HIT Consultant

FEBRUARY 13, 2023

Tom Wriggins, Principal Industry Advisor at SAS John Maynard, CPA, CFE, AHFI Principal Solutions Architect at SAS In 2022, the Center for Medicare and Medicaid Services (CMS) established health equity as a pillar of its future work. Health outcomes and Medicaid program integrity Health outcomes are a function of the quality of care.

Fraud 52

Fraud Medicaid Medicaid Medicare 52

Healthcare It News

JANUARY 18, 2022

Social determinants of health are major contributors to health inequity and rising healthcare costs in vulnerable populations such as Medicaid beneficiaries. How do care management interventions to mitigate SDOH as a risk for undesired health outcomes work?

Medicaid 347

Medicaid Medicaid Patient Satisfaction Health Outcomes 347

HIT Consultant

OCTOBER 11, 2024

Neena Patel, MHA, CSM, VP of Client Success at Chordline As population health initiatives for Medicare and Medicaid members pick up steam, one of the biggest obstacles to care transformation remains a lack of trust among healthcare’s key stakeholders. That’s a risk that organizations can’t afford to take.

Medicare 98

Medicare Medicare Health Outcomes Medicaid 98

HIT Consultant

MARCH 9, 2023

Rajesh Sharma, Vice President and General Manager of Systems Integration, Data Analytics and Interoperability Product Offerings, Gainwell Technologies The Centers for Medicare and Medicaid Services (CMS) has laid the critical groundwork to create a connected healthcare system in which patients, providers, and payers can easily exchange information.

Health Outcomes 94

Health Outcomes Governance Compliance Medicaid 94

HIT Consultant

SEPTEMBER 12, 2022

– Using Gainwell’s advanced research platform and de-identified Medicaid claims data from select clients, Stanford concluded that 30 percent of patients prescribed opioids for the first time developed a dependency. Stanford used 180,000 de-identified Medicaid claims from six states.

Medicaid 97

Medicaid Medicaid Health Outcomes Governance 97

HIT Consultant

AUGUST 12, 2024

Austin-based Cartmell has 25 yearsof experience in healthcare as a Chief Operating Officer, Chief Revenue Officer, board member and VC investor, as well as an advisor to Morgan Stanley, UnitedHealthcare, the University of Texas at Austin Dell Medical School and the British Government.

Pharmaceutical Industry 52

Pharmaceutical Industry Medicaid Medicaid Health Outcomes 52

HIT Consultant

NOVEMBER 7, 2024

Often, their health needs are complex, influenced by significant trauma, and exacerbated by the systemic barriers they encounter. Despite these challenges, there is an immense opportunity for the healthcare system, particularly Medicaid, to play a transformative role in addressing health equity for this population.

Medicaid 52

Medicaid Medicaid Health Outcomes State Policy 52

Healthcare IT Today

APRIL 5, 2024

The acquisition advances Healthy Together’s mission to improve collective health and make government and enterprises more efficient. This acquisition reinforces Healthy Together’s commitment to driving positive change in public health outcomes.

Public Health 91

Public Health Medicaid Medicaid Governance 91

Healthcare IT News - Telehealth

SEPTEMBER 9, 2024

Meanwhile, the American Telemedicine Association is pleading with the Centers for Medicare and Medicaid Services for expanded flexibilities and further guidance on payment and coverage. The government must take the lead. One recent study reported on telehealth trends in U.S. Industry experts also see the need for clarity.

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Telemedicine Licensing Health Outcomes Governance 151

Jane Sarashon

NOVEMBER 7, 2024

With my ongoing focus on social determinants and drivers of health for health equity and access, the first essay that caught my attention is on Government Obligations and the Negative Right to a Healthy Urban Environment. I’ll focus this post on one of the pieces that resonate with what I’m working on these days.

Bioethics 52

Bioethics Public Health Governance Medicaid 52

MRO Compliance

AUGUST 8, 2024

However, it gained significant traction in the early 2000s and continues to evolve with ongoing efforts to refine payment models, improve care coordination, enhance patient outcomes, and manage cost efficiency. In addition to cost-savings, payers are increasingly adopting population-specific health plans to better address health equity.

Patient Satisfaction 147

Patient Satisfaction Medicare Medicare Medicaid 147

HIT Consultant

JUNE 7, 2023

In 2016, the Golden State began its Whole-Person Care (WPC) pilots at the county level integrating physical health, behavioral health, and social services for complex needs Medicaid enrollees. The reentry population faces complex barriers to healthcare and behavioral health help. And they were a great success!

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Healthcare It News

FEBRUARY 28, 2023

The payer mix of health insurance is typical, with 35% of patients representing government insurance such as Medicare or Medicaid, 60% commercial insurance, and 6% self-pay patients. Virtual-first primary care has been shown to improve health outcomes by increasing access, he reported.

Electronic Medical Records 250

Electronic Medical Records Telemedicine Health Insurance Health Outcomes 250

MedTrainer

NOVEMBER 30, 2023

Like other regions in the United States, Wisconsin is characterized by its unique blend of rules and mandates that govern healthcare compliance within the state. Medicaid Telehealth Services For healthcare providers and compliance professionals in Wisconsin, the Medicaid Telehealth Expansion is an important policy to consider.

Compliance 52

Compliance Medicaid Medicaid Licensing 52

Healthcare IT Today

NOVEMBER 8, 2024

We reached out to our brilliant Healthcare IT Today Community with the question – how is the integration of digital health tools, telemedicine, and mobile health applications contributing to the enhancement of population health management, and what challenges exist in ensuring equitable access to these technologies across diverse communities?

Telemedicine 136

Telemedicine Health Outcomes COVID-19 Governance 136

AIHC

OCTOBER 20, 2023

Value in healthcare is the measured improvement in a person’s health outcomes for the cost of achieving that improvement1. The government is reforming healthcare into a new health ecosystem. When done “right,” value-based healthcare’s focus for better health outcomes aligns clinicians with their patients.

Health Outcomes 59

Health Outcomes Medicare Medicare Governance 59

Healthcare IT Today

MAY 10, 2023

In healthcare, that means understanding the unique challenges for each patient based on their social determinants of health and using technology to fill gaps that traditional healthcare models might have overlooked. We believe the critical avenue to mental health equity is ensuring access to timely and high quality care through Medicaid.

Health Outcomes 124

Health Outcomes Medicaid Medicaid Nurses 124

HIT Consultant

MAY 3, 2022

Anne Davis, VP of Government Markets & Strategy at Wellth. Social drivers of health, which impact a disproportionate number of non-white Americans who live below the poverty line, account for as much as 90% of individuals’ health outcomes. These are just two examples of data that highlight the need for equity.

Medicaid 52

Medicaid Medicaid Governance Health Outcomes 52

MedTrainer

DECEMBER 7, 2023

The Medical Assistance Division (MAD) within the New Mexico Human Services Department (HSD) administers the state’s Medicaid program, providing essential healthcare services and financial assistance to eligible low-income residents and families in New Mexico.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

Healthcare IT Today

MARCH 24, 2023

Prioritizing data that has been purpose-built and clinically validated ensures that we’re tracking data that truly predicts and impacts health outcomes, not just correlation. Cancer researchers are investigating the impacts of cancer on long-term health outcomes, financial strain, and household impact.

Health Outcomes 111

Health Outcomes Public Health Medicaid Medicaid 111

MedTrainer

NOVEMBER 27, 2023

The Division of Health Benefits administers the state’s Medicaid program, which provides essential healthcare coverage to eligible individuals and families. Under this law, it is mandated that no individual or entity can start or offer a new institutional health service unless they have secured a certificate of need (CON).

Compliance 52

Compliance Licensing Telemedicine Medicaid 52

MedTrainer

NOVEMBER 27, 2023

Ohio Healthcare Compliance Resources Let’s start with the important state government agencies you’ll need to work with: The Ohio Department of Health (ODH) is key to safeguarding and enhancing the health of Ohio residents. The license is valid for three years unless revoked.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

DECEMBER 4, 2023

Kentucky Healthcare Compliance Resources Let’s start with the important state government agencies you’ll need to work with: The Kentucky Department for Public Health (DPH) plays a vital role in promoting and protecting the health and wellness of the citizens of Kentucky through various programs, initiatives, and health services.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

AIHC

SEPTEMBER 30, 2024

Value-based care (VBC) is a healthcare delivery model where healthcare providers are paid based on patient health outcomes instead of based on the volume of patients seen and services delivered. This was originally mandated by the Centers for Medicare & Medicaid Services (CMS) back in 1997 and implemented in 2004.

Overpayments 52

Overpayments Overpayment Compliance Medicare 52

MedTrainer

NOVEMBER 27, 2023

Georgia Healthcare Compliance Resources Let’s start with the important state government agencies you’ll need to work with: The Georgia Department of Public Health (DPH) plays a crucial role in safeguarding the health and well-being of Georgians.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

DECEMBER 4, 2023

The Nebraska Hospital Association (NHA) represents and advocates for Nebraska’s hospitals and health systems, working to improve healthcare delivery and patient care across the state. Regulations Unique to Nebraska To meet the standards of healthcare compliance in Nebraska , there are a few additional regulations.

Compliance 52

Compliance Licensing Nursing Homes Nurses 52

MedTrainer

DECEMBER 4, 2023

Regulations in the district encompass diverse healthcare areas, including patient privacy and data security, Medicaid and Medicare compliance, health insurance marketplaces, and scope of practice for healthcare professionals.

Compliance 52

Compliance Health Insurance Medicaid Medicaid 52

MedTrainer

DECEMBER 4, 2023

Additionally, the state’s approach to Medicaid expansion involves unique waivers, impacting eligibility criteria and cost-sharing provisions. To maintain compliance with North Dakota healthcare regulations, healthcare organizations should proactively address compliance and stay informed about changes.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

DECEMBER 7, 2023

State-specific governing bodies, such as the West Virginia Department of Health and Human Resources (DHHR) and the Bureau for Medical Services (BMS) , oversee and enforce these regulations. Medicaid telehealth requires real-time, two-way communication with audio and video equipment.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

DECEMBER 7, 2023

For example, the Office of Health Care Assurance (OHCA) is one governing body that healthcare professionals need to understand in order to manage organizational licensure and healthcare compliance in Hawaii effectively. Robust, flexible, and reliable compliance programs must be developed to maintain compliance in Hawaii.

Compliance 52

Compliance Compliance Officers Licensing Medicaid 52

MedTrainer

DECEMBER 7, 2023

State-specific governing bodies, such as the Bureau of Facility Standards , provide oversight with certain standards, adding a layer of complexity to successfully managing healthcare compliance in Idaho. Similar to other states, Idaho has its own unique regulations and requirements that healthcare providers and organizations must adhere to.

Compliance 52

Compliance Licensing Compliance Officers Informed Consent 52

MedTrainer

NOVEMBER 29, 2023

The South Carolina Hospital Association (SCHA) is a private, non-profit organization dedicated to supporting and advocating for hospitals and health systems in South Carolina, aiming to improve healthcare quality and access across the state. Read on for vital information about maintaining healthcare compliance in South Carolina.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

NOVEMBER 28, 2023

The Arizona Health Care Cost Containment System (AHCCCS) is Arizona’s Medicaid agency, providing health care programs to serve Arizona residents through managed care, cost containment, and services aimed at improving the health of those it covers.

Compliance 52

Compliance Licensing Public Health Medicaid 52

Innovaare Compliance

MARCH 24, 2024

According to the National Health Care Anti-Fraud Association, the financial losses due to healthcare fraud are estimated to be in the billions of dollars annually. The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 billion in healthcare fraud judgments and settlements.

Fraud 52

Fraud Health Insurance Medicaid Medicaid 52

MedTrainer

NOVEMBER 29, 2023

Louisiana Healthcare Compliance Resources Let’s start with the important state government agencies you’ll need to work with: The Louisiana Department of Health (LDH) is the state agency responsible for public health initiatives, healthcare policy, and overseeing medical services and facilities throughout Louisiana.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

NOVEMBER 28, 2023

New Jersey Healthcare Compliance Resources Let’s start with the important state government agencies you’ll need to work with: The New Jersey Department of Health (NJDOH) oversees various departments and initiatives aimed at ensuring public health, such as disease control, environmental health, emergency preparedness, and health equity.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). Enrollee Participation in Plan Governance (§ 422.107).

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Medicare Medicare COVID-19 Medicaid 98