Podcasts about Medicaid

Sanofi becomes the latest pharmaceutical company to introduce a rebate model for 340B-eligible healthcare organizations. A new rule proposed by the Biden Administration would allow Medicare and Medicaid to cover drugs like Ozempic for weight loss. And, patients with HIV can now donate and receive organ transplants from other individuals with the disease. We'll get those stories—and more—coming up on today's episode of the Gist Healthcare Hosted on Acast. See acast.com/privacy for more information.

Have you ever wondered if ADHD is being misunderstood or misdiagnosed in children, leading to feelings of failure and unchecked anxiety? In this episode of Pediatric Meltdown, host Dr. Lia Gaggino and Dr. Norrine Russell talk about the complexities of ADHD, from its nuances to the pressing need for systemic change in how it's perceived and treated. They shed light on the importance of recognizing ADHD as non-willful behavior, the role of early intervention, and the imperative of individualized education plans. With data-backed insights and real-world anecdotes, this discussion underscores the urgency of a more equitable and comprehensive approach to ADHD treatment. This is a must-listen for educators, parents, and healthcare providers.[00:38 - 7:37] Unpacking ADHD and Common MisinterpretationsDefinition of "pure ADHD," described as a potential "gift," affecting a smaller segment of diagnosed children.Discussion on comorbidities like dyslexia, dysgraphia, mood disorders, and autism, affecting two-thirds of ADHD-diagnosed children.Issues of whether anxiety stems from late-diagnosed ADHD or contributes to its symptoms.Emphasis on early intervention to prevent ADHD from triggering anxiety and encourages proper diagnosis to avoid misunderstanding behaviors.[07:38 - 14:07] Individualized Educational Approaches and Social SkillsImportance of personalized educational strategies for neurodivergent children, avoiding a "one size fits all" methodology.Benefits of involving children in solution-finding processes for tailored educational support.Highlighting social delays in children with ADHD and the role of structured activities in fostering social interactions.Allowing children to build on their strengths and interests to enhance self-esteem and personal growth.[14:08 - 21:15] Challenges in Diagnosing and Treating ADHDDiscussion on the misconception of oppositional defiant disorder (ODD) and its potential misinterpretation as ADHD symptoms.Need for differential diagnosis to distinguish between ODD and ADHD, particularly in the context of trauma.Advocacy for multimodal ADHD treatment plans, integrating medication, parent education, and school plans as per American Academy of Pediatrics guidelines.Addressing systemic inequities in healthcare affecting children on Medicaid and the impact of racial biases on ADHD treatment.[21:16 - 28:22] Tools, Resources, and the Path ForwardDiscussing genetic links and familial patterns discovered during psychosocial intakes.Importance of early identification to prevent negative academic cycles and enhance engagement.Promoting ADHD acceptance and self-advocacy by normalizing brain differences.Recommendations for educational materials, like "ADHD is Awesome" and "The Anxious Generation," and promoting Norrine's podcast for further insights.Resources Mentioned:Vanderbilt and Connors Symptom Trackers (Symptom Trackers) Vanderbilt ADHD Diagnostic Rating Scale (VADRS) - Psychology ToolsBook: ADHD Is Awesome - ADHD is Awesome: A Guide To (Mostly) Thriving With ADHD: Holderness, Penn, Holderness, Kim, Edward Hallowell: 9781400338610: Amazon.com: BooksBook:

Over the past two decades, nearly 200 rural hospitals have closed, resulting in millions of Americans losing access to an emergency room, inpatient care, and other hospital services. And today, more than 700 rural hospitals in the U.S. – or approximately 1 in 3 – are at risk of closing due to financial problems, according to a report from the nonprofit Center for Healthcare Quality and Payment Reform.  All this comes at a time when rural health disparities are rampant. In the final episode of our rural health series, we consider solutions: What does it take to prevent rural hospital closures? What evidence-based solutions can policymakers consider to ensure all Americans have access to critical health services, regardless of where they live? Health Disparities podcast host Bill Finerfrock speaks with Harold Miller, president and CEO of the Center for Healthcare, Quality and Payment Reform and adjunct professor of public policy and management at Carnegie Mellon University.  Miller says many people assume that when a rural community loses a hospital, it's one of several options, when in reality, “in many small rural communities, the hospital is the only place to get any kind of health care. It is the only place where, not only where there is an emergency department, but because there's no urgent care facility in the community, there's no other place to get a lab test, there may not even be primary care physicians in the community.” When it comes to policy considerations to prevent rural hospital closures, Miller says there need to be a greater emphasis on the role private health insurance plans play in putting hospitals at risk. “The myth, unfortunately, is that the problem of rural hospital payment is all about Medicare and Medicaid, and that has led people to focus, I believe, inappropriately and excessively, on Medicare and Medicaid,” he says, “when what we have found is that the biggest problem for most rural hospitals is private insurance plans who don't pay the rural hospital even as much, in many cases, as Medicare or Medicaid does. … We need to start thinking about how to solve the real problems and to solve them now, rather than waiting until the hospital is faced with closure.” Never miss an episode – be sure to subscribe to The Health Disparities podcast from Movement Is Life on Apple Podcasts, YouTube, or wherever you get your podcasts.

About Mark Del Monte:Mark Del Monte, serves as the CEO and Executive Vice President of the American Academy of Pediatrics (AAP). With an extensive background in law and advocacy, Mark has been instrumental in advancing pediatric health and well-being since joining the AAP in 2005. Under his leadership, the AAP supports 67,000 pediatricians and pediatric specialists, ensuring they have the necessary resources and guidance to provide top-notch care for children. His work is driven by a deep commitment to addressing various issues impacting children's health, such as mental health, equity, environmental health, and public policy. Mark is also a vocal advocate for policies supporting comprehensive healthcare coverage for children, particularly through programs like Medicaid and CHIP (Children's Health Insurance Program).Beyond his policy advocacy, Mark is dedicated to combating misinformation, especially around vaccine trust. He focuses on providing pediatricians with accurate information and reliable resources to build trust between healthcare providers and families. Mark believes in the power of the clinician-patient relationship in promoting healthy behaviors and informed decision-making. His combination of legal expertise and passion for child health advocacy makes him a leading voice in shaping the future of pediatric healthcare, striving to ensure that all children have the opportunity to thrive.Things You'll Learn:The American Academy of Pediatrics (AAP)'s comprehensive approach to addressing diverse issues affecting children's health, including mental health, equity, and environmental health.The critical roles that Medicaid and CHIP play in providing essential healthcare coverage for children.The AAP's strategies to counteract vaccine mistrust and other misinformation, empowering pediatricians with accurate information.Insights into the advocacy for merging Medicaid and CHIP into a national program to ensure consistent healthcare for all children.The importance of the clinician-patient relationship in promoting healthy behaviors and delivering reliable information.Resources:Connect with and follow Mark Del Monte on LinkedIn.Follow AAP on LinkedIn and visit their websiteVisit healthychildren.org to get valuable info for your family.

Unlock the secrets to ensuring your legacy isn't left to chance with our holiday-inspired guide to estate planning! Elder law attorneys Greg McIntyre and Brenton Begley bring you the "Estate Planning Naughty and Nice List," revealing essential strategies to safeguard your assets and avoid legal pitfalls. Learn why simply having a spouse doesn't automatically grant decision-making powers over your financial and healthcare matters, and discover the proactive steps needed to keep your estate out of probate and secure for future generations.Our episode sheds light on the power of taking a thorough inventory of your personal relationships and financial assets as the cornerstone of a robust estate plan. From utilizing Lady Bird deeds to creating Medicaid asset protection trusts, we explore how these tools can shield your wealth from unforeseen claims. Britton and I debunk common misconceptions and stress the importance of appointing powers of attorney, ensuring trusted individuals can step in when needed. With professional guidance, you can craft a comprehensive plan that not only protects your family's future but also honors your personal wishes.

Howie Kurtz on all sides blasting Biden over Hunter pardon, Kash Patel planning to reshape the FBI and Dr. Oz having a few conflicts of interest as Trump's pick to head Medicare and Medicaid. Follow Howie on Twitter: @HowardKurtz For more #MediaBuzz click here Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, Therese Markow and Dr. Joel Gallant discuss the history and evolution of HIV treatment and prevention. He highlights the changes of treatment from early AZT, to the extensive multi-drug regimens of the 90s, and the current single-pill treatment with minimal side effects. They also discuss the racial and regional disparities of new HIV cases in the US. Despite progress, challenges persist, including stigma, lack of healthcare access, and resistance to treatments. Dr. Gallant also gives more information on hope for ending the epidemic and hope for a cure.     Key Takeaways: With early diagnosis and treatment of HIV, AIDS is not commonly seen anymore, though it still exists. HIV is a retrovirus, meaning that it has enzymes that are able to do the opposite of most viruses which transcribe DNA into RNA. HIV can be inserted  into the DNA. With more research, we've seen a steady improvement with more, safer drug choices, and better and easier combinations. Most people can be treated with a single pill once a day and are expected to live a normal lifespan in good health. In the US, no one has to go without treatment based on inability to pay. Even people who are uninsured and live in states that didn't expand, Medicaid can get comprehensive HIV care, including medications, through clinics established by the Federal Ryan White Care Program.   "We do know that treatment is highly effective at preventing transmission, including sexual and mother-to-child transmission. It's so effective that the CDC says that if your viral load (how we measure how much virus there is in your blood) is fully suppressed on treatment (having an undetectable virus) then you cannot treat HIV. Treatment is 100% effective as prevention." —  Dr. Joel Gallant   Episode References:  Ryan White HIV/AIDS Program: https://ryanwhite.hrsa.gov/    Connect with Dr. Joel Gallant: Professional Bio: https://www.iasusa.org/faculty/joel-e-gallant-md-mph/  Website: https://www.axcesresearch.com/  LinkedIn: https://www.linkedin.com/in/joel-gallant-b6875432/    Connect with Therese: Website: www.criticallyspeaking.net Threads: @critically_speaking Email: theresemarkow@criticallyspeaking.net   Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it.  

Today we're talking to CHESS Health Solutions own Tammy Yount who shares her experience as a former practice manager and AHEC practice support coordinator to provide insight on why independent primary care providers, their practices, and especially their patients, will benefit from partnering with the right clinically integrated network. Tammy Yount, welcome to the Move to Value podcast.Glad to be here, Thomas.Tammy, what are some of the primary reasons independent providers choose not to participate in Medicaid or why they might hesitate to increase their Medicaid patient population? Are there particular challenges they face in serving this group?I think one of the biggest barriers is that we still are in this productivity mindset where that time is money paradigm and the goal was to maximize the amount of patients you could see within an 8 to 10 hour day in 15 minute slots. And so, when you think about the reimbursement rates of Medicaid, they tend to be the lowest reimbursement rates coupled with the administrative burden and the regulatory requirements with that. And then oftentimes you have unreliable payment schedules and meaning there may be delays and payments, or whenever there's budgeting shortfalls, or if there's a delay in payment because the state doesn't settle on a budget. Then you also have patients who are high resource demand, and then you have limited resources. So, when you're dealing with patients who have complex health needs or they have social needs or you're dealing with patients who you might need a broader provider network in terms of specialist and those specialists don't accept Medicaid. So you really are looking at a lot of complex issues that when you're thinking about in terms of the overarching population, it is just sometimes maybe the, for lack of a better analogy, the juice isn't worth the squeeze and we don't want we don't want to think of it like that because our patients, it should be patients first, but oftentimes it's a lot of resource intensive and time intensive work.North Carolina's managed Medicaid program is a significant shift for many providers. Can you tell us why this new model represents an opportunity for independent providers, particularly when it comes to improving care quality and practice sustainability?So really, as we move away from this productivity model of healthcare into this paying for value, the Medicaid managed care model has incentivized providers to provide quality care. And they reward them for meeting performance metrics and improving patient outcomes. And the model also allows for per member per month care management fees. So advanced medical homes who meet certain requirements are able to receive these care management fees. And they're able to address the medical, behavioral and social needs that align with the holistic care delivery model. And then also they have included some enhanced reimbursement models and shared savings models where they're allowing for value based payments and risk based contracts that can provide for more, like, predictable revenue streams and then the backbone of all of this is the infrastructure and access to resources that we didn't have prior to Medicaid managed care launched and the plans now offer support for population health management in the form of like data sharing. We have claims data, we have risk data, we have pharmacy lock in data, all of these data sharing has allowed us to be able to risk stratify the patients, align our efforts to those patients who need more intensive care management. We've also have some innovative models like the healthy opportunity pilots that allow the plans to pay for social determinant interventions, things that we weren't able to pay for before. So really it is moving to a more holistic and accountable and value-based care models.That's interesting. Well, from your perspective,...

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Dr. Saum Sutaria is the Chairman and CEO of Tenet Healthcare and a former leader in McKinsey & Company's Healthcare and Private Equity Practices, where he spent almost two decades shaping the field. In this episode, Saum unpacks the complexities of the U.S. healthcare system, providing a detailed overview of its structure, financial flows, and historical evolution. They delve into topics such as private insurance, Medicare, Medicaid, employer-sponsored coverage, drug pricing, PBMs and the administrative burdens impacting the system. Saum's insights help connect healthcare spending to broader economic issues while exploring potential reforms and the role of technology in improving efficiency. Saum highlights how choice and innovation distinguish the U.S. healthcare system, explores the reasons behind exorbitant drug prices, and examines the potential solutions, challenges, and trade-offs involved in lowering costs while striving to improve access, quality, and affordability. The opinions expressed by Saum in this episode are his own and do not represent the views of his employer. We discuss: The US healthcare system: financial scale, integration with economy, and unique challenges [5:00]; Overview of how the US healthcare system currently works and how we got here [9:45]; The huge growth and price impact due to the transition from out-of-pocket payments in the 1950s to the modern, third-party payer model [18:30]; The unique structure and challenges of the US healthcare system compared to other developed nations [22:00]; Overview of Medicare and Medicaid: who they cover, purpose, and impact on healthcare spending [27:45]; Why the US kept a employer-sponsored insurance system rather than pursue universal healthcare [32:00]; The evolution of healthcare insurance: from catastrophic coverage to chronic disease management [36:00]; The challenge of managing healthcare costs while expanding access and meeting increased demand for chronic illness care [44:15]; Balancing cost, choice, and access: how the US healthcare system compares to Canada [48:45]; The role of the US in pharmaceutical innovation, it's impact on drug pricing, and the potential effects of price controls on innovation and healthcare costs [56:15]; How misaligned incentives have driven up drug prices in the US [1:05:00]; The cost of innovation and choice, and the sustainability of the current healthcare cost expenditures in the US in the face of a shrinking workforce and aging population [1:11:30]; Health outcomes: why life expectancy is lower in the US despite excelling at extending lifespan beyond 70 [1:18:45]; Potential solutions and challenges to controlling drugs costs in the US while balancing choice and access and preserving innovation [1:26:15]; Balancing GLP-1 drug innovation with affordability and healthcare spending sustainability [1:40:00]; Reducing healthcare spending: complexities, trade offs, and implications of making needed cuts to healthcare expenditures [1:46:45]; The role of government regulation, opportunities for cost savings, and more [1:56:15]; Hospital billing: costs, charges, complexities, and paths to simplification [2:01:15]; How prioritizing access and choice increased expenditures: reviewing the impact of healthcare exchanges and the Affordable Care Act [2:08:00]; Feasibility of a universal Medicare program, and what a real path to sustainable healthcare looks like [2:15:45]; The challenge of long-term care and the potential of innovation, like device-based therapies and AI, to improve health [2:23:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

Biden pardoned Hunter, lied and lied. Tiger snake in woman's car! Debanking: Evil discrimination? Victims become victimizers!The Hake Report, Monday, December 2, 2024 ADTIMESTAMPS* (0:00:00) Start* (0:01:17) I stand with Hunter!* (0:03:30) Hey, guys!* (0:05:57) RIP Jim Abrahams, movie director* (0:12:13) Tiger snake in car with driver* (0:20:54) DAVID: Kentucky Fried Movie* (0:29:46) Coffee… Merry Holidays, Biden body double?* (0:35:15) Coffee… Popcorn: Biden pardon Hunter?* (0:46:49) Biden's character: Andrew Weissman, Eric Holder* (0:55:33) Supers: Pakistan, Kelly vs gossip, 33, Mobetta* (0:59:14) Supers: Bitterness at Israel, Cam Higby guest* (1:03:09) ALEX, CA: FE, Excuse-making, LYC nose-breathing* (1:11:24) JOE, AZ: Fed… De-banking* (1:21:42) JOE: Discrimination. Medicaid. Genocide. Victimhood* (1:34:45) Victimhood… accusing each other of evil!* (1:35:30) WILLIAM: Snakes. Bigg Bump on jobs. Black-owned banks.* (1:44:44) Lil Hake with a snake* (1:45:24) RICK, VA: Snakes in HVAC; Victimhood* (1:49:31) Supers… Mobetta, etc.* (1:53:01) Ampere - "Remain Unadapted" - 2004, All Our Tomorrows End TodayLINKSBLOG https://www.thehakereport.com/blog/2024/12/2/the-hake-report-mon-12-2-24PODCAST / Substack HAKE NEWS from JLP https://www.thehakereport.com/jlp-news/2024/12/2/hake-news-mon-12-2-24* (CNN or theSkimm or Morning Brew or AP Mon 12-2-24)Hake is live M-F 9-11a PT (11-1CT/12-2ET) Call-in 1-888-775-3773 https://www.thehakereport.com/showVIDEO YouTube - Rumble* - Facebook - X - BitChute - Odysee*PODCAST Substack - Apple - Spotify - Castbox - Podcast Addict*SUPER CHAT on platforms* above or BuyMeACoffee, etc.SHOP (new!) - Spring (old!) - Cameo | All My LinksJLP Network:JLP - Church - TFS - Nick - Joel - Punchie Get full access to HAKE at thehakereport.substack.com/subscribe

Dr. Jeanette Benigas, SLP, and Preston Lewis, MS/SLP, tackle common myths in speech-language pathology, focusing on the necessity of the CCC. They debunk the misconception that the CCC is required to bill Medicare, emphasizing that Medicare policy is federal and does not vary by state. They clarify that reinstating the CCC involves only a fee, a passing Praxis score (if needed), and professional development—no college courses or back pay. Additionally, they confirm that only two and a half states (Nevada, Delaware, and Virginia) require the CCC for initial licensure. They discuss the role of the CCC in completing AAC assessments and dispel fears that removing the CCC requirement will hinder Medicaid reimbursement efforts, sharing real-world case studies to prove otherwise. Through their discussion, they empower SLPs to challenge misinformation, advocate for transparency, and make informed decisions about their professional credentials.Set up a FREE account to begin using the CU tracker.Want to earn some PDHs or CEUs? Use code FIXSLP58 to get a $20 discount coupon off any subscription!Become a sustaining partner.Follow us on Instagram.Find all of our information at fixslp.com and sign up for our email list to be alerted of new episodes and content.Email us at team@fixslp.com.Leave us a message on our Meltdown in the Minivan line.

Join us for this enlightening episode of VRTAC-QM Manager Minute, where we explore the transformative power of Value-Based Purchasing (VBP), also known as Performance-Based Payment (PBP). In the studio, we have Chip Kenney, Co-Project Director of the VRTAC-QM, and Lisa Mills, a consultant and subject matter expert in VBP, sharing their expertise. VBP is more than just a financial model—it's a strategic shift designed to drive better outcomes for individuals with disabilities. By aligning provider incentives with measurable performance outcomes, State Vocational Rehabilitation Agencies (SVRAs) can enhance the quality of services, improve consumer results, and optimize costs. Tune in to hear Chip and Lisa discuss how SVRAs can harness the power of this approach to revolutionize service delivery and create a meaningful impact. Whether you're considering adopting VBP or seeking to refine your approach, this episode is packed with insights you won't want to miss! Value-Based Payment Methodologies to Advance Competitive Integrated Employment: A Mix of Inspiring Examples from Across the Country   Listen Here   Full Transcript:   Chip: Virginia reached out and they wanted to include value based purchasing specifically in their Disability Innovation grant. I said, this is an opportunity we can't pass.   Lisa: Is there anything about our payment structure that incentivizes or rewards this kind of quality that we're saying we're not getting, thus reduce the amount we're investing in unsuccessful closures.   Chip: When we can get to that point where we can identify and measure and demonstrate and get quality outcomes that will move this whole system a gigantic step forward.   Intro Voice: Manager Minute brought to you by the VRTAC for Quality Management, Conversations powered by VR, one manager at a time, one minute at a time. Here is your host Carol Pankow.   Carol: Well, welcome to the manager minute. Joining me in the studio today are Chip Kenney, Co-Project Director of the VRTAC for Quality Management, and Lisa Mills, Consultant and Subject Matter Expert to the QM on Value-Based Purchasing. So here's a little context for our listeners. Value-Based Purchasing, also known as Performance-Based Payment, is a model that offers financial incentives to providers for meeting certain performance measures. And as state rehab agencies look to improve outcomes for individuals with disabilities, the quality of purchased VR services, and overall cost effectiveness. A Performance-Based approach might be an option, so I don't want to steal their thunder, and I'm going to let my guests discuss what they're doing today. So let's dig in. Lisa, lets' start with you. Can you tell us a little bit about yourself and how did you find your way kind of into this VR space?   Lisa: Sure. So I've been in the world of disabilities for my career, for the entire career. So, 33 years, I think where now I've lost count. But about 20 years ago, I got really interested in employment working with Self-advocates way back before there was such widespread support for ending Subminimum wage. You know, the support that we do see now, but that was at a time when that it wasn't even being discussed. But Self-advocates were very clear that they wanted to earn more money and have more opportunities. So I got interested in supported employment and why we weren't using it very much. And so I started working with Medicaid and long term support agencies on improving employment services and outcomes. Back then, there was something called the Medicaid Infrastructure Grants, which allowed states to create Medicaid buy ins for working individuals with disabilities. So I really dug in around what were we doing around employment services. And of course, that brought us to the relationship with VR. And about 16 years ago, I started working on customized employment and developing ways to pay for customized employment, and worked with a couple VR agencies at the time on payment structures for customize. And then most recently, I'm a mom of a transition age son who used VR supported employment services to get his first and second jobs, and he's been employed in competitive, integrated employment since 2020. He's about to turn 21 and that has changed his life. So I'm a firm believer.   Carol: Good for him. That's really cool to know. I always love it finding out the stories people have, because you never know, we all get here a different way. But I love your path. So Chipper over to you. And I'm going to say Chipper because I'm naughty. He Chip is my colleague. So for our listeners I do like to rib Chip a bit. So Chip, how did you find your way into the VR space?   Chip: So very similar to Lisa. My whole career has been in public rehabilitation for a bit then technical assistance centers, but fast forwarding to about 2009 was interested in customized employment and its applications, and the need for VR systems to have an employment system that really addressed what people with the most significant disabilities needed to be successful, and I was sort of glommed on to that space ever since. And then with the passage of WIOA, it just seemed a really necessary connection that VR agencies and systems have something new they can offer. People who would have considered going into sheltered employment now are coming out. What are you going to offer them that's new and different from when they went in and have been at it ever since, mainly focused on the implementation side of it, because there's a bunch of trainers in that space and they're all really good. But we learned early on that it takes an infrastructure to embed, implement and sustain customized employment over a period of time. And so that's been my focus the last several years. I mean, we're still learning a lot. And rate structure is part of that, which, I mean, I've known Lisa for years too, but rate structure is something every agency struggles with. And when the opportunity came to work with Lisa on this and move this forward, I thought, this is a big missing piece that we have to fill.   Carol: Absolutely, I'm underscoring that 100% because we know we get a lot of rate work with our QM work and the whole idea and customized employment with that sustainability. You can have the great idea. And we're going to do the thing and we're all excited. But then what happens. Year one and two and three and four as it goes on and it all fades away. And we don't want that to fade away. We need to have that good sustainability plan. So Chip, how did you get involved in bringing Lisa on board? What was kind of the impetus of that?   Chip: Virginia reached out. The state of Virginia reached out to us and they wanted to include value based purchasing. And they mentioned that specifically in their Disability Innovation grant, and somebody referred them to me. I mean, I knew a bit about it, but then as soon as I saw the Lisa connection and started reading her work on it, I said, this is an opportunity we can't pass, even though I don't have any experience. But Lisa brings all that and the knowledge and the background and said, it's really important to be a part of this.   Carol: Very cool. So, Lisa, I understand you have a very unique superpower. You can speak and interpret languages across multiple partner systems. How did you develop that?   Lisa: Well, I guess I'm a bit of a policy wonk. I did a lot of interviewing of people from different systems to try to understand what was going on with partnerships, what were the challenges. And this was probably 12, 13 years ago. I was doing some work with ODEP at the time, blending and braiding. And when I was doing a lot of my interviews interviewing the different partners, including VR, I figured out that a lot of what was going on at that time was sequencing. It was really not blending or braiding, and if we wanted to get to braiding and ultimately to blending, I felt like we really had to find what was going on then as something foundational, you know? And that's where I kind of coined the term sequencing and said, this is really what we're doing, but we can help people understand then what it means to switch from sequencing to braiding, what it means to switch from braiding to blending, and really start to get people interested in the advantages of moving away from sequencing. So it really was just wanting to dig into each system enough to figure out what solutions might improve collaboration and outcomes. Sometimes it can be easy to lay out all the issues, right? Everything that's not working, but to really dig into each system and figure out where could we align ourselves, where are we aligned, and we just don't realize it? That was more, I guess, the policy wonk side of me.   Carol: I love that because I think I've been on lots of work groups over the years, I mean, I just have when we've worked between, you know, departments of education and your state Department of like maybe developmental disabilities or whatever you are calling it back in the day. And then in the VR system when we all had different ways of describing everything and we could get stuck in the what's the problem? Here's all the problems. We got problems. We have a million problems. Here's all the hundred problems we have to get through before we can get to a solution. But if you go in and go, I love that. Like, how are we aligned right now and what are the things that we could build off of right now instead of always focusing on that whole myriad of things? But I think understanding each other, how we speak about things and we may say the same word, but it means something different to each of us. Once we can kind of clear up that dictionary and talk the same language, it makes it much easier to comprehend what's going on in each other's systems and how that can then work together. I love that you have that. So what is the essence of Value-Based Purchasing?   Lisa: So to me it's quality service combined with efficient service that results in quality outcomes. So I think about that. Efficiency without quality that would not lead to quality outcomes. We'd hurry up and do things, but we wouldn't really see the quality outcomes we wanted to see. And at the same time, if you have a quality service that goes on and on and on, you lose the cost effectiveness and you typically you lose the job seeker. They're going to give up or go find a job some other way. So to me, we have to recognize we need both quality and efficiency in the way services are delivered and that we have a set of quality outcomes we want to achieve. And we have to ask ourselves, to what extent are we getting those quality outcomes? And to me, if we can figure out a payment structure that balances rewarding quality and efficiency and is really clear about what is quality and service delivery, what is efficiency and service delivery, and then what are we looking for? As quality indicators and outcomes? We can design a payment structure that really will deliver on that. And I think as you start to think about that, you realize how the existing payment structures really aren't set up to do those things for various reasons. And that really, I think, helps people buy into the idea that there might be a better way to do this. And this idea of value based purchasing might actually have some legs.   Carol: So that payment structure piece, that's my interest. How did you really dig in and kind of figure it out? Because it sounds good and I understand all the things you're saying about quality outcomes, but how when it comes down, like putting the rubber to the road, do you get at the nuts and bolts of figuring out the payment structure?   Lisa: So everybody always wants that. Next they say, so tell me what it is. And I always say it is what you need to develop locally in your system. You need buy in from those who are purchasing and those who are providing, and you've got to bring them to the table in a constructive way. So in a really collaborative way, sometimes we talk about it as co-creation and you dig into what do we agree is quality service, how do we differentiate quality service from service that we would say is not high quality. And then what do we agree is efficient service? How do we differentiate efficient service from service we would say is inefficient but very important to VR agencies, at least those I've spoken to. Are these quality outcomes, the career path outcomes, the jobs with benefits, the jobs with more hours and better pay? You know, some of these things, you're just not necessarily seeing a lot. You're getting outcomes that you can count as a 26 closure, but they aren't the kind of quality outcomes that, and you see some revolving door effect of certain people who and I know that's a big issue in some states or you see a lot of dropouts in the process. So in every state it's important to sit together and figure out what should we be doing better, what does better quality look like, and then what is quality and efficient service look like? That's how you get the buy in to establish a payment structure that where people want to implement it and intend for it to work. I can certainly share examples of how that co-creation works going on elsewhere and what the ultimate outcome was, but that is what happened there. And I really like the idea that and really believe that you've got to do a local co-creation process to get to something everybody's bought into and something that has a high probability of working. I would never say, oh, Value-Based Purchasing is this. It's only this. Or you just take this model from this other state and you plunk it down here. That won't work.   Carol: Yeah, I can see why you sing to Chip's heart there. Because he's all about systems work, you know, and that whole and everybody's systems in your state are so different. How you're set up, what your relationships are like between your providers and yourself and other entities and all of that. So I do like that you're speaking to that and you can't just pick up and replicate because you've got all your nuances that are happening in your state, and you need to understand those before you can get to the agreeable solution. That makes a lot of sense.   Chip: And it's not only that, and we're finding this to be true now that providers are not a monolith, that there's not a state where you can go, okay, every provider looks like every other provider. There are a lot of uniquenesses, a lot of variables that have to be taken into account to bring at least the majority of them on board. And that's we're finding that to be true as every state system is different, every provider network or non-network is different.   Carol: Absolutely. And even when you think about the states, kind of just the like the geographic challenges they have and the things that are going on, we've saw such an increase, especially after Covid with people moving and some of the states go like our cost of living in certain areas has gone up exponentially, like 300% or something. And so you've got everybody like, decided because they could work from anywhere. We're all moving to this town and then other areas become depleted, maybe from people, and there's less resources available and harder to get providers to serve an area even though you have customers there. I just feel like we have a lot of geographic and economic challenges across states, even tiny states. It's been super interesting. We've found that work as we've been just doing plain old rate setting with states, so let alone what you guys are digging into. So what are some of the biggest challenges in implementing this value based purchasing?   Lisa: I would say the time it takes to do it right. I think sometimes state agencies and I'm not singling out VR, but they want quick solutions. You know, they think about it for a long time and then they say, okay, we want to do it. Let's get it done. Can we get this done in three months or can we, you know, and you have to say probably not in a way that would be successful. And so it is something not to take lightly and to really commit to invest in. I think there's a lot of additional benefits to doing this, including provider relationships and the learning that goes on. Providers now understand what it's like to step in the shoes of a funder. Funders understand what it's like to step in the shoes of a provider. I always think that helps with everybody getting on the same page and agreeing to a model they think will work, but it takes patience, it takes partnership. Some states are, they're very uncomfortable with bringing providers in. They tend to develop things and then release them to providers. So you've got to have a level of trust when you identify the providers you want to involve. I always encourage to identify who are your high performers. They are the providers you want this model to work for because you want more high performers and you want those that you have to expand their footprint, for example, to go into geographic areas that are underserved or to hire more staff. So always thinking about partnering with the high performing providers. But there's a bit of reluctance, you know, and risk in doing that and saying we're going to create something together. Lots of outside the box thinking. It's really hard to get away from payment models that you've been invested in for a long time. Milestone fee for service. Just to think beyond those can be very difficult, but I think once people start to and that's something I do, is kind of bring ideas and thoughts and stimulate thinking to get them to move away from those models and really say, what should we be paying for? What is important to value in the payment structure? I think it really gets to be very exciting, or at least I think so. You really need data to you cannot develop a model without good data. Sometimes the data is readily available. It's reports that VR agencies are already pulling out of their system. Other times the data's in the system, but they don't typically pull it. And so we have to work with them. And it helps to have a data analyst to assist with this process, to be able to pull pieces of data or data analysis and different ways that informs what we're doing. We want a data driven approach. And sometimes, of course, you probably know that data analysts are very, very busy or they're off doing something else. And it may be hard to get them committed to the work.   Carol: Have you seen improvements since? I'm just thinking since WIOA and kind of the requirements that RSA has put on state agencies about collecting a vast amount more of data. Have you seen improvement as you're working with states that they actually have data they may not have had years ago that you can get at. I mean, there might be a little bit of a problem with the staffing or getting your data analysts to pull it, but that availability of the data you need to really to dig into this, that it's actually there.   Lisa: Yeah, I do think the systems are pretty sophisticated, and it's a matter of helping them understand how to use more of the data they have, because we have the standard WIOA measures. We have the way that VR talked about its performance prior to WIOA but I think we're digging in to get it more data elements that help us understand. One of the most important things to understand is demographic information and how that affects maybe how difficult or how easy it is to serve someone. So, for example, adding criminal background to someone's demographic profile, or we know from history that, you know, that does create a challenge. So it's weeding out what are the things that differentiate people who VR would serve and try and understand better how that relates to cost. The other thing that's really important that I don't typically see is what's the average cost of a successful case? So I see this is the average cost of successful closures. So taking all successful closures and dividing it by the number and then average cost of unsuccessful closures, then average cost of a case. But for me what matters most is what are we paying for a successful case if we're including everything we're paying. So including all the that we're spending on unsuccessful closures in that and saying, basically this is what it costs to get a successful case, because we also have to pay for the unsuccessful closures and trying to focus on how do we reduce, how much we're paying for unsuccessful closures, and to really make sure more of the money that we're paying flows to successful closures. There's a little bit of complacency that goes on with every system where if we just compare ourselves to other states, we may say, look, we're doing better. We should be happy with our performance. We are better than 75% of the states. But if we stand back and compare that to people without disabilities and their participation in the workforce, I think that's when we say we're comparing it to school. Like if you got 60% on a test, would you pass it or would you fail it? So I think we have to challenge ourselves to say we may be doing better than so many other states, but we are not performing at a high level and we want to move up. We want to not just judge ourselves by other states. Now, 100% success is unrealistic. I don't think there's anybody who would disagree with that, but it's important for the providers and the funder to come together and say what kind of improvement above where we've been. Do we want to try to incentivize? Do we want to see and to develop the payment structure, to say we believe this structure will directly influence our ability to move those percentages up over time and thus reduce the amount we're investing in unsuccessful closures without reducing the number of people were serving, without cherry picking, but truly improving outcomes.   Carol: I love that that is a good way to challenge the thinking that's going on out there, because people sort of, I don't know, poo poo or they just this is over there in that bucket and they let it be. And we're kind of complacent with just, you know, we're doing better but is better. What's the next state like. You know, like better than what. And so what does that matter.   Chip: But I think I mean, the key to me is the concepts of quality, the quality of services and quality outcomes. And if you can define and you can measure and you can demonstrate quality of services and quality outcomes, it seems like you don't need to compare yourself with other states. You can say this is quality in our state. This is what we're doing. This is how we're doing it. These are the outcomes. So state by state national comparisons are way less important. So when we can get to that point where we can identify and measure and demonstrate and get quality outcomes that will move this whole system gigantic step forward.   Carol: 100% Chip. So what would be your best advice for states as they're listening. Right. You know, they're listening in and they're thinking, well, I want to do something, but I don't know what to do. Like what would be the next steps? What should they do?   Lisa: To me, it's, start the conversation. I find that the process of bringing state people together with providers, that they're all learning together about this different way of thinking, And it helps because it does take a little bit to get your mind around what Value-Based Purchasing is and how it's different from milestone payments or fee for service. And I've often seen like people have come up to me sometimes and said, you know, it was the third time I heard you talk that the bells finally went on, you know? And I said, that's fine. I think it's just the way it is. It's complicated in a way, because it's so different. So getting the conversation started and thinking about, you know, asking yourself questions like, is there quality in the outcomes that we want as an agency that we're not getting quality and service delivery? We don't feel we're getting quality and outcomes we're not getting. Then think about your payment structure and say, is there anything about our payment structure that incentivizes or rewards this kind of quality that we're saying we're not getting? Sometimes maybe there's something there. Sometimes you could say, no, there's absolutely nothing in the payment structure that does that. And then I always say, think about the providers that you think are doing the best work for you. Are they financially benefiting? Are they doing better financially. And in some cases I've seen no, there's no difference. I'm performing better, but financially that's not being recognized. And in other cases I've seen they're actually earning less because they're doing such a good job and they're very efficient. You know, they're producing quality with efficiency. They're actually doing more poorly financially than some of the providers who are performing at a lower level of quality. So I think when we start to think about those questions, people see that the need to try to figure out a different way to do things, then they're willing to, you know, let's talk about what this Value-Based Purchasing is what the principles are, how it's different, and begin to think about how we might bring our high performing providers into a conversation with us about this.   Chip: My advice for states is that you're in this for the long haul. To Lisa's point very early in this discussion that this isn't a quick solution. That's something that can just be laid in the state and just immediately adapted. It does take that level of discussion, that level of understanding, collecting data. It's complex. And sometimes I think to myself, why am I choosing to get involved in the complexity of Value-Based Purchasing overlaid the complexity sometimes of customized employment, but I think in the end result we will have a much better system, much more equitable service delivery system for everyone, including providers, including customers and job seekers. But just keeping the discussion going on things like this, things that CSAVR presentations Getting this into the national discussion, I think, is the first step.   Carol: Those are really good tips. Where outside of VR is Value-Based Purchasing being implemented?   Lisa: So definitely in the Medicaid world, most of your listeners are probably aware of that, but mostly in the Medicaid world, it's on the acute primary care side. So hospitals and doctors, primary care physicians and things. So I always caution people there's things we can learn from that and those examples. But it's not a wholesale import those approaches over to VR. I don't think that would work. But there are some principles or strategies that we can use, like there's a concept called shared savings. There's some other things that I think we can think about and use, but we still have to develop something that's specific to employment. In my work on this around employment on the Medicaid side has been with the long term services and support agencies, the DD agencies, the mental health agencies, managed care organizations who are doing LTSS and employment is a perfect place to start with them around their thinking, around Value-Based Purchasing. They're facing some pressure. I would say some to use Value-Based Purchasing because it's seen to be working on the acute primary side of Medicaid. So they're saying, why aren't we using it in LTSS? And they want better quality and better efficiency too. They want to see people supported to achieve their highest level of independence. They want their high performing providers to do well. So we worked on it with employment because it's so obvious that fee for service, which is the typical payment model, disincentivizes all the things that we associate with high quality supported employment, the better you are at getting people jobs, the better you are at coaching and fading because you're good at it. We reward providers under fee for service with less money. And those providers are performing more poorly, end up with more money. So it's not hard to get people to see why fee for service doesn't work for supported employment. So we've worked on models for job coaching that pay for hours worked rather than hours of coaching, so that providers are appropriately financially compensated if they do better at fading, which goes back to what kind of job did they get people, as well as how good they are at coaching. That model incentivizes them to get people more hours. So if you start with 12 hours a week, that doesn't mean you stay with it. If they're doing well, the employer wants to increase that. The person wants that they can get paid more in the model. Fee for service providers don't get any financial remuneration for increasing people's hours worked, even though we say that's a goal. So that's been a lot of where we see some of the value based models developing. We're paying for things up front services like exploration, which I'm really happy to see the results of states that have added exploration and exploration to their waivers, because we now have a way to tackle people who say no thanks in a planning meeting or I'm not interested, or their families say that we've been paying for developing payment models for that. That's an outcome payment. So they complete the service, then they get paid based on the quality of the information they submit and the efficiency. So there are ways to align what we're doing. Providers certainly appreciate that they would like to be paid the same way. Typically once they experience being paid in a Value-Based structure. So that's where it's happening. But think about just the general business world. There are so many examples of payment based on performance or quality, right. Sales Salespeople earn incentives for sales. So business has long been doing this in terms of creating those kinds of incentives and even nonprofits. Now, United Way and others are funding nonprofits based on outcomes and deliverables. They're no longer funding them to just provide service. So I think if you look, we're seeing it everywhere, really.   Carol: So you brought up a whole lot of points. If people are interested in more information, do you have resources we could send them to?   Lisa: Well, in 2021, I did a publication that looked at examples from around the country that I'd been in some way involved in. That's on the Lead Center website as well as there are a series of webinars we did at the time with representatives from various states. I have a lot of information about what's going on in the Medicaid side. Et etcetera. So I guess I would say that was my thinking in 2021, I continue to learn and evolve my thinking, and I think we're at a point now where we're trying to do in Virginia, is move beyond both fee for service and milestones, because neither are working very well, right? So you've got some state VR agency saying we're paying fee for service. It's not working. Should we move to milestone? But if you talk to states who are using milestone, they will also say it's not working very well. Some of them are thinking about going back to fee for service. And I'm thinking, I don't think we should do either. I think we should work together to figure out what's the next way we attempt this that addresses the shortcomings of both. And I think that pathway is Value-Based Purchasing.   Chip: and helping moving states to. Well, I'm a little concerned about the unknown. What we have may not be working now, but it's the known. I don't really know what's ahead, but I think where in Virginia at least, has done a really good job of creating that safe space. Like, let's explore this together and keep this comfort zone of what we currently have, but move forward into something that's more equitable and beneficial for them.   Carol: So, Chip, if people wanted to reach out, what would be the best thing? Should they contact you or what would be best?   Chip: Either one of us is if it's a state agency, probably me if it's others listening to this. Lisa.   Carol: Do you want to give them your email address?   Chip: It's r k e n n e y at SDSU (San Diego State University) dot EDU.   Carol: Awesome. And, Lisa, do you mind sharing your email address?   Lisa: No, but I'll warn you, it's long. So here we go, Lisa Mills l L i s a M i l l s, all one word, at M as in Michael, T as in Tom, D as in David, D as in David, dot On Microsoft, all one word, com. And that was my IT friends who gave me that ridiculously long email, which I hate.   Carol: Holy smokes, that is long. Well thank you both. I really appreciate it. And I will put a link in our podcast announcement out to your publication from 2021 as well. Then folks could at least see that. But thanks for your time. I really appreciate the conversation.   Lisa: Thank you.   Chip: Thanks. We really appreciate this opportunity.   Outro Voice: Conversations powered by VR, one manager at a time, one minute at a time, brought to you by the VR TAC for Quality Management. Catch all of our podcast episodes by subscribing on Apple Podcasts, Google Podcasts or wherever you listen to podcasts. Thanks for listening!

### The Importance of Succession Planning and Legal Preparedness in the Insurance Industry In a recent "Insurance Business Babes" episode, host Joanna Wyckoff welcomed Kim Hegwood to delve into the critical issues of succession planning and legal preparedness in the insurance realm. Their conversation highlighted several essential considerations that professionals and individuals must keep in mind to ensure stability and protection in the face of unforeseen circumstances. ### Succession Planning & Health Risks Joanna Wyckoff underscored the necessity of succession planning, drawing from her personal experience of a severe illness that nearly jeopardized her business. The unpredictability of life amplifies the need for certified and regularly updated succession plans, ensuring business continuity and personal peace of mind. ### Comprehensive Legal and Estate Planning Kim Hegwood, an experienced elder law attorney, elucidated the complexities of legal and estate planning. She emphasized that while trusts are portable across state lines, documents like power of attorney and wills require state-specific updates upon relocation. Hegwood's office offers a suite of services including estate planning, elder law, probate, and care management to address these needs comprehensively. ### The Necessity of Regular Updates Both speakers stressed the importance of regularly updating legal documents to reflect life changes such as divorce, childbirth, or death. This practice avoids complications, ensuring that estate plans accurately represent current intentions and beneficiaries. ### Educational Outreach and Client Understanding Hegwood's legal practice places a strong emphasis on educating clients about their legal documents. They use dedicated funding coordinators to help clients effectively fund trusts, enhancing the reliability and completeness of their estate plans. ### Guardianship and Trust Planning Guardianship and trust planning emerged as critical themes, particularly for families with disabled adult children. Proper trust planning ensures Medicaid eligibility and safeguards against long-term care disqualification. In Texas, counties may have guardianship programs, and planning often involves utilizing corporate trustees to ensure continued care. ### Planning for "Solo Agers" Joanna Wyckoff's identification as a "solo ager" highlighted the unique needs of individuals without immediate family. Hegwood recommended trust planning for these individuals to prevent assets from being absorbed by the state and to ensure proper care management. ### Senior Living Insights The episode rounded off with insights into senior living, challenging misconceptions by presenting it as an engaging and social option for the aging population. ### Conclusion The "Insurance Business Babes" episode with Kim Hegwood provided invaluable guidance on succession and legal planning. The discussions emphasized the importance of preparedness and regular updates, underscoring how proactive measures can safeguard against unforeseen challenges, ensuring peace of mind and stability for professionals and their loved ones. For more in-depth resources, listeners are encouraged to visit Hegwood's website, which offers free downloads and recorded webinars to aid in effective legal planning. This episode is sponsored by CertifiedMedicareAgents.com

I'd LOVE to hear from you! Now you can send a TEXT MESSAGE! Be sure to leave your contact EMAIL so I can return your message!In this episode, Dr. Joel Fankhauser, board-certified in Internal Medicine and Pediatrics - delves into his successful transition from fee-for-service healthcare to Direct Primary Care (DPC) in Bentonville, Arkansas. Dr. Fankhauser discusses strategies for engaging potential patients before opening his clinic, emphasizing personal connections over online presence. He reveals how his clinic, initially cautious about financial risks, flourished by focusing on underserved populations like Medicaid foster families, without any advertising spend in a decade. The practice excels by offering zero-cost services and including low-cost lab tests in membership fees, enhancing patient satisfaction. Dr. Fankhauser also covers practical steps for physicians considering DPC, such as evaluating administrative skills and patient load management. He highlights the benefits of DPC for small businesses and shares anecdotes showcasing the practice's patient-centric philosophy. The episode concludes with insights on recruiting and retaining compassionate, committed healthcare staff, critical for sustaining a successful DPC model. Tune in to learn more about how DPC can revolutionize patient care and physician satisfaction.This episode is brought to you by DrChrono, powered by EverHealth—the #1 mobile, all-in-one EHR solution. Visit drchrono.com/freetrial and discover how easy it can be! Meet DECENT! What the DPC Community has been waiting for - the company building health plans AROUND Direct Primary Care. Learn more about Decent by visiting Decent.com/DPC FREE 1 month trial - HEIDI HEALTH PRO: As Individualized As Your DPC.Support the showBe A My DPC Story PATREON MEMBER! SPONSOR THE PODMy DPC Story VOICEMAIL! DPC SWAG!FACEBOOK * INSTAGRAM * LinkedIn * TWITTER * TIKTOK * YouTube

Navigating the complex world of finance can be daunting. In this episode, we delve into the crucial questions you should ask your financial advisor. From investment strategies to risk tolerance, we'll uncover the key insights to ensure your financial future is secure. Tune in to empower yourself with knowledge and make informed decisions.

In this very special episode Bill welcomes his kids to the show. Michaela, Grace and Brayden talk about their plans for the future and Bill explains the importance for planning a financial future for you and your children.

During this episode, we're going to highlight the steps you should take in years 10 through five of your 10-year retirement checklist.

Travis and Tony talk about their favorite Thanksgiving Movies and shows. Then Travis talks about financial inertia... what it means and how it can help you reach your financial goals faster.

In this episode of Medical Matters Podcast, Dr. Peter Brier and Nurse Practitioner Kelly McCormick discuss some of President-Elect Trump's cabinet and agency head choices. Among these: the appointment of Robert F. Kennedy, Jr. as Director of the Department of Health & Human Services, TV host Dr. Mehmet Oz is slated to oversee Medicare and Medicaid services. Details of some of Trump's picks can be found here.The doctors will consider some of the selections, and what these mean for you, and your healthcare. 

Our guest today is Vanessa Villaverde, the senior program investment officer at the CHCF Innovation Fund, which invests in technology and service companies with the potential to significantly lower the cost of care or to improve access to care for Californians with low incomes. Vanessa is an exceptional health leader with her eye on expanding the contributions of Latina/o/x innovators in health technologies,Before joining CHCF, Vanessa worked at health tech companies Caresyntax and Remedy Partners, where she developed value-based care programs and products. She worked at the Centers for Medicare & Medicaid Services for 10 years advising on innovative payment models, state Medicaid policy, and 1115 waivers. She has invested into health care companies through special purpose vehicles and Angel networks, created a nonprofit to further readiness for Black and Latino/x founders looking to fundraise, and served as a venture scout for Vamos Ventures, an LA-based and Latino/x-led VC fund providing capital to Latino/x and diverse teams in health care, wellness, workforce, fintech, and sustainability.HealthCare UnTold expresses its gratitude to Vanessa for her dedication and hard work in enhancing the health and prosperity for our communities.#VaneesaVillaverde#CAHealthCareFoundation#HealthCareInnovation#LatinoTechnologyStartups

This week, let's all be thankful for the people we have in our lives. We'll get back to preparing to help them help us better when we need help living  - after enjoying those we love most today! Happy Thanksgiving

Research is proving that being grateful can improve your finances and increase your longevity. In this show we discuss some research around how practicing gratitude may be a "simple" way to improve your chances of having a successful retirement.

We get great questions from our clients and others daily, so we've put together a potpourri of questions and answers about estate planning. We believe education is the key to making smart decisions, and we are here to help. Check out our website to learn more about our free educational workshops.   Thank you for sending in your questions—keep them coming! Jeff is happy to explain and break things down to make The Red Wagon Estate Planning and Elder Law Show as helpful and relevant as possible.    WHAT YOU NEED TO KNOW (00:00) Episode introduction. (03:03) What is estate administration?  (05:38) Who performs estate administration?  (07:52) What's the difference between probate administration and trust administration? What resources are available to help the executor understand and conduct estate administration?  (09:42) How much does estate administration cost?   (11:11) What is estate planning, and does it help me while I'm still alive? What is the benefit of having a financial power of attorney and a medical power of attorney?  (13:18) What is the value of estate planning for my family after I've passed? What is a memorandum of personal property?  (16:37) Why do I need estate planning when Pennsylvania has an intestate succession statute?   (20:02) I don't have children. Do I really need estate planning?   ABOUT BELLOMO & ASSOCIATES Jeffrey R. Bellomo, the founder of Bellomo & Associates, is a licensed and certified elder law attorney with a master's degree in taxation and a certificate in estate planning. He explains complex legal and financial topics in easy-to-understand language. Bellomo & Associates is committed to providing education so that what happened to the Bellomo family doesn't happen to your family. We conduct free workshops on estate planning, crisis planning, Medicaid planning, special needs planning, probate administration, and trust administration. Visit our website (https://bellomoassociates.com/) to learn more.   LINKS AND RESOURCES MENTIONED Bellomo & Associates workshops:https://bellomoassociates.com/workshops/ Life Care Planning The Three Secrets of Estate Planning Nuts & Bolts of Medicaid For more information, call us at (717) 845-5390. Connect with Bellomo & Associates on Social Media Tune in Saturdays at 7:30 a.m. Eastern to WSBA radio: https://www.newstalkwsba.com/ X (formerlyTwitter):https://twitter.com/bellomoassoc YouTube: https://www.youtube.com/user/BellomoAssociates Facebook:https://www.facebook.com/bellomoassociates Instagram:https://www.instagram.com/bellomoassociates/ LinkedIn:https://www.linkedin.com/in/bellomoandassociates WAYS TO WORK WITH JEFFREY BELLOMO Contact Us:https://bellomoassociates.com/contact/ Practice areas:https://bellomoassociates.com/practice-areas/    

How Young Children Can Help Qualify for Medicaid We do estate planning. We do probate. We do it well. If you are in Washington State and need help, you can get a free strategy session at the link in our bio. #estateplanning #probate #realestate #wealth #trusts #legacy #estatetaxes #lawyer #attorney #taxes #money

Tomorrow is Thanksgiving Day in the United States, and many of us will celebrate with full tables. But for millions of Americans, food insecurity is a daily problem, year-round. According to government data from 2023, roughly 14% of American households didn't know where their next meal was coming from, or whether they could afford to feed everyone in their home. Politician, voting rights activist, and ‘Assembly Required' host Stacey Abrams has spent years talking about how food insecurity affects communities of all kinds. She joins us to talk about what she's learned. Later in the show, YouTube star Brian Tyler Cohen shares tips on how to talk politics with your family during the holidays.And in headlines: President Biden announced a ceasefire deal between Israel and Hezbollah in Lebanon, President-elect Donald Trump gets mixed reactions to his plan to immediately enact sweeping tariffs on the top three U.S. trading partners, and the Biden Administration says it wants Medicare and Medicaid to cover the cost of weight-loss drugs like Wegovy and Zepbound.Show Notes:Check out Brian Tyler Cohen's YouTube – www.youtube.com/@briantylercohenCheck out Assembly Required – crooked.com/podcast-series/assemblyrequired/Subscribe to the What A Day Newsletter – https://tinyurl.com/3kk4nyz8What A Day – YouTube – https://www.youtube.com/@whatadaypodcastFollow us on Instagram – https://www.instagram.com/crookedmedia/For a transcript of this episode, please visit crooked.com/whataday

This is a conversation we've wanted to have for a while, and it seemed like there was no better time than now, as many people on the broad center-left are asking tough questions about Donald Trump's strength in rural America—according to one post-election analysis, he won 62 percent of rural voters. To unpack what's happening in these parts of the country, we talked to Luke Mayville of Reclaim Idaho, a grassroots organization that, among other things, helped win a ballot referendum that expanded Medicaid in the state. Why, when an initiative like that can succeed, or voters in red states reject school vouchers or approve hikes to the minimum wage, does the party that opposes these measures tend to clean up in such places? What can be gleaned from talking to voters from all over a state like Idaho about how they view the two major political parties, understand the role of government, and explain the problems facing them in their lives? We take up these questions and more! Sources:Luke Mayville, "Do Something Big," Commonweal, Sept 22, 2020— "The Battle Against School Vouchers," Commonweal, Dec 11, 2023— John Adams and the Fear of American Oligarchy (Princeton University Press, 2016)Paul Demko, "The Ballot Revolt to Bring Medicaid Expansion to Trump Country," Politico, Oct 19, 2018Daniel Nichanian, "How Organizers Are Defending Direct Democracy," Bolts, Aug 16, 2023Dana Goldstein and Troy Closson, "Voters Poised to Reject Private School Vouchers in Three States," New York Times, Nov 7, 2024Keith Orejel, "The Political Economy of the Urban-Rural Divide," Law & Political Economy Project, Nov 11, 2024...and don't forget to subscribe to Know Your Enemy on Patreon to access all of our bonus episodes! 

Today's Headlines: Israel and Hezbollah have agreed to a ceasefire after 14 months of conflict, brokered by the U.S. and France. The deal halts fighting for two months, requiring Hezbollah to withdraw from southern Lebanon and Israeli troops to leave the area, with Lebanese forces and UN peacekeepers ensuring compliance. Meanwhile, Donald Trump plans to impose tariffs on goods from Mexico, Canada, and China after his inauguration, sparking threats of retaliation from Mexico's President Claudia Sheinbaum. The Biden administration proposed a new rule requiring Medicare and Medicaid to cover GLP-1 drugs like Ozempic. Lastly, Macy's revealed that one employee hid $154 million in delivery costs over three years, delaying its earnings report. Resources/Articles mentioned in this episode: AP News: Israel and Lebanon's Hezbollah agree to a ceasefire after nearly 14 months of fighting Axios: Trump to impose new tariffs on China, Canada, Mexico AP News: Mexico suggests it would impose its own tariffs to retaliate against any Trump tariffs Axios: Medicare and Medicaid would cover Ozempic, Wegovy under new Biden rule CNN: Macy's found a single employee hid up to $154 million worth of expenses Morning Announcements is produced by Sami Sage alongside Bridget Schwartz and edited by Grace Hernandez-Johnson Learn more about your ad choices. Visit megaphone.fm/adchoices

Israel and Hezbollah have reached a cease-fire agreement.USA TODAY National Immigration Reporter Lauren Villagran discusses the response in Mexico after President-elect Donald Trump's tariff threats.Elon Musk and Vivek Ramaswamy push for federal workers to return to the office.Millions of Americans could have expanded Medicare and Medicaid to cover blockbuster weight loss drugs.USA TODAY Reporter Andrea Riquier discusses what this week's announcement by Fannie May and Freddie Mac means for the housing market.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Pigskin Picks Open Phones where Dillion/Dillon asks us “What are you guys eating for Thanksgiving?” Headlines with semiglutide about to be covered by Medicaid and other insurances

The Biden administration wants to expand access to popular weight loss drugs like Wegovy and Ozempic. The new proposal would allow millions of obese Americans covered by Medicaid and Medicare to be eligible for the drugs. Out-of-pocket costs could plunge as much as 95%. CBS News medical contributor Dr. Celine Gounder explains what to know about the proposed rule.More than 5,000 public schools have closed in recent years, often due to low enrollment, leading to abandoned buildings. One Detroit nonprofit is helping underserved communities repurposed the closed schools. CBS News' Meg Oliver shows how the program is changing neighborhoods and lives.In an exclusive interview with "CBS Mornings" co-host Gayle King, 23andMe CEO Anne Wojcicki discusses the challenges of losing family, recent company changes, and her vision for the company's future.In an exclusive interview, Anne and Janet Wojcicki share how their family is working to raise awareness and fund research following Susan Wojcicki's death from lung cancer.Iconic band The Grateful Dead, is remembering one of the band's original members, Phil Lesh, who died in October at 84 years old. The surviving original members of the band credit Lesh for the impact he made in each of their lives and revealed they were hoping to play together one more time.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Andrew, Tom and Carl discuss Monday's decision to dismiss Special Counsel Jack Smith's cases against Donald Trump, and President Biden's proposal to add Medicare and Medicaid coverage for Ozempic and other weight loss drugs – a move opposed by Trump's HHS Secretary nominee Robert F. Kenney Jr. They also talk about reports that longtime Trump insider and aide Boris Epshteyn is the subject of an internal probe by Trump's attorneys for trying to sell access to the President Elect. Plus, a look at repercussions from Trump's plan to place a 25% tariff on imports from Canada and Mexico. Next, Tom Bevan talks to RCP senior elections analyst Sean Trende about whether the 2024 results were “Trump-specific” or reveal a long-term trend within the GOP, and why California takes so long to count votes. And finally, Andrew Walworth talks to Republican strategist John Feehery about how Speaker Mike Johnson will lead given his slender majority in the House, and what the nomination of former GOP Rep. Lori Chavez-DeRemer for Labor Secretary will mean for public sector unions.

Howie and Harlan are joined by Vin Gupta, a physician, a medical analyst for NBC News, and the chief medical officer of Amazon Pharmacy. Harlan reports on the Biden administration's proposal to cover obesity drugs with Medicare and Medicaid; Howie offers some reasons to be thankful.   Links: Coverage of Obesity Medication “White House Fact Sheet: Biden-⁠Harris Administration Takes Latest Step to Lower Prescription Drug Costs by Proposing Expanded Coverage of Anti-Obesity Medications for Americans with Medicare and Medicaid” “The (Minimum) Emergency Savings Needed in America's 50 Largest Cities” “The implications of defining obesity as a disease: a report from the Association for the Study of Obesity 2021 annual conference” “Expanded Medicare Coverage of Antiobesity Drugs May Cost Billions Each Year” Harlan Krumholz: “Eligibility for Cardiovascular Risk Reduction Therapy in the United States Based on SELECT Trial Criteria: Insights From the National Health and Nutrition Examination Survey” Vin Gupta “Ozempic and Wegovy may help curb alcohol addiction, study suggests” “Amazon Launches $5-a-Month Prescription Drug Plan in Further Healthcare Push” “As Mail Order Pharmacies Continue to Climb in Customer Satisfaction, Chain Drug Stores Fall Behind, J.D. Power Finds” “The Powerful Companies Driving Local Drugstores Out of Business” “Amazon Purchase of One Medical Health Clinics Won't Be Blocked by FTC” Anthropic: Meet Claude “A.I. Chatbots Defeated Doctors at Diagnosing Illness” Reasons to be Thankful “As Medicaid Unwinding Concludes in Most States, KFF Finds 25 Million Lost Medicaid Coverage but Enrollment is 10 Million Higher Than Pre-Pandemic Levels” “Egypt has been declared malaria-free by the World Health Organization” “FDA Approves First Gene Therapies to Treat Patients with Sickle Cell Disease” “Novel pulsed field ablation offers patients safer and faster atrial fibrillation ablation” Learn more about the MBA for Executives program at Yale SOM. Email Howie and Harlan comments or questions.

Randy is concerned about the number of women who seem to enjoy true crime podcasts and TV shows thoroughly. Plus, why the internet is mad about mac and cheese and Ozempic coverage.

Sara and the panel discussed Trump's vow to place new and additional tariffs on Canada, Mexico, and China and the effects its already having. Trudeau got on the phone with President-elect Trump to discuss the border and Mexican President Claudia Sheinbaum stopping a north-bound immigrant caravan. Trump is over a month away from inauguration, yet he's already shaking things up on the global stage. The panel shifted their attention to California's Governor Newsom. Newsom responded to President-elect Trump's statement that he was eliminating Biden's electric vehicle tax rebate Newsom has decided to institute his own EV tax credits. However, he will not extend the tax credits to those who purchase a Tesla. All indications point toward Newsom having a political vendetta against his state's only EV manufacturer. The panel pivots to the news that Big Government and Big Pharma are teaming up yet again — this time to offer a weight loss drug to Medicaid and Medicare recipients. Sara and the panel are of the mindset that pharmaceuticals should be an absolute last resort, never the first resort. American pharmaceutical companies continue lining their pockets off the poor health of American citizens. The episode concludes with Sara and the panel discussing CNBC's news that Thanksgiving is more affordable this year than in previous years. Anyone who's been to the grocery store recently understands how farcical that statement sounds. Sara is joined by BlazeTV contributor Jaco Booyens, host of "The Bottom Line," and Eric July, founder of Rippaverse Comics. Learn more about your ad choices. Visit megaphone.fm/adchoices

It's News Day Tuesday! Sam and Emma speak with Richard Beck, senior writer at n + 1 Magazine, to discuss his recent book Homeland: The War on Terror in American Life. First, Sam and Emma run through updates on Trump's tariffs, Trump's cabinet drama, Trump's legal woes, Biden's gift to Trump, deaths under Texas' abortion ban, Missouri's ban on trans care for minors, Charlotte's airport workers' strike, bird flu, and Mississippi's runoff election, before diving a little deeper into Biden's plan to expand Medicare and Medicaid to include weight loss drugs like Ozempic, Trump's tariff plan, and problems in the Trump cabinet. Richard Beck then joins, jumping right into his particular perspective for the war on terror as a teenager at the time of 9/11, unpacking the bipartisan normalization of the shift to a domestic surveillance state backing a globalized project of enforced American hegemony, and looking at how the Democratic Party (under Obama), in particular, worked to simultaneously present the Bush administration as an aberration, while bureaucratizing, rationalizing, and, ultimately, reinforcing the exact project that was supposedly so absurd. After briefly touching on the window Occupy provided to the Obama administration's blatant rejection of a progressive movement outside of the political establishment, Beck steps back, diving into the overwhelming media backlash to any sort of critical lens on US hegemony, with a direct line between the “owning the libs” politics of today and the Limbaughian obsession with making fun of the progressive identifiers of the nineties and aughts, alongside a direct tie-in to the bipartisan militarization of American society, be it tanks in police departments, an influx of Humvees on the street, or the catapulting of “SpecOps”-esque comic movies to the forefront of US culture, and how those elements worked to further legitimize the amoral (and often actively immoral) maintenance of US hegemony across the globe. Wrapping up, Richard, Sam, and Emma briefly touch on the particular role of oil in the War on Terror, and why it fails to actually explain the quest for American hegemony in an age of dwindling capitalist expansion, tackling the major role of the US plays well outside of petroleum reserves in an effort, more than anything else, to simply protect its impunity at the top of the global liberal order. And in the Fun Half: Sam and Emma touch on future coverage of the Longshoremen's strike, before diving into the continuing death and devastation coming from Texas' abortion ban, and reflecting on Tim Pool's desire to make every victim of rape a subject of public criticism if they want an abortion. They also tackle some backlash to Trump naming a pro-vaccination doctor to the position of Surgeon General, plus, you IMs! Follow Richard on Twitter: https://x.com/richard__beck Check out Richard's book here: https://www.penguinrandomhouse.com/books/677393/homeland-by-richard-beck/ Become a member at JoinTheMajorityReport.com: https://fans.fm/majority/join Follow us on TikTok here!: https://www.tiktok.com/@majorityreportfm Check us out on Twitch here!: https://www.twitch.tv/themajorityreport Find our Rumble stream here!: https://rumble.com/user/majorityreport Check out our alt YouTube channel here!: https://www.youtube.com/majorityreportlive Join Sam on the Nation Magazine Cruise! 7 days in December 2024!!: https://nationcruise.com/mr/ Check out StrikeAid here!; https://strikeaid.com/ Gift a Majority Report subscription here: https://fans.fm/majority/gift Subscribe to the ESVN YouTube channel here: https://www.youtube.com/esvnshow Subscribe to the AMQuickie newsletter here: https://am-quickie.ghost.io/ Join the Majority Report Discord! http://majoritydiscord.com/ Get all your MR merch at our store: https://shop.majorityreportradio.com/ Get the free Majority Report App!: http://majority.fm/app Go to https://JustCoffee.coop and use coupon code majority to get 20% off your purchase! Check out today's sponsors: Delete Me: Take control of your data and keep your private life private by signing up for DeleteMe. Now at a special discount for our listeners. Today get 20% off your DeleteMe plan by texting MAJORITY to 64000. Follow the Majority Report crew on Twitter: @SamSeder @EmmaVigeland @MattLech @BradKAlsop Check out Matt's show, Left Reckoning, on Youtube, and subscribe on Patreon! https://www.patreon.com/leftreckoning Check out Matt Binder's YouTube channel: https://www.youtube.com/mattbinder Subscribe to Brandon's show The Discourse on Patreon! https://www.patreon.com/ExpandTheDiscourse Check out Ava Raiza's music here! https://avaraiza.bandcamp.com/ The Majority Report with Sam Seder - https://majorityreportradio.com/

A.M. Edition for Nov. 26. Donald Trump vows to slap 25% tariffs on Mexican and Canadian imports from day one and an additional 10% tariff on Chinese imports, stirring currency markets. Plus, with the President-elect directly linking these new levies to the international narcotics trade, we ask WSJ correspondent Brian Spegele whether Trump's hardball tactics on China will work to ease the fentanyl crisis. And the White House proposes a big coverage expansion plan for Medicare and Medicaid to pay for popular weight-loss drugs. Luke Vargas hosts. Sign up for the WSJ's free What's News newsletter. Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of the Main Street Business Podcast, Mark J. Kohler and Mat Sorensen host an open forum, addressing your top tax and legal questions. They dive into why having an LLC is crucial for protecting your assets, how Medicaid clawbacks can impact your estate, and the benefits of elder law planning. Whether you're looking to safeguard your wealth or prepare for the future, this episode has essential insights.Here are some of the highlights:Mark & Mat Matt explain how Medicaid can go after significant assets if the parents have them, but the home is typically exempt.Mat warns about potential estate planning issues if the parents sell the house to their children for less than market value.Mark and Mat advise against using a Lady Bird Deed alone and recommend setting up a trust instead for a more comprehensive estate plan.How you can either take mileage deductions or actual expenses, but an LLC provides better asset protection.LLC provides asset protection and can be converted to an S corporation if needed.Airdropped crypto is considered a disallowed contribution to the Roth IRA and should be moved to a personal wallet.Children under age 18 do not require a 1099 or W-2, and paying them as outside labor is best.Mat emphasizes the importance of understanding the tax rules for paying children and offers strategies for maximizing tax benefits. Grab my FREE Ultimate Tax Strategy Guide HERE! Are you ready to get certified in EVERY strategy I teach? Start your journey with a FREE 15-minute demo to explore the Main Street Tax Pro Certification. You don't want to miss this! Secure your tickets for the most significant tax & legal event of the year: Tax and Legal 360 Looking to connect with a rock star law firm? KKOS is only a click away! Check out our YOUTUBE Channel Here: https://www.youtube.com/markjkohler Craving more content? Check out my Instagram!

In our news wrap Tuesday, G7 foreign ministers renewed their "unwavering" support for Ukraine, at least six people have died in Pakistan during violent clashes between security forces and protesters who are seeking the release of former Prime Minister Imran Khan from prison and a new Biden administration proposal would cover the cost of popular weight-loss drugs through Medicare or Medicaid. PBS News is supported by - https://www.pbs.org/newshour/about/funders

Plus: Mexico is in a dilemma over a new BYD plant after Donald Trump's election win. And, the White House proposes a big expansion of obesity-drug coverage by Medicare and Medicaid. Kate Bullivant hosts. Sign up for WSJ's free What's News newsletter.   Learn more about your ad choices. Visit megaphone.fm/adchoices

Carl Quintanilla, Jim Cramer and David Faber explored President-elect Trump's threat to impose tariffs on Mexico and Canada and raise them on China. What's  at stake for certain sectors in this market? With Black Friday just days away, the anchors discussed earnings and holiday quarter guidance from the likes of Best Buy and Dick's Sporting Goods. Also in focus: Shares of Amgen tumble after a mid-stage trial for its experimental obesity drug misses analyst expectations, President Biden proposes requiring Medicare and Medicaid to cover weight-loss drugs, bitcoin extends post-record slide, California Gov. Newsom vs. Elon Musk, Nvidia's new AI sound model. Squawk on the Street Disclaimer

Employers have been saying for years that they can't absorb any more cost growth for health insurance; health plans feel like they've squeezed about as much juice as possible out of traditional cost mitigation levers. Both are looking for creative alternatives to curb rising health costs. Enter ICHRAs. Usually, when we talk about the health insurance landscape, we focus on Medicare, Medicaid, or employer-sponsored insurance. But roughly 21 million people in the US are covered by individual marketplace plans, and in 2020, a new type of plan hit the individual market, moving health insurance from a “defined benefit” to a “defined contribution” in an effort to curb employer health costs. In this episode, host Abby Burns invites Advisory Board health plan expert Morghen Philippi to shed light on what Individual Coverage Health Reimbursement Arrangements, or ICHRAs, actually are, how employers, plans, and providers are responding to their rise, and what leaders need to keep an eye on when it comes to these plans. Note: This episode was recorded prior to the 2024 elections. Given the results, it is unlikely that the enhanced subsidies referenced in this episode will be renewed, which will affect the health of the individual marketplace. If enhanced subsidies expire at the end of 2025, you can expect it to have a direct impact on the individual market and on ICHRA viability, specifically. That said, because of the first Trump administration's role in establishing the ICHRA model, the incoming administration may work to support ICHRA growth. Links: Is the cost of employer-sponsored insurance at a tipping point? Market outlook for individual and small group health insurance Ep. 176: Test, fail, and test again: Morgan Health's approach to employer costs Enhanced subsidies propelled ACA marketplace enrollment. What's next? What health system growth will look like in 2025 Get exclusive, early access to Advisory Board's annual “What CEOs need to know” briefing. A transcript of this episode as well as more information and resources can be found on www.advisory.com/RadioAdvisory.