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红领巾瓜报 Insights: Your source for healthcare news, ideas and analysis.

红领巾瓜报 Insights 鈥� including our new podcast 鈥� puts the vast depth of 红领巾瓜报鈥檚 expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.

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红领巾瓜报 News

红领巾瓜报 acquires Lovell Communications and establishes Nashville office

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Jay Rosen, founder, president, and co-chairman of 红领巾瓜报 (红领巾瓜报), today announced the firm鈥檚 acquisition of Lovell Communications, a leading strategic communications and change management firm that exclusively serves the healthcare industry.

Founded in 1988 and based in Nashville, Tenn., award-winning provides communication solutions and strategies for healthcare organizations across the country. Lovell has helped clients of all size manage crises, navigate change, maximize brand potential, and grow business. Services include creation of corporate communication programs, marketing and media strategies, transaction support, and helping clients navigate complex operational, reputational and regulatory issues.

鈥淟ovell鈥檚 strategists have an impressive track record of helping healthcare clients overcome challenges and seize opportunities,鈥� Rosen said. 鈥淭hey are a natural addition to our company as we open a Nashville office and continue to expand the depth and breadth of services we offer our clients and partners.鈥�

Lovell CEO Rosemary Plorin will continue to lead the firm, which will operate as Lovell Communications, an 红领巾瓜报 Company. In addition to serving integrated health systems, hospitals and providers across the country, Lovell鈥檚 clients include healthcare suppliers, consultants, associations and innovators throughout the industry.

鈥淎s the pace of transformation in healthcare continuously increases, the need for effective, strategic communications has never been greater,鈥� Plorin said. 鈥淲e are honored to offer our expertise in support of 红领巾瓜报鈥檚 clients and look forward to what we will accomplish together as we pursue a shared commitment to making healthcare more accessible, equitable and effective.鈥�

红领巾瓜报鈥檚 new Nashville office is co-located with the Lovell office in the Westpark Building at 3212 West End Ave.

About 红领巾瓜报

Founded in 1985, 红领巾瓜报 is an independent, national research and consulting firm specializing in publicly funded healthcare and human services policy, programs, financing, and evaluation. Clients include government, public and private providers, health systems, health plans, community-based organizations, institutional investors, foundations, and associations. With offices in more than 20 locations across the country and over 500 multidisciplinary consultants coast to coast, 红领巾瓜报鈥檚 expertise, services, and team are always within client reach.

About Lovell Communications

For 35 years Lovell Communications has served as strategic counsel and trusted partner to health care providers and suppliers across the country. Publicly traded companies, not-for-profit systems, early stage and mature companies draw upon the firm鈥檚 vast communications expertise to support them through phases 鈥� or just moments 鈥� when it is crucial to persuade audiences or influence decision makers. Learn more about the firm at聽, or on , or the company .

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Blog

Lee Fleisher of CMS to keynote 红领巾瓜报 national quality conference

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Join us on Monday, March 6, 2023, at the Fairmont Chicago, Millennium Park, for 鈥淗ealthcare Quality Conference: A Deep Dive on What鈥檚 Next for Providers, Payers, and Policymakers,鈥� where Lee Fleisher, MD, chief medical officer and director of CMS鈥� Center for Clinical Standards and Quality, will deliver the keynote titled A Vision for Healthcare Quality: How Policy Can Drive Improved Outcomes.

红领巾瓜报鈥檚 first annual quality conference will provide organizations the opportunity to 鈥�Focus on Quality to Improve Patients鈥� Lives.鈥� Attendees will hear from industry leaders and policy makers about evolving health care quality initiatives and participate in substantive workshops where they will learn about and discuss solutions that are using quality frameworks to create a more equitable health system.

In addition to Fleisher, featured speakers will executives from ANCOR, CareOregon, Commonwealth Care Alliance, Council on Quality and Leadership, Intermountain Healthcare, NCQA, Reema Health, Kaiser Permanente, United Hospital Fund, and others.

Working sessions will provide expert-led discussions about how quality is driving federal and state policy, behavioral health integration, approaches to improving equity and measuring the social determinants of health, integration of disability support services, stronger Medicaid core measures, strategies for Medicare Star Ratings, value-based payments, and digital measures and measurement tools. Speakers will provide case studies and innovative approaches to ensuring quality efforts result in lasting improvements in health outcomes.

鈥淲hat鈥檚 different about this conference is that participants will engage in working sessions that provide healthcare executives tools and models for directly impacting quality at their organizations,鈥� said Carl Mercurio, Principal and Publisher, 红领巾瓜报 Information Services. 

View the Full Agenda

Early Bird registration ends January 30. Visit the conference website for complete details. Group rates and sponsorships are available.

Blog

2022 Yearly Roundup: a year of successful partnerships

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The holiday season is grounded in gratitude. At 红领巾瓜报, we are grateful for successful partnerships that have fueled change to improve lives.

We are proud to be trusted advisors to our clients and partners. Their success is our success. In 2022 our clients and partners made significant strides tackling the biggest healthcare challenges, seizing opportunities for growth and innovation, and shaping the healthcare landscape in a way that improves the health and wellness of individuals and communities.

Reforming Colorado鈥檚 Behavioral Health System

红领巾瓜报 partnered with the Colorado Department of Human Services to support the planning and implementation of a new Behavioral Health Administration (BHA). 红领巾瓜报 provided technical research and extensive stakeholder engagement, drafted models for forming and implementing the BHA, employed an extensive change management approach, and created a detailed implementation plan with ongoing support. Today the BHA is a cabinet member-led agency that collaborates across agencies and sectors to drive a comprehensive and coordinated strategic approach to behavioral health.

Wakely Consulting Group, an 红领巾瓜报 Company, was engaged to support the launch of a Medicare Advantage (MA) joint venture partnership between a health plan and a provider system. Wakely was responsible for preparing and certifying MA and Medicare Part D (PD) bids, a highly complex, exacting, and iterative effort. The Wakely team quickly became a trusted advisor and go-to resource for the joint venture decision makers. The joint venture has driven significant market growth over its initial years, fueled by a competitive benefit package determined by the client product team.

Laying the Foundation for Modernizing Indiana鈥檚 Public Health System

In 2021 Indiana Governor Eric Holcomb appointed a 15-member commission to assess Indiana鈥檚 public health system and make recommendations for improvements. The Indiana Department of Health (IDOH) engaged 红领巾瓜报 to provide extensive project management and support for six workstreams. 红领巾瓜报 prepared a draft report summarizing public input as well as research findings and recommendations. The commission鈥檚 final report will form the basis of proposed 2023 legislation, including proposals to substantially increase public health service and funding across the state.

Multiple Clients Accepted into ACO REACH Model

In early 2022 红领巾瓜报 and Wakely Consulting Group, an 红领巾瓜报 Company, assisted multiple clients with their applications to participate in the new CMS ACO REACH model. The purpose of this model is to improve quality of care for Medicare beneficiaries through better care coordination and increased engagement between providers and patients including those who are underserved. The team tailored their support depending on each client鈥檚 needs. The application selection process was highly competitive. Of the 271 applications received, CMS accepted just under 50 percent. Notably, nine out of the 10 organizations 红领巾瓜报 and Wakely supported were accepted into the model.

Pipeline Research and Policy Recommendations to Address New Innovative Therapies

红领巾瓜报, and subsidiaries The Moran Company and Leavitt Partners, were selected by a large pharmaceutical manufacturer to analyze the current pipeline of innovative therapies, examine reimbursement policies to assess long-term compatibility with the adoption of innovative therapies and novel delivery mechanisms, and make policy recommendations to address any challenges identified through the process. The project equipped the client with a holistic understanding of future potential impacts and actions to address challenges in a detailed pipeline analysis of innovative therapies.

Blog

Early bird registration discount expires July 11 for 红领巾瓜报 conference on the future of publicly sponsored healthcare, October 10-11 in Chicago

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Be sure to register for 红领巾瓜报鈥檚 2022 Conference by Monday, July 11, to get the special early bird rate of $1,695 per person. After July 11, the rate is $1,895.

Nearly 40 industry speakers, including health plan executives, state Medicaid directors, and providers, are confirmed for 红领巾瓜报鈥檚 The New Normal: How Medicaid, Medicare, and Other Publicly Sponsored Programs Are Shaping the Future of Healthcare in a Time of Crisis conference, October 10-11, at the Fairmont Chicago, Millennium Park.

In addition to keynote sessions featuring some of the nation鈥檚 top Medicaid and Medicaid executives, attendees can choose from multiple breakout and plenary sessions on behavioral health, dual eligibles, healthcare investing, technology-enabled integrated care, social determinants of health, eligibility redeterminations, staffing, senior care, and more.

There will also be a Pre-Conference Workshop on The Future of Payment Reform: Delivering Value, Managing Risk in Medicare and Medicaid, on Sunday, October 9.

Visit our website for complete details: . Group rates and sponsorships are available. The last 红领巾瓜报 conference attracted 500 attendees.

State Medicaid Speakers to Date (In alphabetical order)

  • Cristen Bates, Interim Medicaid Director, CO Department of Healthcare Policy & Financing
  • Jacey Cooper, Medicaid Director, Chief Deputy Director, California Department of Health Care Services
  • Kody Kinsley, Secretary, North Carolina Department of Health and Human Services
  • Allison Matters Taylor, Medicaid Director, Indiana
  • Dave Richard, Deputy Secretary, North Carolina Medicaid
  • Debra Sanchez-Torres, Senior Advisor, Centers for Disease Control and Prevention
  • Jami Snyder, Director, Arizona Health Care Cost Containment System
  • Amanda Van Vleet, Associate Director, Innovation, NC Medicaid Strategy Office, North Carolina Department of Health & Human Services

Medicaid Managed Care Speakers to Date (In alphabetical order)

  • John Barger, National VP, Dual Eligible and Medicaid Programs, Humana, Inc.
  • Michael Brodsky, MD, Medical Director, Behavioral Health and Social Services, L.A. Care Health Plan
  • Aimee Dailey, President, Medicaid, Anthem, Inc.
  • Rebecca Engelman, EVP, Medicaid Markets, AmeriHealth Caritas
  • Brent Layton, President, COO, Centene Corporation
  • Andrew Martin, National Director of Business Development (Housing+Health), UnitedHealth Group
  • Kelly Munson, President, Aetna Medicaid
  • Thomas Rim, VP, Product Development, AmeriHealth Caritas
  • Timothy Spilker, CEO, UnitedHealthcare Community & State
  • Courtnay Thompson, Market President, Select Health of SC, an AmeriHealth Caritas Company
  • Ghita Worcester, SVP, Public Affairs & Chief Marketing Officer, UCare
  • Mary Zavala, Director, Enhanced Care Management, L.A. Care Health Plan

Provider Speakers to Date (In alphabetical order)

  • Daniel Elliott, MD, Medical Director, Christiana Care Quality Partners, eBrightHealth ACO, ChristianaCare Health System
  • Taylor Nichols, Director of Social Services, Los Angeles Christian Health Centers
  • Abby Riddle, President, Florida Complete Care; SVP, Medicare Operations, Independent Living Systems
  • David Rogers, President, Independent Living Systems
  • Mark Sasvary, Chief Clinical Officer, CBHS, IPA, LLC
  • Jim Sinkoff, Deputy Executive Officer, CFO, SunRiver Health
  • Tim Skeen, Senior Corporate VP, CIO, Sentara Healthcare
  • Efrain Talamantes, SVP & COO, Health Services, AltaMed Health Services Corporation

Featured Speakers to Date (In alphabetical order)

  • Drew Altman, President and CEO, Kaiser Family Foundation
  • Cindy Cota, Director of Managed Medicaid Growth and Innovation, Volunteers of America
  • Jesse Hunter, Operating Partner, Welsh, Carson, Anderson & Stowe
  • Bryant Hutson, VP, Business Development, MedArrive
  • Martin Lupinetti, President, CEO, HealthShare Exchange (HSX)
  • Todd Rogow, President, CEO, Healthix
  • Joshua Traylor, Senior Director, Health Care Transformation Task Force
  • James Whittenburg, CEO, TenderHeart Health Outcomes
  • Shannon Wilson, VP, Population Health & Health Equity, Priority Health; Executive Director, Total Health Care Foundation
Blog

Staying ahead of the star rating curve: insights from 红领巾瓜报 and Wakely鈥檚 Medicare Summit

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This week, our In Focus section highlights a presentation from 红领巾瓜报 and Wakely, an 红领巾瓜报 company, titled 鈥�Staying Ahead of the Star Rating Curve 鈥� A Case Study,鈥� which was given at the 12th Medicare Stars, HEDIS, Quality Assurance, & Risk Adjustment Summit on June 15, 2022.

The presentation provided an overview of major changes in the Medicare stars program, which will result in both higher ratings and significantly higher revenues for many Medicare Advantage plans in 2023.  However, the presentation indicated the higher ratings reflect temporary changes and not necessarily improvements in quality, adding that Medicare Advantage plans should be cautious about enhancing future benefits based on additional 2023 revenues.

Click here to view the presentation.

For questions, please contact our experts below.

Blog

Quality standards in addiction care

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Across the healthcare landscape, quality standards are in place to ensure patients are receiving safe, appropriate, evidence-based, and standardized care that is tailored to their individual needs and symptomology.   

A significant gap has long existed in the treatment of substance use disorders (SUD), as there was no standardized method to provide treatment based on an individual鈥檚 needs at that moment, meaning people seeking treatment often received care that was either too intense or not intense enough, preventing them from attaining sustained recovery.

To create standardized treatment protocols and build additional credibility around programs, the American Society of Addiction Medicine (ASAM) developed criteria based on a holistic, multidimensional assessment[1] to determine what level of care (LOC) an individual needs. This development was revolutionary as it was the first time the field agreed on established criteria. After 35 years of improvement and refinement, the ASAM Criteria has become the national standard.

Learn More about ASAM Level of Care Certification

While many providers have adopted the ASAM criteria, and most regulators and payers require its use to determine the LOC a person may need, a significant gap still persists in ensuring services are delivered with fidelity to the criteria. As a result, those seeking treatment for themselves or a loved one continue to face challenges identifying a setting that provides evidence-based treatment focused on their specific needs. 

To close this gap, ASAM partnered with CARF International, the leading accreditor of behavioral health services, to develop criteria that demonstrates providers are, in fact, delivering the LOC for which they are admitting persons. Programs that are providing can be certified for three levels including: 3.7- Medically Monitored Intensive Inpatient Services, 3.5- Clinically Managed High Intensity Residential Services, and 3.1- Clinically Managed Low Intensity Residential Services.

By achieving the ASAM LOC certification, residential treatment programs can establish themselves as high quality SUD providers and ensure future program licensing as well as future funding from states, and private and public payors. This certification demonstrates that facilities are delivering the appropriate care to the appropriate person at the appropriate time. 

Preparing for certification is different from preparing for licensure in that a program must take an in-depth look at their clinical practice to ensure alignment with the ASAM criteria.

Because of our long and proven track record of helping clients prepare for, and secure, NCQA, AAAHC and URAC accreditation as well as deep expertise in SUD programs and treatment, 红领巾瓜报 was selected by ASAM as a preferred partner to provide technical assistance and usher programs through the certification process as well as help address shortfalls and gaps in programs and care.

Our team has the right mix of clinical and operational knowledge, training, and frontline experience to guide clients through the certification process and help build better systems of care and accountability from the ground up.

红领巾瓜报 has the depth and breadth of services across the healthcare spectrum, and we are uniquely positioned to help organizations address gaps identified in the certification process and improve care by ensuring services are delivered in fidelity to the LOC at which a person presents.

红领巾瓜报 is able to provide a full complement of services and support to residential providers including ASAM LOC clinical expertise, developing policies and procedures, building and operationalizing clinical programs, and improving revenue cycle, operations, and as well as payor contracting strategies.

Certification is really step number one. Utilizing 红领巾瓜报鈥檚 鈥淪urvey Ready Model,鈥� we will identify ways to build quality into everyday practice allowing programs to stay on top of – and ahead of – requirements. 

For more information, contact our expert below.

[1] https://www.asam.org/asam-criteria/about-the-asam-criteria

Webinar

Webinar Replay: Comparing Medicaid program delivery models on quality outcomes

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This webinar was held on February 15, 2022.

In 2020, state and federal government spending on Medicaid was $646 billion, with just over half going to Medicaid managed care programs and the rest to fee-for-service (FFS), primary care case management (PCCM), and other models. Despite the large investments, little evidence exists on differences in quality between the various models. Using the 2019 CMS Adult and Child Core Set Quality Measures, 红领巾瓜报 normalized performance data across states to compare outcomes between managed care, FFS and PCCM. During this webinar, 红领巾瓜报 consultants discussed the findings, which were published in an 红领巾瓜报 white paper in November 2021.

Learning Objectives:聽

  • Understand how the different Medicaid delivery models performed on quality measures from the 2019 Adult and Child Core Set.
  • Learn more about the Adult and Child Quality Measure Core Set and why the 2019 dataset provides one of the first opportunities to make valid comparisons between the Medicaid delivery models.
  • Find out how this research could be expanded upon in the future to assess the key factors that drive higher quality and better performance in population health for low-income individuals.
  • Explore the broader implications of this research for policymakers and state Medicaid officials.

红领巾瓜报 Speakers

Anthony Davis, Managing Director, Quality and Accreditation Services, Portland, OR
David Wedemeyer, Principal, Los Angeles, CA
Joe Moser, Principal, Indianapolis, IN
Beth Kidder, Managing Principal, Tallahassee, FL

Ready to talk?