERE to save 40% off Medbridge Today! CONNECT WITH AMPLIFY OT:WebsiteServicesFree NewsletterInstagramLinkedInFacebookTikTokLINKS MENTIONED IN THIS EPISODE:Ep 50: Volume-Based vs. Value-Based Reimbursement Models in OTCMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process [CMS.gov Article]Medicare Advantage in 2023: Enrollment Update and Key Trends [KFF.org Article]Medicaid: Last Week Tonight with John Oliver [YouTube]...

Dr. Samar Mohanty, president and CSO of Nanoscope Therapeutics joins us to shed light on the revolutionary gene therapy that's giving hope to individuals with retinal degenerative diseases by pioneering a treatment that can re-sensitize the retina to detect low light levels. We open the curtains on their groundbreaking multi-characteristic opsins (MCOs), which have the potential to address all forms of retinal degeneration and restore vision in millions of visually impaired individuals.First In Human is a biotech-focused podcast that interviews industry leaders and investors to learn about their journey to in-human clinical trials. Presented by Vial, a tech-enabled CRO, hosted by Simon Burns, CEO & Co-Founder. Episodes launch weekly on Tuesdays. To view the full transcript of this episode, click here.Interested in being featured as a guest on First In Human? Please reach out to owen@vial.com.

In today's episode, we visit with Josh Vire, Vice President of Value-based Operations at CHESS Health Solutions, who shares his insights on managed Medicaid and how CHESS leveraged years of experience to enter into Medicaid to create an all patient solution.Josh Vire, welcome to the Move to Value podcast.Thank you, Thomas. Thanks for having me. Pleasure to be here.So, Josh, let's talk about managed Medicaid. First, can you tell me what is managed Medicaid?Sure. It may be easiest to start by sort of describing how traditional Medicaid works. In traditional Medicaid, typically this operates under what's called a fee for service payment model. This model is going to reimburse providers directly for every service that they provide to Medicaid beneficiaries. And generally the upside to this model is that it's going to allow for the flexibility and provider choice for the beneficiaries. But what we often see is that this leads to fragmented care and ultimately the incentives in this fee for service type model really incentivizes the volume of services over outcomes. So, in contrast to that, Managed Medicaid utilizes alternative payment models including capitation and what are called value-based payments. And the way that the capitation works is that a managed care organization or a MCO as they're referred to will receive a fixed monthly payment per Medicare beneficiary that's going to cover all their health care needs. And then that fixed payments are paid regardless the amount of services that are provided. And then those MCOs are going to use those funds to incentivize providers to be more cost effective in their care as well as incentivize sort of tighter coordination of the care. And then what they can layer on to those, as I mentioned, is the value-based care payments which are intended to reward providers based on the quality and outcomes of care rather than just the quantity of services provided. And so in theory, right, this would encourage more efficient, high-quality delivery of care. In addition, managed Medicaid may employ other payment models that are along that continuum of value based care payments, which could be like pay for performance or bundle payments. But really the goal there is to align the incentives to focus on driving down total cost of care as well as improving health outcomes for beneficiaries.Well last December North Carolina made the transition to managed Medicaid and Chess spent the year prior to that establish establishing the infrastructure and beginning to make preparations to offer this service. Can you tell me why this decision was made and a little bit of the story about how Chess built this service line.Absolutely. CHESS has a decades plus long history of working with providers to transform care delivery to value based care. And historically our focus has been on traditional Medicare, Medicare Advantage and commercial contracts. But as we went through our engagements with our value partners and then as we began to have discussions with providers across the state, we heard consistently that one of their pain points was the need to work with of having to work with multiple enablement companies to serve all their patients. So some enablement companies only work with MA or maybe the traditional Medicare options or commercial. But no one was really acting as sort of a one stop shop in in serving the entire patient population for these providers. So our decision to expand our services to include Medicaid was really driven by our desire to be what we call an all-patient solution, which essentially just means we want to be able to align incentives across the provider's entire patient population. And really that's because we believe this is how true transformation can and will occur, not in certain segments, but by treating all patients with an eye towards that cost containment and...

In this episode, Robert Garber, Partner at 7wireVentures, sits down with Irina Ahmad and Joy Basinger to discuss his healthcare predictions for 2024, specifically around topics relating to AI, Health Equity, and GLP-1 therapies. Robert's top three predictions:  AI: The majority of health systems will leverage generative AI in clinical documentation and conversational tools.  Health equity: Payers and MCOs will drive more integrated SDoH-focused initiatives tied to the CMS Framework for Health Equity and improvement of HEDIS measures.  GLP-1 Therapies: As payers face increasing demand to ease GLP-1 restrictions, successful weight loss startups will incorporate these therapies as a part of a broader, thoughtful weight-loss solution. 

US equities were higher in Tuesday trading, though ended off best levels, with the Dow, S&P, and Nasdaq finishing up 0.40%, 0.52%, and 0.58%, respectively. Today's strength extended Monday's rally after markets shook off some early geopolitics-induced weakness. Airlines, banks, beverages, credit cards, chemicals, and homebuilders were among the outperformers. Big tech was mixed, while energy, MCOs, REITs, exchanges, insurance, food, and software were among the relative laggards. In all, today's upside can be tabbed to factors including Treasury strength and oil stabilization. While some of Treasury rally tabbed to flight-to-safety move amid geopolitical uncertainty given the ongoing conflict in Israel, recent dovish Fedspeak from Jefferson and Logan acknowledging tightening conditions from a higher-rate backdrop could warrant more caution on possible rate hikes. That said, Atlanta Fed's Bostic was the latest to say no further rate hikes are needed. Overseas, there was some positive takes on reports that China is planning a new $140B stimulus round with spending on infrastructure projects. The market awaits more macro data this week and the beginning of earnings season on Friday.

Heather Holberg, Director of Eligibility and Enrollment at CountyCare Health Plan stops by the podcast to talk about how MCOs in Illinois are supporting Medicaid Redetermination efforts in creative and effective ways.

The Government Accountability Office (GAO) is recommending expansion of the Medicaid Recovery Audit Contractors (RACs) program, to include auditing of payments made to managed care organizations (MCOs), according to a GAO report released in June.Launched in 2011 as a consequence of the Patient Protection and Affordable Care Act (PPACA) by the Centers for Medicare & Medicaid Services (CMS), the Medicaid RACs were purported to be aggressive in their recouping of alleged Medicare Fee-for-Service (FFS) overpayments. They could now be poised to expand into the rapidly growing MCO plans.  During the next live edition of Monitor Mondays, Dennis R. Jones, senior director of revenue cycle at Jefferson Health, will report on this developing story.Broadcast segments will also include these instantly recognizable features:Monday Rounds: Ronald Hirsch, vice president of R1 RCM, will make his Monday Rounds.The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullen, will report the latest news about auditors.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.Legislative Update: Folana Houston, assistant general counsel for Zelis, will report on current healthcare legislation.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.07.02.547398v1?rss=1 Authors: Yang, J., Ran, K., Ma, W., Chen, L., Chen, C., Zhang, C. M., Ye, H., Lu, Y. M., Ran, C. Abstract: Reduction of the production of amyloid beta (A{beta}) species has been intensively investigated as a potential therapeutic approach for Alzheimer disease (AD). However, the degradation of A{beta} species, another potentially beneficial approach, has been far less explored. In this study, we discovered that ceruloplasmin (CP), an important multi-copper oxidase (MCO) in human blood, could degrade A{beta} peptides. We also found that the presence of Vitamin C could enhance the degrading effect in a concentration-dependent manner. We then validated the CP-A{beta} interaction using total internal reflection fluorescence (TIRF) microscopy, fluorescence photometer, and fluorescence polarization measurement. Based on the above discovery, we hypothesized that other MCOs had similar A{beta}-degrading functions. Indeed, we found that other MCOs could induce A{beta} degradation as well. Remarkably, we revealed that ascorbate oxidase (AO) had the strongest degrading effect among the tested MCOs. Using induced pluripotent stem (iPS) neuron cells, we observed that AO could rescue neuron toxicity which induced by A{beta} oligomers. In addition, our electrophysiological analysis with brain slices suggested that AO could prevent an A{beta}-induced deficit in synaptic transmission in the hippocampus. To the best of our knowledge, our report is the first to demonstrate that MCOs have a degrading function for peptides/proteins. Further investigations are warranted to explore the possible benefits of MCOs for future AD treatment. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Welcome to the BT360 Podcast: What's Up in Business Travel for Week 49 of 2022.  This is a weekly podcast where we update you on what's up this week in the world of business travel.  This podcast is great for those who need to know what's happening all in less than 15 minutes.Topics covered during this podcast -Airline revenue is up but not bookingsNovember airfares dropAAA expects 113 million to travelAmerican tells TMCs to be NDC readyAir France-KLM stops FCM subsidiaryThoma Bravo acquires CoupaFocus partnership appoints TripStaxHighgate buys Viceroy HotelsUniglobe joins Business Travel Association CWT partners with WenrixPorter reveals first Embraer destinationsAmerican Airlines makes loyalty harderUnited orders 200 Boeing JetsFairFly automates MCOs for TMCsAir France-KLM suspends booking toolFrance bans some short-haul flightsJetBlue signs deal for 92M gallons of SAFVirgin Atlantic agrees to SAF supply dealAmsterdam Airport's ground vehicles to run on biofuel___________________________________Tune in every Monday morning to get your weekly update.  We hope you will make this a regular part of your week and listen in while you on the move or sitting back and sipping your coffee.  You can subscribe to this podcast by searching BusinessTravel360 on Google Podcast, Apple Podcast, iHeart, Pandora or Spotify.Be sure to sign up for regular updates at BusinessTravel360.com - Enjoy!Support the show

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.11.07.515284v1?rss=1 Authors: Sadikoglou, E., Domingo-Fernandez, D., Savytska, N., Fernandes, N., Rizzu, P., Illarionova, A., Strauss, T., Schwarz, S., Kodamullil, A., Hoeglinger, G., Dhingra, A., Heutink, P. Abstract: The microtubule associated protein tau (MAPT) chromosome 17q21.31 locus lies within a region of high linkage disequilibrium (LD) conferring two extended haplotypes commonly referred to as H1 and H2. The major haplotype, H1 has been genetically associated with an increased risk for multiple neurodegenerative disorders, including Progressive Supranuclear Palsy (PSP), Corticobasal Degeneration (CBD), APOE epsilon4-negative Alzheimer`s disease (AD) and Parkinson`s disease (PD). The mechanism causing this increased risk is largely unknown. Here, we investigated the role of Mild Chronic Oxidative Stress (MCOS) in neurogenin 2 (NGN2) induced neurons (iNeurons) derived from iPS (induced pluripotent stem cells) from carriers of both haplotypes. We identified that iNeurons of the H1 homozygous haplotype showed an increased susceptibility to MCOS compared to homozygous H2 carriers, leading to cell death through ferroptosis. We performed a cellular screen in H1 iNeurons using a FDA-approved Drug Library and identified candidate molecules that rescued the increased susceptibility to MCOS and prevented ferroptosis in H1 iNeurons. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Resources: CHANT (COMMUNITY HEALTH ACCESS AND NAVIGATION IN TENNESSEE)       Available for eligible individuals from birth-age 21. Provides care coordination/assistance in navigating the health and social service needs of qualifying families and individuals for various programs. Referrals are accepted from all medical providers and social service agencies.   Self-referrals to CHANT are also accepted. https://www.tn.gov/health/health-program-areas/fhw/early-childhood-program/chant.html Online referrals: https://stateoftennessee-cvlyz.formstack.com/forms/chant_referral_form Program phone number: (615) 532-8192 CSS (CHILDREN'S SPECIAL SERVICES) Provides medical care for eligible children with physical disabilities from birth to 21 years of age. Eligibility is determined by: residency, income, age and diagnosis.       The program consists of two components:   Care coordination and Reimbursement of medical services as a payor of last resort. CSS provides: case management, referrals, community resources, collaboration with schools, MCOs and other agencies, transition planning, medical equipment, assistive technology, supplies, prescription assistance, therapies, screening/evaluations, and support services for families (medical and non-medical needs) Referrals can be made through CHANT. Program phone number: (615) 741-7353 For more information: https://www.tn.gov/health/health-program-areas/mch- (https://www.tn.gov/health/health-program-areas/mch-)cyshcn/mch-cyshcn-css.html   FAMILY VOICES OF TENNESSEE A program of the TN Disability Coalition. Provides emotional and educational support to the families of children with special healthcare needs, chronic illnesses or disabilities.       Connects families to community resources.       Shares first-hand experience and tips.       Makes referrals to outside agencies.       Provides assistance in navigating the healthcare system. Connects parents/families in peer networks. For more information: https://www.familyvoicestn.org/ Online referrals: https://familyvoicestn.org/get-connected/ Program phone number: (615)383-9442 Email: familyvoices@tndisability.org TEIS (TN EARLY INTERVENTION SERVICES)   Available for eligible children from birth to age 3 and beyond. Provides services and referrals for children who have disabilities or other developmental delays (refer to qualifying diagnosis list). Supports families in helping their child's development. Helps the child participate in family and community activities. Encourages the active participation of the whole family in the child's development. Referral form can also be found in the MyTN app, available in any mobile app store. For more information: https://www.tn.gov/didd/for-consumers/tennessee-early-intervention-system-teis.html Diagnostic list and prematurity criteria: https://www.tn.gov/didd/for-consumers/tennessee-early-intervention-system-teis/eligibility-information.html (https://www.tn.gov/didd/for-consumers/tennessee-early-intervention-system-teis/eligibility-information.html) Online referrals: https://stateoftennessee-cvlyz.formstack.com/forms/teis_referral Referral phone number: (800) 852-7157 No content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical advice. Neither healthcare providers nor patients should rely on TIPQC's Podcasts in determining the best practices for any particular patient.  Additionally, standards and practices in medicine change as new information and data become available and the individual medical professional should consult a variety of sources in making clinical decisions for individual patients. TIPQC undertakes no duty to update or revise any particular...

Listen in as Jay Karen (NGCOA CEO) and Don Rea, PGA (Secretary, PGA of America) chat with special guest John Brown, CEO of GreatLIFE Golf. Find out what's in store for one of the nation's largest MCOs and we'll touch on other critical golf operation issues, including an overview of where the industry is regarding the prevalence of bartering tee times and effects that can have on a course owner's bottomline. Then, Golf Business LIVE host Michael talks to Anthony Robinson, Founder of Golf Surprize, an NGCOA Smart Buy Partner, for our House Chat segment. Discover how they're keeping the attention of the recent surge of new golfers with an entertaining rewards based golf app that's catching the attention of owners and operators. Are you looking for other innovative ways to increase entertainment at your course?

The KL property index suffered the same fate as the broader FBMKLCI, giving a negative return of 9.5% in the first 6 months of 2022. There were some witnessed improved property transactions thank to MCOs easing as Malaysia moves towards endemicity. Loong Kok Wen, Head of Regional Property Sector, RHB Research Institute shares her thoughts on where this is going.

In this episode, Dave Dillon interviews Dustin Ryan, FSA, MAAA about the everchanging landscape of Medicaid pharmacy.  They discuss how the states pulling the levers in the pharmacy world to lower their drug expenditures.  They dive into the impact of state impacts on MCOs and the future of pharmacy.

Medicaid Paid Benefits to the Dead: Incompetence or Fraud? INDIANA The state of Indiana paid some $1.1 million in Medicaid-related payments in 2016 and 2017 to managed-care organizations (MCO) on behalf of beneficiaries who were dead, according to federal auditors reported by the United States Department of Justice. The audit, carried out by the Department of Health and Human Services Office of Inspector General (OIG) and released on February 13, 2020 revealed that in a random sample of 100 so-called capitation disbursements made to MCOs, the state of Indiana “made 95 unallowable payments.” The Office of the Attorney General found: Indiana made capitation payments on behalf of deceased beneficiaries. We confirmed that 70of the 71beneficiaries associated with the 100 capitation payments in our stratified random sample were deceased. Of the 100 capitation payments, Indiana made 95 unallowable payments totalling $79,403 ($58,773 Federal share). On the basis of our sample results, we estimated that Indiana made payments totalling at least $1.1 million ($862,097 Federal share) to MCOs on behalf of deceased beneficiaries during our audit period. Indiana did not always fully process Medicaid beneficiaries' death information in the MMIS. Although the State agency's eligibility systems interfaced with Federal and State data exchanges that identify dates of death, the State agency did not enter the dates of death in the MMIS for 48 of our sampled beneficiaries. Additionally, the State agency did not recover the capitation payments for 22 sampled beneficiaries that did have a date of death in the MMIS. The organizations that received the unlawful payments are part of the Medicaid Managed Care health care delivery system. Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services,” the Medicaid program site states. MCOs use capitation payments to manage health care costs, utilization, and quality. The OIG concluded that the State agency made capitation payments on behalf of deceased beneficiaries. OIG confirmed that 70 of 71 beneficiaries associated with the 100 capitation payments in our sample were deceased. Of the 100 capitation payments, the State agency made 95 unallowable payments totalling $79,403 ($58,773 Federal share). The State agency did not recover any of the 95 sampled capitation payments. On the basis of the sample results, the DOJ estimated that the State agency made payments totalling at least $1.1 million10($862,097 Federal share) to MCOs on behalf of deceased beneficiaries for service dates during the audit period. Yet aspects of the system have been plagued by problems, with the Indiana report coming on the heels of others that similarly found that some states had improperly paid capitation payments on behalf of the deceased. --- Support this podcast: https://anchor.fm/barry-zalma/support

It is critical that healthcare providers to be fairly compensated by payers and managed care organizations (MCOs) if they are to remain financially sustainable. While many factors in managed care contracts have a financial impact on compensation, there are also many nonfinancial terms to consider.Listen to this informative Healthy Outcomes podcast episode as our leading industry specialists answer and discuss common questions surrounding managed care. Learning objectives of today's episode include:Understanding price transparency implementations for regulation complianceUnderstanding the future and payer coverage of telehealth in response to CovidReviewing the industry's response to new but expensive technologies and drugsDiscussing ways to improve the financial performance of employee medical groups

Malaysia’s economy declined 4.5% year-on-year in the third quarter of 2021 due to the MCOs that were in place in June which was below the street expectations of -2.6% but can we still achieve GDP growth of 3-4% for 2021 and what about 2022? We ask Woon Khai Jhek, RAM’s Co-Head of Economic and Sovereign Research. Image credit: Shutterstock.com

It is critical for healthcare providers to be fairly compensated by payers and managed care organizations (MCOs) if they are to remain financially sustainable. This podcast episode discusses the many factors in managed care contracts that have a financial impact on compensation as well as the nonfinancial terms organizations should consider. 

This is Stephen Schmidt from the Gazette digital news desk and I'm here with your update for Thursday, September 30. There will be a chance for rain Thursday, although it appears to be much more likely on Friday. According to the National Weather Service there will be a 10 percent chance of showers in the Cedar Rapids area after 4 p.m. and a 30 percent chance after 7 p.m. Besides that it will be mostly sunny, with a high near 85 degrees. Thursday night it will be partly cloudy, with a low around 64 degrees. The availability of intensive care unit beds in Iowa is at the lowest level since the COVID-19 pandemic began in March of 2020. As of Wednesday, 163 ICU beds were available statewide, an all-time low according to new coronavirus data from the Iowa Department of Public Health. A week ago, there were 182 available beds. In slightly more positive news, while the state still continues to pile on new cases, the rate appears to have stabilized for the moment. Iowa reported 10,812 new COVID-19 over the past week, compared to the 12,163 new cases reported last Wednesday. The state's seven-day positivity rate was 9.5 percent, slightly lower than last week's 9.6 percent. Although the ICU bed situation remains dire, the number of people hospitalized with COVID dropped slightly. In total, 624 people were hospitalized with the virus as of Wednesday, compared to the 638 hospitalizations reported last week. Given the staffing concerns at a University of Iowa hospital facing the confluence of surging patient demand and a frazzled workforce, administrators announced Wednesday they're doubling extra shift premium pay for inpatient nurses and respiratory therapists over the next seven weeks. According to a message from UI Health Care's Chief Nursing Executive Kimberly Hunter and Human Resources Associate Vice President Jana Wessels, the extra shift premium differential will increase from $15 to $30 an hour beginning Sunday and going through Nov. 21. The boost in pay comes as health care employee burnout has emerged as among the biggest challenges of this wave of COVID-19 infections. The prolonged stress has led health care providers to struggle to adequately keep staff. An out-of-state company hopes to become the newest insurer for Iowans under the state's Medicaid and Children's Health Insurance Program, also known as CHIP. The Dayton, Ohio-based health care company CareSource announced its intent to submit a bid for consideration to join Iowa's $6 billion program as state officials conduct their search for another managed-care organization later this year. MCOs are private insurance companies that deliver health care services to poor and disabled Iowans through a contract with the state. Medicaid health benefits in Iowa currently are administered by two managed-care organizations — Amerigroup and Iowa Total Care. Even after a sometimes tumultuous five years of the privatized Iowa Medicaid program, CareSource officials say they are excited to help Iowa “re-imagine what Medicaid can do for Iowans.” A former Eldridge police officer has been arrested for allegedly sexually abusing a 14-year-old girl while on-duty. 24-year-old Andrew Patrick Denoyer resigned Monday and was taken into custody Tuesday night by agents with the Iowa Division of Criminal Investigation. Denoyer was booked into the Scott County Jail with a $10,000, cash-only bond. The assault happened May 1, while Denoyer was employed and on-duty as an Eldridge police officer, according to an arrest affidavit. He's charged with third-degree sexual abuse, a Class C felony under Iowa law that carries a prison sentence of 10 years. Be sure to subscribe to The Gazette Daily news podcast, or just tell your Amazon Alexa enabled device to “enable The Gazette Daily News skill" so you can get your daily briefing by simply saying “Alexa, what's the news? If you prefer podcasts, you can also find us on iTunes or wherever else you find your Podcasts. Support this podcast

On this week's short episode, we'll be speaking with Adrian Lau from The Posh Egg, a business selling ready-to-eat kodawari onsen eggs. Adrian started his small business over the pandemic, cooking and selling eggs from his home kitchen, and like many small businesses, it has done well in the past months with the rise of online sales over the MCOs we've had. And on the show, we'll find out about his business and what makes his eggs special.IMAGE SOURCE: The Posh Egg / INSTAGRAMSee omnystudio.com/listener for privacy information.

On this week's short episode, we'll be speaking with Adrian Lau from The Posh Egg, a business selling ready-to-eat kodawari onsen eggs. Adrian started his small business over the pandemic, cooking and selling eggs from his home kitchen, and like many small businesses, it has done well in the past months with the rise of online sales over the MCOs we've had. And on the show, we'll find out about his business and what makes his eggs special.IMAGE SOURCE: The Posh Egg / INSTAGRAM

On this week's short episode, we'll be speaking with Adrian Lau from The Posh Egg, a business selling ready-to-eat kodawari onsen eggs. Adrian started his small business over the pandemic, cooking and selling eggs from his home kitchen, and like many small businesses, it has done well in the past months with the rise of online sales over the MCOs we've had. And on the show, we'll find out about his business and what makes his eggs special.IMAGE SOURCE: The Posh Egg / INSTAGRAM

Medicare and Medicaid auditors are becoming more and more aggressive, threatening the livelihood of providers willing to accept such federally covered beneficiaries.Should there be an act of Congress to pass legislation to address this? How long will aggressive auditing that allows third parties to run roughshod over providers continue? To learn the extent of recent auditing activities, listen to the next live edition of Monitor Mondays, coming your way on Monday, Aug. 9 at 10 a.m. EST.You'll also learn about the extraordinary move by the U.S. Department of Justice (DOJ) to intervene in whistleblower lawsuits brought by Constantine Cannon against Kaiser Permanente, one of the nation's largest managed care organizations (MCOs), which has been accused of knowingly submitting false claims for risk-adjusted payments to the Centers for Medicare & Medicaid Services (CMS). Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, will return to the broadcast next Monday to report on this developing story.Other segments to be featured during the live broadcast include the following:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will return to make his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the latest healthcare regulatory news coming out of Washington, D.C.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will have the latest news on a trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listeners Survey.

Since March 2020, Malaysia has been placed under several movement control orders (MCOs) that restrict movement and business operations in order to curb COVID-19 infections. However, the MCOs have also resulted in rising unemployment, business closures and increased food insecurity. Cash aid from the government has been disbursed in several stages, with the next one only due to arrive in August 2021. As the country faces increasing economic difficulties in the wake of the pandemic, mutual aid funds have sprung up around Malaysia to provide food and cash aid to affected communities. However, LGBTQIA+ people face an extra hurdle when it comes to accessing aid. Fears of discrimination, being dead-named and an increasingly hostile environment toward queer people prevents them from accessing aid from public COVID-19 funds. In this episode, Deborah Augustin speaks to Nisha Ayub from SEED Foundation and Connie Connor, an organiser with the Queer Solidarity Fund, about the need for LGBTQIA+ specific mutual aid funds that are more gender-inclusive, and how the queer community in Malaysia has organised themselves against the backdrop of an increasingly hostile environment. For the sake of full transparency, we'd like to disclose that the presenter has previously donated to both SEED Foundation and the Queer Solidarity Fund.

Rebecca Jo-Rushdy is Malaysia's first and only Gold certified KonMari® consultant. After experiencing life-changing results, she founded Spark Joy & Flow, to help fellow Malaysians apply the fundamentals of the KonMari Method beyond just our homes - to create a foundational system that supports productivity, efficiency and growth at work. We discuss the benefits of decluttering, the results she’s created with her clients, and how she’s helping the workforce get the best out of these MCOs.

These recurring MCOs have not been kind to local F&B businesses. With shifting SOPs and guidelines, restaurants and outlets have had to stay on their toes for nearly a year now. With MCO 3.0 and the announcement to close for dine-ins yet again, F&B players are pleading with the government to reconsider their stance as it could cause irreparable damage to their business.

Achieving health value demands the formation of a new social construct, one that puts aside self-interest and builds systems of care for the common good. One that prioritizes health and equity for all, including the underserved and most vulnerable among us. This effort requires stronger leaders and better leadership than ever before. Getting Medicaid right, transforming addiction and substance use disorder treatment, reframing behavioral health, and removing silos – these are a few of the efforts of this week's guest as his work exemplifies the mission of achieving health as the seminal American institution to drive social connectedness and economic prosperity. Our guest is David Smith, CEO and founder of Third Horizon Strategies (THS), a Chicago-based, boutique advisory firm focused on maximizing human potential through a better health system. David serves on the Health Care Council of Chicago, the Alliance for Addiction Payment Reform, the board of the Sinai Hospital System, the Founder's Council of United States of Care and as a Senior Advisor at AVIA and a Project Executive for their Medicaid Transformation Project. 04:55 Facts on Medicaid: 75 million Americans covered (1 in 5 Americans), 50% of US births, $600B annual spend 05:40 Medicaid beneficiaries may even approach 100M in the next five years 06:00 Background on the Medicaid Transformation Project (MTP) 08:00 “The Medicaid program is the single most important endeavor in our country, PERIOD. And that's not just in healthcare, I'm talking about in total.” 09:00 Health is required to serve in the function in the full human capacity. 09:45 The neglect of the Medicaid program over the years and why we need to get it right to improve health in underserved communities 10:18 “Getting Medicaid right improves health, and improving health creates economic development.” 10:30 Disparities in public health are drawn across racial lines 11:00 Transformation Factor #1:  Evolution of payment models and realignment of incentives 11:45 Transformation Factor #2:  An evidence-based approach to Care Model research and implementation 12:15 Transformation Factor #3: Leveraging technology innovation for underserving communities 12:40 Transformation Factor #4: Social impact investments to fuel innovation 13:00 Transformation Factor #5: Social determinants of health 13:30 Transformation Factor #6: Growth in Medicaid enrollment requiring scalable solutions 14:10 Lack of government boldness, states not moving fast enough, MCOs not eager to develop new payment models 14:40 Partnering with health systems in the MTP to look for disruptive solutions that with financial self-sustainability 16:40 Facts about Substance Use Disorder (SUD): 23.4 million Americans affected, 81,000 drug overdose deaths per year, 1 in 5 Medicaid beneficiaries, 46% of the total Medicaid spending 18:40 David shares how he has personally been impacted by drug overdose through the loss of his father, brother, and sister 21:25 The role of Big Pharma in creating the opioid problem and how Addiction (the “dopamine rush”) is the #1 most common human failing 23:00 How the system of care is setup to treat patients with SUD as “bad people” 23:35 “If we think our fee-for-service system is bad for our physical health, it is a dumpster fire for people who struggle with addiction.” 24:15 The total cost of care for a patient with high acuity SUD is $31-32k per year, and how that creates a $17k value gap. 25:20 “There is no “cure” for Substance Use Disorder; there is only reducing a person's risk to a baseline.” 25:50 The Value Gap due to waste and inefficiency in the treatment of SUD that also results in poor outcomes in long-term recovery. 27:05 The Alliance for Addiction Payment Reform and its role in advocating for a new value-based payment model for long-term recovery of SUD 29:30 Partnering with commercial payers to develop APMs for Substance Use Diso...

This week, Cara Stewart joined us to talk about healthcare policy in Kentucky.  The conversation ranged from the extraordinary open enrollment period to the situation with Kentucky's *6* MCOs.  If you care about healthcare policy, don't miss it! Jazmin and Robert also talked about the passage of the Historic Horse Racing bill, Mitch McConnell's role in the second impeachment of Donald Trump, the situation around reopening JCPS schools in Louisville, and a COVID update.

The Human Rights Commission of Malaysia - or SUHAKAM - has urged the government to establish a dedicated helpline to ensure the safety and wellbeing of children. This came amid an increased number of cases involving the physical, sexual, and emotional abuse of children throughout the various MCOs last year. To delve into why a dedicated government helpline is important we’ll be speaking with SUHAKAM’s Children’s Commissioner Professor Datuk Noor Aziah Mohd Awal, as well as Pam Guneratnam the founder of HumanKind, which established Buddy Bear, a helpline for children to talk about their worries and concerns amid the pandemic. Image source: Shutterstock

For many of us, the first MCO probably seems ages ago. And with the new year, I think it’s fair to say that we want to put 2020 behind us and look forward to a better year, and one without lockdowns. But for Viji Krishnamoorthy and Shireen Zainudin, our experiences during the various MCOs are a valuable part of our history. So much so that they decided to compile some of those experiences into a book titled The Lockdown Chronicles, which they edited. Image Source: Shutterstock

For many of us, the first MCO probably seems ages ago. And with the new year, I think it’s fair to say that we want to put 2020 behind us and look forward to a better year, and one without lockdowns. But for Viji Krishnamoorthy and Shireen Zainudin, our experiences during the various MCOs are a valuable part of our history. So much so that they decided to compile some of those experiences into a book titled The Lockdown Chronicles, which they edited. Image Source: Shutterstock

Talks of implementing targeted MCOs have surfaced, as new Covid-19 infections soar to an all-time high. We speak with Dr Khor Swee Kheng for his thoughts on whether this is a good idea, and what it would achieve. Image Source: Charles Deluvio, Unsplash

Among the many crucial duties of a school board is evaluating risk management programs for the district. Whether you are a new or veteran board member, that task is not easy. For those board members not familiar with the workers' compensation system, you might wonder, “What is an MCO and what does it offer my district?” Lance Watkins, vice president of client services for Sedgewick Managed Care Ohio, formerly CompManagement Health Systems, joins the podcast to talk about MCOs and the recent merger and what it means for districts that use the OSBA endorsed program. Resources: https://sedgwickmco.com. Thank you to our sponsor: CompManagement, an OSBA endorsed program. Learn more at https://www.ohioschoolboards.org/ohio-schoolcomp.

Lockdowns, MCOs and curfews is all that seems to be going on these days. But the one thing that still gets me pumped as the world seems to be crumbling down around me is the massive opportunity online! Don't get left behind. Enjoy! ;)

This week we continue talking about the wave of protests all across Kentucky, and update the status of the COVID-19 outbreak, which is probably not getting any better as we reopen.  Also discussed are the selection of new MCOs for Kentucky's Medicaid Program, and a lawsuit about voting locations. Jazmin and Robert interviewed Kentucky Representative and U.S. Senate candidate Charles Booker this week.  He spoke candidly about his campaign having it's best days in the midst of a painful time for his House district and the city he represents in Frankfort, as well as his thoughts on Louisville Mayor Greg Fischer and what he hopes to accomplish if he is elected to serve in Washington.

In this edition of the Embedded Insiders, Brandon and Rich wonder how the COVID-19 pandemic has been affecting the tech sector, both from a financial perspective and with regards to the productivity of engineers now working at home. Are those engineers executing, innovating, or just relaxing?Later, Rich interviews Jean Labrosse, formerly a distinguished engineer and software architect at Silicon Labs. Jean shares some somewhat unpopular viewpoints on open source software in response to an Embedded Executives podcast with Gurjot Singh of Lynx Software Technologies in late April. Who can guarantee that open source software will work every time, all the time? And, what does that mean for open source in critical applications?Finally, the Insiders circle back to highlight the Best-in-Show Winners from Embedded World 2020.Tune in.

Steven talks about staying productive during this period of RMOs, MCOs, Lockdowns, Circuit Breaker...etc. whatever u wanna call it. But is he biting off way more than he can chew? Or is all this work really just to stay occupied and won't lead anywhere? only time will tell...

A quick snap shot about what is a Managed Care Organization, what are some of the types of MCOs and how they operate with a focus in Medicare and Medicaid Managed Care concepts. https://youtu.be/-fwesoCYqvM

A quick snap shot about what is a Managed Care Organization, what are some of the types of MCOs and how they operate with a focus in Medicare and Medicaid Managed Care concepts. https://youtu.be/-fwesoCYqvM

Listen in as CPR’s Director of Projects & Research, Julianne McGarry, checks in with Beth Waldman,JD, MPH, Senior Consultant with Bailit Health. Beth Waldman is one of the leading experts in Medicaid delivery system and payment reform design, having served as the Director of Medicaid for the Commonwealth of Massachusetts from 2003-2007 and consulting for a multitude of states and other stakeholders upon joining the Bailit Health team. Since the beginning of 2019, Beth has served as a subject matter expert to guide CPR’s work assembling key contract provisions from the 39 states with Medicaid Managed Care programs to help state Medicaid agencies leverage model contract language. During the call, Julianne asks Beth to provide a high-level look of the trends in how state Medicaid agencies use their contracts with MCOs to advance payment reform. She also asks Beth to gauge the enthusiasm level of state Medicaid agencies toward the payment reform movement. It's a special time when many providers are finally getting comfortable with certain payment reform methods put forward through programs like State Innovation Models, though it's still to early to know exactly which models are working. Want to hear more from Beth Waldman? Register for CPR’s Virtual Summit on Tuesday, December 10 where Beth will be speaking on a panel to explore how Medicaid MCO contracting is likely to evolve.

Many hospitals are likely in the throes of preparing to implement the Centers for Medicare & Medicaid Services (CMS) Discharge Planning Conditions of Participation Final Rule, including how to reconcile the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The new rule becomes effective Friday, Nov. 29, 2019.“CMS has spent the last two years working on the IMPACT Act, and they are now ready to implement,” reports Mary Beth Pace, vice president of care management at Trinity Health. “Does the CoP resemble anything akin to what you thought they would come out with? It does not to us. Let me reflect on our initial shock, and then our action.”For a field report on how one major health system is preparing for this major new policy, RACmonitor has invited Ms. Pace to be the special guest during the next edition of Monitor Mondays.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel will report on the status of the Medicaid lawsuit filed after more than two dozen plaintiff Virginia behavioral healthcare providers had their managed care contracts terminated by six defendant managed care organizations (MCOs). Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will have the latest news on a trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Fraud Report: The manager of multiple medical clinics in Brooklyn and Queens, New York, was found guilty for his role in a nearly $100 million healthcare kickback and money laundering scheme, according the U.S. Department of Justice. Reporting this story will be famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon. Risky Business: Healthcare attorney David Glaser will join the broadcast with his trademark segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

Join Dr. Roy Alabado and Kristin discussing the inside and often misunderstood side of managed care. Dr. Roy Alabado is a highly accomplished Healthcare Consultant and Academic Practitioner. He is an Senior Professor at Rowan College of South Jersey located in Vineland, New Jersey and a Healthcare Consultant for a prominent hospital located in South Jersey. More importantly, he is a single parent, devoted to his son, Bronson. Dr. Alabado received his undergraduate degree from West Chester University located in West Chester, PA. He also received his Master of Science degree in Health Education and Administration and a Doctorate of Educational degree in Educational Leadership from St. Joseph’s University located in Philadelphia, PA. Being a parent is the most important role in life. Raising a child can be challenging and demanding for a single parent, but we live life to love our children. Love is the basic element of life. We all share a common bond of devotion and affection for our children. Dr. Alabado lives with his son, Bronson, in South Jersey. He is a lover of traveling, culinary arts, yoga, martial arts and spending quality time with the people he loves. Whether going to the beach, vacationing at an exotic destination, or practicing Tae Kwon Do with Bronson, spending time with each other is God’s blessing.

Patient mortality is closely monitored. If a patient dies, the hospital wants to be sure the documentation accurately portrays the acuity of the patient, with all diagnoses, so that when the risk of mortality is calculated with the complex algorithm used by federal agencies, it demonstrates that the death was not unexpected, and is not indicative of poor-quality care. Reporting the lead story during this episode of Monitor Mondays is Melinda Battaile, MD, physician advisor and clinical documentation advisor for Vidant Health in Greenville, N.C.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the status of the Medicaid lawsuit filed after more than two dozen plaintiff Virginia behavioral healthcare providers had their managed care contracts terminated by six managed care organizations (MCOs).Monday Focus: Algorithms are a trending topic, made even more so with recent accusations of gender bias in the Goldman Sachs Apple Card leveled by presidential candidate and U.S. Senator Elizabeth Warren. RACmonitor investigative reporter and New York attorney Ed Roche returns to the broadcast to continue his reporting on algorithms and their use in claims auditing.Policy Update: The Centers for Medicare & Medicaid Services (CMS) intends to press forward with payment cuts for some hospital clinic visits, as well as cuts to the 340B drug discount program, despite an adverse court ruling in September. Matthew Albright, chief legislative affairs officer for Zelis, reports on this developing story. Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his trademark segment, in which he reports on CMS's final rule’s reference to “shoppable” services. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

This is the final installment of three special, post-Medtrade episodes. Kim Brummett, vice president of regulatory affairs for the American Association for Homecare, sheds some light on a proposed rule by HHS to loosen the regulatory prohibitions against physician self-referrals when it comes to DME. Brummett talks about what this could mean for providers and how the industry is approaching the issue. While the situation is still coming it to focus, it is already concerning.

Direct or indirect past affiliation with an individual the Centers for Medicare & Medicaid Services (CMS) deems to be a bad actor could trigger revocation from Medicare.The new rulemaking this so, 52 CFR, Section 424.519, Disclosures of Affiliations, authorizes CMS to deny or revoke enrollment based on disclosures of certain affiliations the agency determines to pose an undue risk of fraud, waste, or abuse.Reporting our lead story during this edition of Monitor Mondays is healthcare attorney Andrew Wachler, a managing partner at Wachler and Associates. Mr. Wachler also discusses what constitutes an “affiliated entity” and what events must be disclosed.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the status of the Medicaid lawsuit in which more than two dozen Virginia behavioral healthcare providers had their managed care contracts terminated by six managed care organizations (MCOs). Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.Court Report: Famed whistleblower attorney Mary Inman reports on Tenet Healthcare’s proposed $66 million False Claims Act settlement. Inman is a partner in the London office of Constantine Cannon.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his trademark segment, in which he reports on problematic issues facing providers.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on a trending topic that is attracting significant media attention. Ellen also conducted the Monitor Mondays Listener Survey. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Giant healthcare insurer Optum has been in the news this week, and the news isn’t particularly favorable.The results of a study published last week by Science revealed what researchers identified as a "significant racial bias" in Optum’s algorithm, which reportedly undervalues the healthcare needs of black patients. Although Science didn’t mention Optum by name, other news organizations have confirmed that it was, indeed, Optum.Reporting on this developing story during this edition of Monitor Mondays is RACmonitor investigative reporter and New York attorney Edward Roche, director of business intelligence for Barraclough New York LLC.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the status of the Medicaid lawsuit in which more than two dozen Virginia behavioral healthcare providers had their managed care contracts terminated by six managed care organizations (MCOs). Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.Ring of Fire: Dr. Alvin Gore, the physician advisor at St. Joseph Health in Santa Rose, Calif., reports on disaster planning in the wake of horrific wildfires burning out of control in Northern California. Shortages of nurses who were ordered to evacuate is one of the many emergencies he continues to monitor as the fire rages.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his trademark segment, in which he reports on problematic issues facing providers.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on a trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.Monday Rounds: Substituting for Dr. Ronald Hirsch, is Dr. Howard Stein, associate director of medical affairs and physician advisor in care management at CentraState Medical Center in Freehold, New Jersey.

In the 18th episode Thomas Krogh Jensen, CEO of Copenhagen Fintech talks to Jason Channell, Managing Director, Head of Sustainable Finance, Citi Global Insights and Karim Jabbar, Co-founder of Solstroem & Industrial PhD Fellow.  Jason was in Copenhagen for the C40 World Mayors Summit and to share his key-findings in the latest GPS Energy Darwinism report - The Electrifying Path to Net Zero Carbon. Solstroem automates the generation of micro carbon offsets (MCOs) from distributed solar installations in real-time, thus offering a fully-traceable and data-driven offsetting option to businesses and individuals. In this episode we focus on the role of technology and specifically fintech in accelerating the UN Global Sustainable Development Goals and deliver on the targets by 2030. Listen in and get inspired by Jason and Karim that work every day towards making the world more sustainable and make fintech matter. 

This is the second of three special, post-Medtrade episodes. Third-party administrators (TPAs) are increasingly getting involved in Medicaid Managed Care Organizations (MCOs) and often run right past protections for providers. Furthermore there have been some business developments in the MCO-TPA world that are compounding this problem. Laura Williard VP of payer relations for AAHomecare, provides all the details on the situation; sheds light on what’s being done to combat this problem; and outlines what providers should do to protect their businesses. 

As expected, the Governor of Virginia, Ralph Northam, along with six managed care organizations (MCOs), have been named as defendants in a federal lawsuit filed on Wednesday, claiming that more than a dozen of the state’s Medicaid behavioral and mental healthcare providers had their agreements terminated by the MCOs without cause.The suit was filed by the Potomac Law Group.During this edition of Monitor Mondays, healthcare attorney Knicole Emanuel, a partner in the aforementioned law firm and a member of the RACmonitor editorial board, provides an update on the lawsuit as it makes its way through the court system.Also covered in this edition of Monitor Mondays:SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SdoH), has the latest news on this trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Monday Focus: A listener reports that Noridian (Jurisdiction F), rather than providing any diagnosis codes for non-dialysis usage, insists on having five scenarios provided in order to determine if an order meets guidance criteria. Attorney and physician Dr. John Hall weighs in on this topic, which seems to have entangled front desk staff, schedulers, and physicians.Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

How and why are social determinants of health making its way into the Medicaid managed care realm? To find out, Suzanne Delbanco calls Tricia McGinnis, MPP, MPH, Executive Vice President and Chief Program Officer of the Center for Health Care Strategies. The Center's December 2018 report, "Addressing Social Determinants of Health via Medicaid Managed Care Contracts and Section 1115 Demonstrations," analyzed 40 Medicaid managed care contracts and 25 approved § 1115 demonstrations across the country to analyze the trends in this emerging area of focus. Tricia McGinnis highlights states and health plans with programs and policies in place as well as new approaches to bringing social determinants of health investments to life. Through the Center's work in thinking through health equity, they have found that community-based organizations are well positioned to play an important role in bringing necessary and culturally-tailored support to patients.

Zach and Elaine talk about the limitations imposed on her by the MCOs. Not only is she prevented from pursuing a career as a video editor and writer, but she is not able to get out of bed for more than a few hours a day. At times, she has been left in bed for up to 45 hours with no one to move her. All of these limitations make Elaine feel as if she doesn't have a life, but she holds on to the hope that this will one day change. If you would like to learn more or get involved, follow us on Facebook and Twitter or find us at upgrademedicaid.com . #LivingLifeLimited #UpgradeMedicaid

Is it possible to get a job as CMO in a year? Well, it depends. It’s certainly easier if the organization you’re working for is looking for a CMO. Or if you’re in a large city with multiple hospitals, MCOs and large medical groups. What do you need to do to get that job as soon as possible, even if you have limited management and leadership experience? Well, let me be your mentor and show you how it might be done. Let’s start with the end in mind. What skill sets will a CMO candidate need to demonstrate so that an employer will... read a cover letter and resume, set up a series of interviews and, select you as the new CMO? If you’ve graduated medical school, completed a residency and worked clinically for a few years, you already have many of the necessary leadership skills. But you’ll need to work on those additional business and management skills that will enable you to work in a corporate environment. I break down those skills into five general areas that a health care organization will generally be looking for: Data Management Financial Management Business Practices Leadership Skills Talent Management So, let’s break those 5 skill sets down into how they’re learned and demonstrated on your resume. Data Management. In this arena you should be able to demonstrate the ability to analyze a variety of data, simplify and explain it to others, and create action plans to address underperformance. The type of data typically analyzed includes quality and patient safety metrics, utilization review, including length of stay and resource utilization, patient and physician satisfaction data, and process measures, such as turnaround times. You should also be able to design balanced scorecards and dashboards, understand Lean Process Improvement and Six Sigma principles, and prepare for accreditation surveys.  You may already have experience reviewing your own, and possibly others’, quality data. But to fully demonstrate this skill set, you can consider taking the following steps. Take a course on quality reporting. These are available through the National Association for Healthcare Quality and the AAPL. Participate in committees that review data: QI Committees, and UM Committees. These committees can be at your medical group, hospital staff, or at nonprofit organizations you might join as a volunteer. I’m on the board of a hospice and chair of the quality committee. Other nonprofit healthcare organizations have boards and many have quality committees. Seek a position as a part time medical director for quality, utilization management, or clinical documentation improvement. All of them collect and analyze data. Chat with the director of the department that manages those activities to see if they need part time assistance with analyzing and presenting reports based on their collected data. Become certified in Lean Process Improvement or Six Sigma. Some courses can be completed in as little as 8 weeks. Volunteer to help prepare for the next accreditation survey of your ambulatory surgical center, hospital, or wound center.  Financial Management. This includes understanding health system financial reports, departmental revenues and expenses, and creating an annual budget and managing to it. One of the biggest concepts here is to understand accrual accounting. There are other unique issues related to health care finances, such as gross vs. net revenues, income adjustments, and bad debt that must be understood.  To gain experience, you can do the following. Review your own personal financial and productivity reports from your medical group. Volunteer to work part-time as medical advisor or medical director to present and explain reports to other physicians in the group. Find a nonprofit that has Finance Committee. The hospice I spoke about earlier has a Finance Committee, and members review monthly income and expense statements, balance sheets and other financial documents. If possible, chair the committee. This forces you to be understand the financial reports more thoroughly. Hospitals also have boards and finance committees that need members and chairs. Take a health care finances class through the AAPL or ACHE. Or take a course through a local community college in accounting to become more familiar with common accounting terminology and practices.  Business Practices. These include running effective meetings, writing reports, preparing and delivering presentations, identifying and writing management goals, and project planning.  You can learn some of these skills in the following ways. Take business and management courses through the AAPL, ACHE and others. Participate in service line committees such as those for a wound center, ICU, CCU, observation unit, occupational medicine clinic, spine center, vascular center, family planning clinic, STD clinic, and other inpatient units and outpatient service lines. Then participate in or chair planning committee meetings, strategic planning meetings, and marketing meetings for any such committees. Volunteer for the CME planning committee at your hospital. If there isn’t one, locate national educational organizations in your area by searching the list of accredited providers on the ACCME at accme.org. Work hard to become the chair of the CME committee, if possible.  Leadership Skills. In order to effectively lead a division that includes multiple departments, you will need experience in negotiation; healthcare law, (including contracting, Medicare fraud and abuse, credentialing and privileging, and risk management); team building and coaching skills; strategic planning, and working effectively in an executive team.  You can acquire these skills in the following ways. Take courses on health care law through the AAPL, ACHE or local universities in your area. Read up about SWOT (S. W. O. T.) analysis and take a committee or a department through one as medical director for any service line or medical group department, or your own medical practice. Use the SWOT Analysis to develop an action plan and set of SMART goals at the beginning of each year and follow up with progress and completing of the goals at the end of the year. Participate in as many boards, committees and teams as possible, and chair as many as you can, and keep track of each one’s accomplishments for your resume.  Talent Management. This goes beyond simply hiring, firing and supervising employees. A seasoned CMO will need to know how to attract and recruit good managers and directors, maintain accountability, build loyalty, develop future leaders, communicate with clarity, delegate appropriately, create succession plans, and avoid micromanagement.  This is the most difficult of the five major areas to get experience in, unless you have staff directly reporting to you. Most medical groups involve physicians by having them attend and chair meetings. But physicians often do not have direct line responsibility for employees.  You might not be able to get real life experience in this aspect of management skills until you’re at least part time in management as medical director, or department director or an equivalent position.  There are some things you can do, however. If you’re already working as a medical director, try to get the department restructured in such a way as to have staff report directly to you. You’ll need to take on the responsibility of meeting individually with direct reports, providing direction, and completing evaluations. But it’s the only way to truly learn how to do these activities. You can start by taking these roles on in your practice. Become the managing partner, if you’re in a small to medium group, and actively manage supervisors and managers to gain this valuable experience. By following these suggestions, you will be able to demonstrate the skills to be a successful CMO, and land a high-paying and fullfilling job as a physician executive and leader. For the show notes, go to vitalpe.net/episode052 I've also developed a paid mentoring program in which I assess your current skills, identify gaps in each of the 5 domains, and help you to obtain new skills through part-time paid and volunteer experiences. To find out more about this program, go to Become CMO in a Year

Managed Care Organizations - in some states, they're already in effect; in others, they are coming down the pipe. We'll get into some of the details about how Managed Care Organizations, or MCOs, work and what they can mean for our families. Then we'll have David's conversation with Illinois State Sen. Dave Koehler, of the 46th District. He'll discuss his work toward preventing MCOs from destroying healthcare in the state. We'll also touch on U.S. HR 620, which looks to devastate the Americans with Disabilities Act of 1990. As I mentioned, here is the link to the Washington Post op-ed by Sen. Tammy Duckworth (D-IL). She discusses HR 620 and what it would do to the Americans with Disabilities Act of 1990.  https://www.washingtonpost.com/opinions/congress-is-on-the-offensive-against-americans-with-disabilities/2017/10/17/f508069c-b359-11e7-9e58-e6288544af98_story.html?utm_term=.f066266e1645 I encourage you to read about the bill more than just this article; but this is a good starting point.

How involved are you in my community?  Imagine what it must be like for newcomers to Saskatchewan who have so many challenges that many of us take for granted. Perhaps learning a new language, adapting to a new climate, finding ones place in the community and so much more. INVOLVE is an initiative launched in 2015 through the combined efforts of the Multicultural Council of Saskatchewan (MCoS), SaskCulture and the Regina Open Door Society (RODS).   The facilitator training program readies select participants from local community organizations to integrate INVOLVE into their own communities.  In turn, newcomers have opportunities where they can begin to contribute to their communities and have their voices heard. Kevin Power is joined by guests from MCoS, SaskCulture, RODS, and the city of Yorkton.  You'll hear about the exciting impact INVOLVE is having, and will continue to have throughout Saskatchewan. ========================================== THIS EPISODE OF SASKSCAPES IS SPONSORED BY SASKCULTURE ======================================= SaskScapes is a podcast featuring the stories of arts, culture and heritage in Saskatchewan. The series is produced and hosted by Kevin Power.  To sponsor your own episodes contact SaskScapes via twitter, Facebook or by email for more information. Your reviews in the iTunes store help boost the ratings so be sure to have your say! Host: Kevin Power www.kevinpower.net Music provided by Jeffery Straker www.jefferystraker.com SaskScapes is also available through the iTunes Store on Stitcher Radio and TuneIn Radio. SaskScapes now has its own app for android devices available in Google Play. IF YOU ARE ENJOYING THE PODCAST WE'D LOVE YOUR SUPPORT http://bit.ly/1TSJw8C Follow SaskScapes on Twitter @saskscapes Follow SaskScapes on Facebook: Facebook.com/saskscapes Follow Kevin Power on Twitter @kevinpowerlive Thanks to SaskCulture for their ongoing support of SaskScapes Funding for the cultural sector in Saskatchewan is provided by the Saskatchewan Lotteries Trust Fund for Sport, Culture and Recreation. Your lottery dollars at work!

This podcast discusses the recently released report by The Society of Actuaries that describes the components of margin for calculating capitation rates in a Medicaid context along with a description of practical issues that may be encountered by MCO’s. The report includes observations from interviews with MCO executives as well as financial results analysis of MCOs nationwide. The material was authored by Sara Teppema, Jeff Goldman, Luke Smith, and Steve Tutewohl from Valence Health.