POPULARITY
2 episodes with Medicaid managed care
3 episodes with Medicaid managed care
2 episodes with Medicaid managed care
2 episodes with Medicaid managed care
2 episodes with Medicaid managed care
4 episodes with Medicaid managed care
2 episodes with Medicaid managed care
2 episodes with Medicaid managed care
OU Students rally against the war in Gaza.Lawmakers hope to wrap up budget talks soon.A look at Oklahoma's new managed care for Medicaid patients.You can find the KOSU Daily wherever you get your podcasts, you can also subscribe, rate us and leave a comment.You can keep up to date on all the latest news throughout the day at KOSU.org and make sure to follow us on Facebook, Twitter and Instagram at KOSU Radio.This is The KOSU Daily, Oklahoma news, every weekday.
In this week's HLbytes Roundup, host Jeff Wurzburg discusses the byte on the “CMS Issues Final Medicaid Managed Care Rule” submitted by Ellie Cochran. For more on these story and others like it, go to ambar.org/hlsnews and check your inbox every Friday for the next edition of HLbytes.
In today's episode, we're excited to introduce our guest, Dr. Minal Giri. Dr. Giri is a distinguished general pediatrician and the former medical director and owner of Melrose Park Pediatrics. This multilingual practice catered to children from immigrant families in a medically underserved community. After finishing her residency training, Dr. Giri teamed up with her father, Dr. Kundan Giri, a pediatrician who has been serving the area since 1982. They worked together for 15 years until the practice had to close its doors in 2020, amidst the height of the pandemic. Now, Dr. Giri is associated with PediaTrust, a group of practices serving the northern, northwestern, and western suburbs of Chicago.Dr. Giri is not just a practicing pediatrician, but also a highly respected leader in the medical community. She is the founder and chair of the Illinois Chapter of the American Academy of Refugee Immigrant Child Health Initiative. Additionally, she is the co-chair of the Midwest Human Rights Consortium, an organization that conducts forensic evaluations to aid asylum seekers in their immigration proceedings.Nationally recognized for her contributions to immigration and asylum medicine, Dr. Giri serves on the executive committee of the National American Academy of Pediatrics Council on Immigrant Child and Family Health. Join us as we delve into her journey and discuss her valuable work in these critical areas.00:00 Welcome Back from Sunny Miami: A Snowy D.C. Morning00:09 Introducing Dr. Minal Giri and the Challenges of Medicaid in Private Practice01:01 Dr. Giri's Journey: From Childhood Illness to Pediatrician01:37 A Family Legacy in Medicine: Practicing with Dad04:12 The Shift to Medicaid and Serving an Underserved Community04:58 The Struggles with Medicaid Managed Care and Regulation06:57 The Impact of Technology and Regulation on Small Practices08:49 Reflecting on the Closure of a Community-Centric Practice15:18 Navigating the Complexities of Healthcare Payment Systems24:52 Creative Solutions and the Importance of Patient Communication27:34 Addressing Mental Health: Beyond the Scope of Primary Care29:36 Navigating Mental Health Stigma in Pediatric Care30:28 The Impact of COVID-19 on Medical Practices30:50 Struggles with Healthcare Systems and Diversity Initiatives32:37 The Decline of Pediatric Care and Its Consequences44:28 Challenges and Discrimination Faced by Foreign Medical Graduates51:55 Rethinking Medical Education and Community Support55:33 Reflecting on the Future of Healthcare and Closing ThoughtsSupport the show
In this enlightening episode of IDD Health Matters, host Dr. Craig Escude welcomes David Ervin, a seasoned expert in the field of supports and services for individuals with intellectual and developmental disabilities (IDD). With a career sparked by a pragmatic need that turned into a lifelong passion, Ervin shares his journey from a direct support professional to becoming the CEO of a community-based organization in Rockville, Maryland, named Mome. This episode delves into the critical importance of health equity, wellness, and the development of health care systems tailored to the unique needs of the IDD community. David Ervin discusses the challenges and triumphs of creating multidisciplinary clinics and healthcare collaboratives aimed at providing culturally competent and accessible care to individuals with IDD. He emphasizes the transformative impact of such specialized care on the quality of life and health outcomes for this population. The conversation also explores the potential of Medicaid Managed Care models to revolutionize care by integrating acute medical services, long-term supports, and a holistic approach to wellness. Listeners will be inspired by Ervin's vision for a future where health care systems are inclusive, equitable, and capable of meeting the diverse needs of all individuals, especially those with IDD. This episode is a must-listen for anyone interested in health equity, the power of community-based solutions, and the ongoing efforts to ensure that individuals with IDD can access the high-quality care they deserve. Tune in to IDD Health Matters for a deep dive into how health, wellness, and equity intersect in the lives of people with intellectual and developmental disabilities, featuring insights from one of the field's most passionate advocates, David Ervin.
In this enlightening episode of IDD Health Matters, host Dr. Craig Escude welcomes David Ervin, a seasoned expert in the field of supports and services for individuals with intellectual and developmental disabilities (IDD). With a career sparked by a pragmatic need that turned into a lifelong passion, Ervin shares his journey from a direct support professional to becoming the CEO of a community-based organization in Rockville, Maryland, named Mome. This episode delves into the critical importance of health equity, wellness, and the development of health care systems tailored to the unique needs of the IDD community. David Ervin discusses the challenges and triumphs of creating multidisciplinary clinics and healthcare collaboratives aimed at providing culturally competent and accessible care to individuals with IDD. He emphasizes the transformative impact of such specialized care on the quality of life and health outcomes for this population. The conversation also explores the potential of Medicaid Managed Care models to revolutionize care by integrating acute medical services, long-term supports, and a holistic approach to wellness. Listeners will be inspired by Ervin's vision for a future where health care systems are inclusive, equitable, and capable of meeting the diverse needs of all individuals, especially those with IDD. This episode is a must-listen for anyone interested in health equity, the power of community-based solutions, and the ongoing efforts to ensure that individuals with IDD can access the high-quality care they deserve. Tune in to IDD Health Matters for a deep dive into how health, wellness, and equity intersect in the lives of people with intellectual and developmental disabilities, featuring insights from one of the field's most passionate advocates, David Ervin.
Based on AHLA's annual Health Law Connections article, this special series brings together thought leaders from across the health law field to discuss the top ten issues of 2024. In the eighth episode, Martie Ross, Consulting Principal, PYA, speaks with Caroline Brown, Partner, Brown & Peisch PLLC, about current proposals that are on the table for Medicaid that may come to fruition in 2024. They discuss how the regulatory process works between CMS and the states and the proposed rules related to quality rating systems, payment adequacy and access, medical loss ratio, network adequacy requirements, and prior authorization. Sponsored by PYA.Watch the conversation here.To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
Today we talk with healthcare consultant, Tim Gallagher, who works with clients that serve the uninsured and underinsured. He counsels in navigating emerging models of care, leveraging better system solutions, tying into public sector funding, and forming value-based partnerships. Tim's work in the NC Medicaid Managed Care Transformation efforts have placed him at the forefront of navigating a new care model in this state. Tim Gallagher, welcome to the Move to Value podcast.Thanks, Thomas. Glad to be here.So, Tim, it, it seems like you've got a varied background. You've done a lot of really cool stuff. So can you tell me a little bit about that background in healthcare and how you became involved in Medicaid?Sure. After college, I actually started helping some local physicians figure out how to build their claims electronically. There was a CPA who had a practice full of physicians and there were requirements for billing the federal programs like Medicare. Physicians were actually required to start submitting their claims online before everything had been paper. So that was like 30 years ago, now as it turns out, and I made a career out of that healthcare revenue cycle, all of my strategy work has involved how we pay for things and sometimes it was more public sector focused like Medicaid or Medicare or Veterans health and sometimes it was commercial and private pay.So can you tell us the story of the Medicaid transformation efforts in North Carolina?Sure. I became exposed probably a 10 years ago as I was volunteering in the free clinics in and around the Winston Salem area and they were concerned about how the impact of Medicaid expansion might have on their operations. Much like the Affordable Care Act in 2010 diminished the need for uninsured to seek access in free clinics, they thought Medicaid expansion would also diminish their demand.And so, from that perspective, I watched the state roll out a whole bunch of things. At the same time, my family was actually transitioning our daughter who has IDD intellectual and developmental disabilities and we were transitioning her out of, you know, school based supports into whatever was next. Alex qualifies for various benefits under Medicaid after she turned 18. And so we were unpacking how best to translate her benefits into actual services. You could say we're a card-carrying family on North Carolina Medicaid.Outstanding. So, you get that first-hand experience, that's I bet that was that's very helpful when it came to really learning the pain points of what was involved with Medicaid. What opportunities are there for managed Medicaid to accelerate value-based care?Yeah, the opportunities are really just beginning. There was a white paper that the state put out probably back in January of 2020 and they articulated what they thought was a glide path for getting more provider arrangements into what they call alternative payment models. And the first year they knew it was just going to be a baseline for value based contracting and the state then encouraged people to move providers mainly to move towards quality and value via care coordination payments and pay for reporting.And we're just now getting into the fun part of like pay for performance and arrangements that allow meaningful differences in compensation in terms of higher quality provider groups. If you recall, only about 1.6 of the 2.2 million eligible for Medicaid transitioned in to managed Medicaid initially and Medicaid expansion and tailored plans this summer, the number has you know continued to increase. So Medicaid not only is rolling out value based, but more people are moving into the system. I would say today there's about two million within the standard plans out of a 2.9 million who are the total population receiving Medicaid benefits.What do you see
Government Accountability Office (GAO) Podcast: Watchdog Report
Medicaid is the government's program that helps low income, medically needy, populations receive health care services. Within Medicaid, managed care allows beneficiaries to receive these services from a network of approved providers. Spending…
Join host Jeff Wurzburg and Felicia Sze (Athene Law) as they discuss the Medicaid program, the history of Medicaid managed care, how the program is funded, and current hot topics. This episode was recorded in January 2023.
Investing in housing for Medicaid enrollees is one of the ways Dr. Bradley Gilbert has pioneered Whole Person Health in California. He's an original population health thinker, from his start as a county public health officer to decades of service as CEO of one of the nation's largest Medicaid managed care plans and his most recent role as Director of Health Care Services in California. Dr. Gilbert chats with Claudia about lessons learned along the way and why we need to focus on what's good for people, not just saving money. Relevant LinksEvaluation of IEHPs housing investmentOverview of CalAIMRecent CMS guidance for states offering social supports through Medicaid managed careAbout Our GuestDr. Bradley Gilbert, MD, MPP was Director of California's Department of Health Care Services in 2020 and helped lead the state through its first response to the COVID-19 pandemic and initial implementation of CalAIM. Before that Dr. Gilbert headed the Inland Empire Health Plan, one of the largest Medicaid Managed Care plans in the nation. IEHP serves more than a million Members in Riverside and San Bernardino Counties in California. Previously Dr. Gilbert was the Public Health Officer for San Mateo and Riverside Counties. While he was CEO at IEHP Brad was board chair of the organization Claudia led, Manifest MedExConnect With UsFor more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email claudia@theother80.com and follow us on twitter @claudiawilliams or on LinkedIn.
Jennifer Sprague, LTSS Manager at Molina HealthCare of Illinois, talks to Samantha about the importance of value-based care and care coordination.
As Ohio prepares to offer a new Medicaid Managed Care program, a new player in Ohio seeks to partner with community health centers providing medical care to underserved communities. Loren Anthes, the new head of policy and programs for New York-based Yuvo Health, joined The Landscape to talk about how the company assists with administrative and contracting services to allow the centers to focus their attention on providing value-based health care. This episode of the Landscape is sponsored by Delta Dental of Ohio. With offices in Cleveland, Cincinnati and Dublin, Delta Dental of Ohio is proud to be an industry leader in dental benefits. Together with their customers, providers and employees, Delta Dental of Ohio builds a higher standard of oral health care in Ohio communities. Delta Dental of Ohio also works with entrepreneurs, innovators and change-makers who are committed to improving the health and wellbeing of all Buckeyes. Together, they are building healthy, smart, vibrant communities for all. For more information, visit deltadentaloh.com.
Katie Capelli, an Epidemiologist in the Office of Health Crisis Response at the Delaware Division of Public Health, discusses a new public service campaign to promote a positive, drug free, lifestyle to youth across the state; Dr. Umair Shah, Secretary of Health for the Washington State Department of Health, attends an event with Vice President Kamala Harris, U.S. Senator Patty Murray, and Governor Jay Inslee where green energy buses for several school districts in the state were announced; agencies looking to reflect the social determinants in upcoming Medicaid Managed Care contracts can check out a new ASTHO resource now online; and stay in the know with ASTHO's Public Health Weekly email newsletter. Delaware.gov Webpage: DPH Announces #MyReasonWhyDE Youth Campaign ASTHO Webpage: Impacting Social Determinants of Health Through Managed Care Contracts ASTHO Webpage: Be in the Know
Letting private insurers offer Medicaid coverage was supposed to lower costs and improve care. We dig into the research on Medicaid managed care.Guests:Sayeh Nikpay, PhD, Tradeoffs Contributing Research Editor; Associate Professor of Health Policy and Management, University of MinnesotaKathleen Adams, PhD, Professor of Health Policy and Management, Rollins School of Public Health at Emory UniversityAllan Baumgarten, JD, Independent Health Policy AnalystRead more of the research on Medicaid managed care and find a full transcript on our website: https://tradeoffs.org/2021/11/04/medicaid-managed-care/Sign up for our weekly newsletter to see what research health policy experts are reading right now, plus recommendations from our staff: bit.ly/tradeoffsnewsletterSupport this type of journalism today, with a gift. If you give before Dec. 31, 2021, your donation will be doubled thanks to a match from the Institute for Nonprofit News: https://tradeoffs.org/donateFollow us on Twitter: https://twitter.com/tradeoffspod Our GDPR privacy policy was updated on August 8, 2022. Visit acast.com/privacy for more information.
Listen to Achilles Natsis, FSA, MAAA, FLMI, SOA Research Institute Health Research Actuary and Grant Porter, PhD, Senior Consultant at Faulkner Consulting Group discuss the Medicaid Managed Care Underwriting Margin Model with host, R. Dale Hall, FSA, CERA, MAAA, CFA, Managing Director of the Society of Actuaries Research Institute. We welcome your questions or comments at researchinsights@soa.org.
Letting private insurers offer Medicaid coverage was supposed to lower costs and improve care. We dig into the research on Medicaid managed care. Guests: Sayeh Nikpay, PhD, Tradeoffs Contributing Research Editor; Associate Professor of Health Policy and Management, University of Minnesota Kathleen Adams, PhD, Professor of Health Policy and Management, Rollins School of Public Health at Emory University Allan Baumgarten, JD, Independent Health Policy Analyst Read more of the research on Medicaid managed care and find a full transcript on our website: https://tradeoffs.org/2021/11/04/medicaid-managed-care/ Sign up for our weekly newsletter to see what research health policy experts are reading right now, plus recommendations from our staff: bit.ly/tradeoffsnewsletter Support this type of journalism today, with a gift. If you give before Dec. 31, 2021, your donation will be doubled thanks to a match from the Institute for Nonprofit News: https://tradeoffs.org/donate Follow us on Twitter: https://twitter.com/tradeoffspod See acast.com/privacy for privacy and opt-out information. -| The Health Equity Podcast Channel is made possible with support from Bayer G4A. Learn how Bayer G4A is advancing equity, access and sustainability at G4a.health -| This episode originally aired on November 4, 2021 on Tradeoffs. Listen, follow and subscribe here.
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
Letting private insurers offer Medicaid coverage was supposed to lower costs and improve care. We dig into the research on Medicaid managed care.Guests:Sayeh Nikpay, PhD, Tradeoffs Contributing Research Editor; Associate Professor of Health Policy and Management, University of MinnesotaKathleen Adams, PhD, Professor of Health Policy and Management, Rollins School of Public Health at Emory UniversityAllan Baumgarten, JD, Independent Health Policy AnalystRead more of the research on Medicaid managed care and find a full transcript on our website: https://tradeoffs.org/2021/11/04/medicaid-managed-care/ Sign up for our weekly newsletter to see what research health policy experts are reading right now, plus recommendations from our staff: bit.ly/tradeoffsnewsletterSupport this type of journalism today, with a gift. If you give before Dec. 31, 2021, your donation will be doubled thanks to a match from the Institute for Nonprofit News: https://tradeoffs.org/donateFollow us on Twitter: https://twitter.com/tradeoffspod See acast.com/privacy for privacy and opt-out information.
Jo Campbell is an experienced nurse with a demonstrated 10+ year history working in the mental health care industry serving both the adolescent and adult population. Skilled in Medication Administration, Medication Aide and CPR Trainer, Supervisory Management, Case Management, Substance Abuse Prevention, Team Leadership, and Interviewing. Strong professional focused in Licensed Practical/Vocational Nurse Training from Riverside School of Health Careers. She's currently a Care Coordinator for a Virginia Medicaid-managed Care Organization. Virginia Medicaid has low-cost and no-cost health coverage programs. There are programs for children, pregnant women and adults, including those with disabilities. For more information, visit https://coverva.dorg/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/tidewater-podcast/support
Chris Priest, Vice President of Medicaid Solutions for Centene, joined hosts Laura Evans and AHIP President Matt Eyles to discuss what the health insurance provider is doing to promote better communit
Chris Priest, Vice President of Medicaid Solutions for Centene, joined hosts Laura Evans and AHIP President Matt Eyles to discuss what the health insurance provider is doing to promote better community health and vaccine acceptance.
How has Medicaid Managed Care affected the availability of mental health services for low-income patients? Do corporate insurance industry practices, like medication preauthorization, complicate the treatment of mental health patients? Dr. Stephen Kemble, psychiatrist and past president of the Hawaii Medical Association, and host Brenda Gazzar discuss how Managed Care creates burdens for patients and psychiatrists alike and how new models, such as collaborative care, might help.
How has Medicaid Managed Care affected the availability of mental health services for low-income patients? Do corporate insurance industry practices, like medication preauthorization, complicate the treatment of mental health patients? Dr. Stephen Kemble, psychiatrist and past president of the Hawaii Medical Association, and host Brenda Gazzar discuss how Managed Care creates burdens for patients and psychiatrists alike and how new models, such as collaborative care, might help.
For Mental Health Awareness month, this week's pod looks at how Medicaid Managed Care affects the availability of mental health services for low-income patients. Do corporate insurance industry practices, like preauthorization, complicate the treatment of mental health patients? Dr. Stephen Kemble, psychiatrist and past president of the Hawaii Medical Association, and host Brenda Gazzar discuss how Managed Care burdens patients and psychiatrists alike and how new models, such as collaborative care, might help.
With Medicaid enrollment and spending on the rise, the pressure is on states to use their Medicaid managed-care programs to control spending and improve outcomes. We talked about how on today's episode of the 4sight Friday Roundup podcast. Here the week's biggest news around market-based change. David Johnson is CEO of 4sight Health. Julie Vaughan Murchinson is Partner of Transformation Capital and former CEO of Health Evolution. David Burda is News Editor and Columnist of 4sight Health. Subscribe on iTunes, Spotify, other services. Click play to listen to the 5/14/2021 Episode.
Innovating Medicaid Managed Care This week host David Burda with his panel, Julie Murchinson and David Johnson discuss how with Medicaid enrollment and spending on the rise, the pressure is on states to use their Medicaid managed-care programs to control spending and improve outcomes. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/
Sarah DeSilvey, DNP, FNP-C, social determinants of health clinical informatics director of the Gravity Project and faculty at the University of Vermont Larner College of Medicine speaks with Michael Bailit, MBA, founder of Bailit Health, a consulting firm dedicated to ensuring insurer and provider performance accountability. This conversation is the fourth in a series focused on health care sector efforts to increase Awareness about both patient and community-level social conditions. Sarah and Michael share design considerations from state Medicaid agencies weighing the use of quality measures for social risk screening.Recommended references: Bailit Health. Developing a Social Risk Factor Screening Measure. 2020. Bailit Health. Social Risk Factor Screening in Medicaid Managed Care. 2020. Alderwick H, Gottlieb LM. Meanings and misunderstandings: A social determinants of health lexicon for health care systems. Milbank Q. 2019. The Gravity Project Gottlieb L, DeSilvey SC. New Clinical Coding Guidelines Account for Patients' Social Risk: We Should Do More to Ensure They Advance Health Care Quality and Equity. Health Affairs Blog. 2020.
In the February 2021 episode of NCFM Today, learn about the role of the Advanced Medical Home as North Carolina transitions its Medicaid Program to Managed Care. Carol Stanley, Medicaid Transformation Manager for the NC AHEC Practice Support Team, and Nicole Cannady, Practice Support Coordinator and Quality Improvement Coach for the Southeastern AHEC in Wilmington, discuss tools that NC AHEC has available to help primary care practices achieve Advanced Medical Home (AMH) Status, the differences between a Tier 2 and a Tier 3 AMH, and what family medicine and other primary care practices should be doing now to prepare for Medicaid Managed Care in North Carolina. The two also discuss significant financial incentives for practices who are achieve AMH Tier-3 status early, and how those incentives can impact your practice. Any primary care practice currently taking Medicaid should listen to this important update.
In this episode of Inside Health Care, Dr. Douglas Jacobs, Chief Innovation Officer of Pennsylvania’s Department of Human Services, chats with Eric Musser, NCQA Deputy Director of State Affairs about his background, how Pennsylvania responded to COVID-19 and built equity inside the department in response to America’s racial reckoning in 2020. Dr. Jacobs also talks […]
Question to John Hood and Chris Fitzsimon – Medicaid managed care was supposed to begin this year but COVID-19 has delayed its implementation to the point some say it will be January of 2021 at the earliest before it could happen. But there are now voices saying maybe we shouldn’t even embark on the reform, that other states haven’t had the desired savings and perhaps a better model might be the Community Care North Carolina approach to Medicaid. What are your current feelings about Medicaid Managed Care?
THE EMBC NETWORK featuring: ihealthradio and worldwide podcasts
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
THE EMBC NETWORK featuring: ihealthradio and worldwide podcasts
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
Suzanne Paolucci is a Licensed Clinical Social Worker who has dedicated her career spanning three decades to the field of geriatrics and life care planning. Suzanne's Advocacy Company, NY Care Consultants, LLC is a sought after company with professionals and patients due to her proven record of ensuring that her clients receive the best care possible and obtaining, when required, 24-hour live-in personal, or skilled care services through Medicaid Managed Care and Long-Term Care Insurance. In the past two ye
Every summer, Mathematica welcomes a handful of doctoral students to spend 12 weeks at one of our nine office locations, working on an independent research project that intersects with one or more of Mathematica's focus areas. On this episode of On the Evidence, we feature six short interviews with the 2019 summer fellows about the research questions they pursued and what they have learned so far. In most cases, the fellows are joined by a mentor from Mathematica. Find more information about Mathematica's summer fellowship program here: https://www.mathematica.org/career-opportunities/summer-fellowships What factors influence individuals' long-term care decisions? Guests: Selena Caldera, a doctoral student at the LBJ School of Public Affairs at the University of Texas at Austin, and Julia Baller, a senior researcher at Mathematica (1:45 - 11:32) If Medicaid is more generous in reimbursing for home and community based services, does it encourage more beneficiaries with disabilities to live in their homes, rather than in a nursing facility? Guests: Sijiu Wang, a doctoral student at Health Services Research and Policy program in the Department of Public Health Sciences at the University of Rochester, and Bob Schmitz, a senior fellow at Mathematica who retired at the end of 2019 (11:43 - 26:50) Did New York City's "fair student funding" reform lead to better outcomes for students with disabilities? Guests: Sana Fatima, a doctoral student in public policy at NYU Wagner Graduate School of Public Service, and Mariesa Herrmann, a senior researcher at Mathematica, (26:55 - 36:55) How does reducing the cost of participating in the Supplemental Nutrition Assistance Program affect takeup of the program and ultimately impact infant health? Guests: Leah Shiferaw, a doctoral student in economics at the University of California, Berkeley, and Nan Maxwell, a senior researcher at Mathematica who retired at the end of 2019 (36:59 - 46:21) How can policy improve the quality of care that children receive in early childhood education and care programs? Guest: Katie Gonzalez, a doctoral student at the Harvard Graduate School of Education (46:26 - 1:02:31) How does Medicaid Managed Care impact hospitalization rates among people who are enrolled in both Medicare and Medicaid? Guests: Rebecca Gorges, a doctoral student at the Harris School of Public Policy at the University of Chicago, and Andrea Wysocki, a senior researcher at Mathematica (1:02:36 - 1:17:44)
Listening In (With Permission): Conversations About Today's Pressing Health Care Topics
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.
In part two of a provider-centric conversation on value-based care, IAMHP ED Samantha Olds Frey and Genesis Orthopedics & Sports Medicine CEO Andrew Shadid discuss the growth of his organization, the need in the marketplace and what's on the horizon in the Illinois' Medicaid Managed Care space.
written post at https://healthy-skeptic.com/2019/08/05/medicaid-managed-care-plans/
On this edition of Inside Healthcare, catch up with our friend Tom Curtis, Senior Manager of Quality Improvement for the Michigan State Dept. of Health and Human Services. He sits on NCQA’s Public Sector Advisory Board. We wanted to get an inside look at the state that has grown it’s Medicaid Managed Care program under the expansion of the Affordable Care Act. It’s been about 5 years since the expansion in Michigan, and Tom sees first-hand how changes impact Medicaid beneficiaries. We also talk about population health and how states leverage HEDIS to address commonly noted disparities. Tim describes the disappointment of early results and describes the journey to improved performance. Learn more about HEDIS measures and the programs it supports to address health equity and disparities. It’s particularly important during this Minority Health Month! Listen now.
On this edition of Inside Healthcare, catch up with our friend Tom Curtis, Senior Manager of Quality Improvement for the Michigan State Dept. of Health and Human Services. He sits on NCQA’s Public Sector Advisory Board. We wanted to get an inside look at the state that has grown it’s Medicaid Managed Care program under […]
This week we’ll be discussing some of the groundbreaking transformations being developed by the North Carolina Department of Health & Human Services (DHHS) under the leadership of Dr. Mandy Cohen. The North Carolina DHHS is charged with the health and wellness of over 10 million people. This healthcare system, with an annual budget of $20 billion, is one of the largest state healthcare systems in the country. The NC Medicaid program within the DHHS directly serves nearly 2.3 million people - 1 out of every 5 people in North Carolina. It also serves approximately 1.2 million children in North Carolina.Our guest on this episode is Dr. Mandy Cohen, who was appointed to the role of Secretary of the North Carolina Department of Health & Human Services (DHHS) in January 2017 by Governor Roy Cooper. Before coming to NC, Dr. Cohen served as the Chief Operating Officer and Chief of Staff at the Centers for Medicare & Medicaid Services (CMS). She was responsible for implementing policies for Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and the Federal Health Insurance Marketplace. In February 2019 she was named one of the Top 25 Women Leaders in Healthcare. In this interview, we’ll talk with Dr. Cohen about:Why North Carolina is shifting its statewide Medicaid program to Managed Care.How she is reframing and redefining healthcare within the NC DHHS - from “buying healthcare” to “buying health” services - a progressive shift that is consistent with the direction the healthcare market is heading.The highly innovative initiatives being launched in the Medicaid Managed Care program, with a particular focus on the social determinants of health, and some illustrative examples of how this is leading to markedly improved health outcomes and lower costs of health.How DHHS is integrating mental health with physical health - and the advantages of that integration.North Carolina is one of the last of the large states to transition to Medicaid Managed Care. As a result, it’s also one of the most informed states making this transition. Dr. Cohen and her team have intentionally studied the successes of other state healthcare systems as well as the successes of healthcare systems within NC - attempting to build on those lessons. As you’ll hear in the interview, the overarching plan is to fundamentally shift from “buying healthcare” to “buying health” - that is to purchase services that cost-effectively advance health outcomes - whether those services be clinical care, behavioral care, or social and community care. Another facet of the plan is to deploy outcomes-based payment models instead of the current volume-based, fee-for-service payment.The systematic approach of the Medicaid Managed Care program will begin with the screening of individuals’ medical care needs as well as factors related to social determinants of health. The approach also includes rigorous testing of the numerous pilots & initiatives in order to determine which innovations work and which do not. It is a healthcare outcomes analyst’s dream, but more importantly, it’s what we need if we’re to advance the health and well being of North Carolina, as well as the country. The success of this immense and critically important effort will require a multi-stakeholder approach. To that end, the DHHS has been, over the past couple of years, actively engaging the expertise of numerous physicians and administrators from across the state - drawing from the sophisticated world-class hospital systems and academic medical centers that call North Carolina home, as well as the independent providers and community-based organizations serving both urban and rural communities. I applaud the legislature and political leaders of North Carolina for initiating this innovative transition to Medicaid Managed Care - for supporting it and funding it; as well as CMS for providing the waiver. As Dr. Cohen points out in this interview, health and well-being is not a partisan issue - it’s an issue that is fundamental to the overall health and well-being of our commonwealth and our nation.
The federal government has been releasing a number of policies and proposals that will affect care delivery and are aimed at rising costs of care and prescription drugs. Ted Okon, executive director of the Community Oncology Alliance (COA), sat down with Managed Care Cast to discuss a number of policies affecting COA’s members, including proposals around chimeric antigen receptor T-cell therapies, pharmacy benefit managers, and the Oncology Care Model. Read more about the stories in this podcast: CMS Proposes That Patients Be Enrolled in Studies to Get Coverage for CAR T-Cell Therapy: https://www.ajmc.com/newsroom/cms-proposes-that-patients-be-enrolled-in-studies-to-get-coverage-for-car-tcell-therapy Ted Okon on Policy Priorities for COA in 2019: https://www.ajmc.com/conferences/coapayersummit2018/ted-okon-on-policy-priorities-for-coa-in-2019 COA's OCM 2.0: Moving Toward a Universal Payment Model: https://www.ajmc.com/conferences/coapayersummit2018/coas-ocm-20-moving-toward-a-universal-payment-model More Than 300 Groups Seek Halt to CMS' Plans for Global Drug Pricing Index: https://www.ajmc.com/newsroom/more-than-300-groups-seek-halt-to-cms-plans-for-global-drug-pricing-index Trump Proposes Allowing Medicare to Base Drug Prices on What Other Countries Pay: https://www.ajmc.com/newsroom/trump-proposes-allowing-medicare-to-base-drug-prices-on-what-other-countries-pay HHS Proposes to End Drug Rebates in Medicare, Medicaid Managed Care: https://www.ajmc.com/newsroom/hhs-proposes-to-end-drug-rebates-in-medicare-medicaid-managed-care
Mandy Cohen, MD, MPH, North Carolina Sec. of the Department of Health and Human Services, joins BOH host Matthew Hanis for a live interview in front of 200 NC physician practice leaders. That same day, bids were due for the conversion of 1.6 million NC Medicaid beneficiaries to managed care. Previously, Cohen helped resuscitate the federal ACA insurance exchange platform healthcare.gov and helped innovate federal alternative payment models such as bundle payments and MSSP accountable care organizations.
Devon Kim and Megan Poindexter (Trinity In-Home Care Executive Director) take the discussion of the Pulitzer Price winning work of Andie Dominick to Kansas and talk about privatized Medicaid for Home and Community Based Services.
Devon Kim and Megan Poindexter (Trinity In-Home Care Executive Director) discuss the editorial Pulitzer Prize Winner's work on the negative impacts of privatizing Medicaid in the state of Iowa. Reporter Andie Dominick's work is discussed. The podcast discussion also centers around similar conditions in Kansas and other states that have chosen to privatize Medicaid.
On this week's TribCast, Emily talks to Ross, Emma and The Dallas Morning News' Dave McSwane about the separation of immigrant families on the Texas-Mexico border and McSwane's Pain and Profit series about misdeeds in the state's Medicaid managed ...
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.
The Johnson County Task Force on Aging hosts Shawn Zierke, the Vice Chair of the Task Force, to discuss Medicaid Managed Care Services and what the consumer should know. Click here for more information on the Johnson County Task Force on Aging.
Host Richard Yadon and MHPA Director of Government Affairs and Interim Executive DirectorJoe Moser discuss today's Medicaid Managed Care.We'll take a look at the key developments of the past 12 months and then an insightful look into the future.Some of the topics we'll cover include:Medicaid policy changesDual EligiblesHealth Insurance ExchangesMedicaid Expansion Learn more about MHPA at www.MHPA.org
Host Richard Yadon and MHPA Director of Government Affairs and Interim Executive DirectorJoe Moser discuss today's Medicaid Managed Care.We'll take a look at the key developments of the past 12 months and then an insightful look into the future.Some of the topics we'll cover include:Medicaid policy changesDual EligiblesHealth Insurance ExchangesMedicaid Expansion Learn more about MHPA at www.MHPA.org
Join Richard and his guest Dr. Dale Alverson, Medical Director, Center for Telehealth and Cybermedicine Research University of New Mexico, as they discuss the uses, challenges, and implications of Telehealth and Medicaid health care. Topics of the discussion include: What is really Telehealth? How would it apply to Medicaid? Where is it being used successfully in Medicaid now? What are the challenges? Where do we go from here? What impact does this have on Health Information Exchange?
Join Richard and his guest Dr. Dale Alverson, Medical Director, Center for Telehealth and Cybermedicine Research University of New Mexico, as they discuss the uses, challenges, and implications of Telehealth and Medicaid health care. Topics of the discussion include: What is really Telehealth? How would it apply to Medicaid? Where is it being used successfully in Medicaid now? What are the challenges? Where do we go from here? What impact does this have on Health Information Exchange?
Listen NowIt's estimated the Affordable Care Act will add another 16-17 million lives to the 60 million Americans already receiving Medicaid. Of these current 60 million Medicaid enrollees, two-thirds receive their health care via managed care companies and over half of Medicaid managed care enrollees are in for profit plans. Concerning the quality of care for profit plans deliver, a 2011 study published by the Commonwealth Fund found for profit Medicaid plans did significantly worse than non profit plans at ensuring members receive preventive care and managing members chronic disease. Also too, for profit plans had comparatively higer administration costs than non profit plans.Ms. Alker begins this 24-minute interview discussing reasons for ever-growing Medicaid managed care plan enrollment and the issue of access to, or provider participation in, Medicaid and in Medicaid managed care plans. She assesses the state of quality data collection and explains why data is generally lacking, spotty and/or not uniformly collected. She makes comment on for profit interest in expanding to cover additional Medicaid sub-populations, what relevant ACA reforms promise, the challenges and opportunities for reducing costs since the Medicaid program as already an efficient payer, findings from her recent study of a five-county managed care demonstration in Florida and lastly provides comment on the recent decision in Arkansas to use federal Medicaid subsidies to purchase insurance in 2014 via their state exchange for citizens otherwise eligible for Medicaid under the ACA's expanded coverage provision. Ms. Joan Alker is the Co-Executive Director at the Center for Children and Families (CCF) and for the past ten years a Research Associate Professor at the Georgetown University Health Policy Institute. Her work focuses on health coverage for low-income children and families, with an emphasis on Medicaid, the Children's Health Insurance Program (CHIP) and the Affordable Care Act (ACA). She has authored numerous reports and studies on a range of issues including Medicaid waivers, child and family coverage, premium assistance and is the principal investigator of a multi-year study on Florida's Medicaid program. Ms. Alker holds a Master of Philosophy in politics from St. Antony's College, Oxford University and a Bachelor of Arts with honors in political science from Bryn Mawr College. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com
Joining us for today's show is Leonard J. Kirschner M.D. M.P.H., Member, The National Advisory Board on Improving Healthcare Services for Seniors and People with Disabilities Now that the election is over and most states have declared their position on expansion, what happens now? Where are we winning in Medicaid and where are we losing? What are the 3 things Medicaid must get right? How do we capitalize on the momentum? Where does the private sector land in all of this? We'll try to answer these questions and more!
Joining us for today's show is Leonard J. Kirschner M.D. M.P.H., Member, The National Advisory Board on Improving Healthcare Services for Seniors and People with Disabilities Now that the election is over and most states have declared their position on expansion, what happens now? Where are we winning in Medicaid and where are we losing? What are the 3 things Medicaid must get right? How do we capitalize on the momentum? Where does the private sector land in all of this? We'll try to answer these questions and more!
Behavioral health is one of the hottest topics in Medicaid today. Join host Richard Yadon as he explores the developments, innovations, and challenges of this issue. Our guests include: Danis Russell, CEO, Genesee County Community Mental Health Sheila Putnam, Director Medicaid Care Management, Priority Health
Behavioral health is one of the hottest topics in Medicaid today. Join host Richard Yadon as he explores the developments, innovations, and challenges of this issue. Our guests include: Danis Russell, CEO, Genesee County Community Mental Health Sheila Putnam, Director Medicaid Care Management, Priority Health
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