Home Health Compliance Handbook
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A complete overview of CMS compliance requirements for Home health agencies to follow in 2017 and to be implemented by 2018.
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Presentation - The Future of Home Health
"Instead of it being described as home healthcare, in a few years the services performed by home health care agencies will simply be known as "modern healthcare".
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Recommended
Presentation - The Future of Home Health
"Instead of it being described as home healthcare, in a few years the services performed by home health care agencies will simply be known as "modern healthcare".
-Dr. Steve Landers, VNA Health Group, New Jersey
Primary Health Care Strategy
Primary Health Care Strategy:
Key Directions for the Information Environment
Case study report and composite success model
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Improving ruli district hospital's patient referral system, final, 4.12.11
Presentation by team of MBA students from Ross School of Business at University of Michigan. Describes recommendations for improving the referral process for rural health centers to the district hospital in rural Rwanda.
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This document discusses the need to shift from a healthcare system focused on treatment of illness to a population health system focused on preventative care. It notes rising healthcare costs in the US and projections that Medicare and Medicaid will consume all tax revenue by 2050 without reforms. The document outlines Trinity Health's vision of building a "people-centered health system" through initiatives in population health management, care management, and addressing social determinants of health. It provides examples of Trinity Health's work in accountable care organizations, bundled payments, and community engagement initiatives.
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The document discusses population health management (PHM) and its role in supporting integrated care systems (ICS) in the UK. Key points:
- ICSs will be established everywhere by 2021 to integrate primary/specialist care, physical/mental health, and health/social care.
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- PHM aims to improve population health through proactive, data-driven care that prevents illness and reduces health inequalities.
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2) The SDNPC consists of 3 clinics with a multidisciplinary team including 5.5 NPs, 2 part-time physicians, and other health professionals. They provide comprehensive primary care.
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The document summarizes a presentation by Paul Grundy on extracting value from the patient centered medical home model. It discusses:
1) How the patient centered medical home model creates partnerships across the healthcare system to drive primary care redesign, offer population health management, and move away from an episodic, fee-for-service model.
2) Studies that show improvements in costs, quality, access, and utilization from implementing the patient centered medical home model, including reduced hospital and ER use.
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This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
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AltaMed uses a team-based care coordination approach in its PCMH model, with teams including nurses, health coaches, behavioral health specialists, pharmacists and others supporting primary care providers. For its PACE program, AltaMed provides comprehensive medical and social services to elderly patients to allow them to remain in their communities. Data shows AltaMed's PACE program achieves lower costs, utilization and mortality compared to other models through its integrated care approach.
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ISBJeevan
The document discusses challenges with access to primary healthcare in India, particularly in rural areas. It notes a lack of medical infrastructure and insufficient investments have led to high out-of-pocket healthcare expenses. Other challenges include underutilization of existing resources, inadequate healthcare workforce numbers, and pressure on rural infrastructure from population growth. Solutions proposed include expanding government health insurance, improving primary healthcare centers, and public-private partnerships to increase coverage and efficiency.
IntJournalofIntCare2014
This document summarizes a study evaluating the implementation of an integrated care policy called Partners in Recovery (PIR) for people with severe and complex mental illness in Western Sydney, Australia. PIR aims to improve coordination of clinical and other support services for these individuals. The study is prospectively evaluating PIR's impact on individual recovery outcomes, service delivery processes, and system integration over three years. Preliminary findings after the first year will describe any indications of improved system integration found so far and factors facilitating or impeding the integration process. The study setting presents challenges as the target population and their needs were previously unknown, requiring discovery during implementation. However, this practice-based enactment also allows for positive innovation and regional variation in services.
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Patient Engagement Presentation - MPN Network Forum April 18, 2017
April 18, 2017
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Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, Where patients take a leading role and responsibility. Objective: To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine
whether access, quality, and cost impacts differ by chronic condition status. Design, setting, and patients: This study
conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Results: Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care.
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Surgeon General of the Navy VADM Matthew L. Nathan, MC USN
Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.
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Krames Patient Education is the only choice for enterprise-wide patient education. In this presentation, practices will learn who Krames Patient Education is and What we can do for you.
We will review Patient-Centered Care and Patient Education; The Case for a Patient Education Investment, The Krames Differencet; Return on Investment; and Krames Solutions.
Keystone colorado jan 2015
The document summarizes a presentation by Paul Grundy on extracting value from the patient centered medical home model. It discusses:
1) How the patient centered medical home model creates partnerships across the healthcare system to drive primary care redesign, offer population health management, and move away from an episodic, fee-for-service model.
2) Studies that show improvements in costs, quality, access, and utilization from implementing the patient centered medical home model, including reduced hospital and ER use.
3) How payment models are shifting towards value-based purchasing tied to quality, utilization, and patient satisfaction outcomes rather than volume of services.
MPN Research Priorities
This document outlines research priorities related to improving health systems and community care. It identifies priorities such as exploring how other jurisdictions have organized health systems to improve outcomes and reduce costs, ensuring the needs of vulnerable populations are met, and redesigning mental health and addiction services to improve access and outcomes. Other priorities include exploring models of integrated health and social services, enhancing care transitions between settings and sectors, developing housing support options, expanding self-management support, and redesigning community care and payment systems to improve care coordination and reduce system utilization.
Projects
Chronic diseases account for $93 billion annually in Canada to manage. Despite this spending, 12% of Canadians report being unsatisfied with healthcare quality, posing a challenge for policymakers. The document proposes several projects to identify effective interventions for improving primary care practices and outcomes for patients with chronic conditions. It will analyze policies across Canadian provinces to better integrate health, social, and community services and identify best practices. It will also evaluate tools to screen for social determinants of health and characterize high healthcare users.
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Health literacy and consumer-centred care: at the brink of change?Consumers Health Forum of Australia
Leanne Wells, Chief Executive Officer, Consumers Health Forum of Australia, gave the Ian Webster Health for All Oration to the annual forum of the Centre for Primary Health Care and Equity on 13 August 2015. National Conference on Health and Domestic Violence. Plenary talk
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
outcomes 2015 pcpcc Evidence Report
This document provides a summary of evidence on the impact of patient-centered medical homes (PCMHs) and primary care innovations on cost and quality from 2013-2014. It finds that PCMH interventions are associated with modest improvements in quality of care and reductions in utilization and costs. It also discusses challenges in evaluating PCMHs and outlines opportunities to further integrate primary care with other specialties and engage consumers. The future of the PCMH relies on continued financial support, training interprofessional teams, harnessing technology, and partnering with patients and communities.
AltaMed - The Patient Centered Medical Home, PCMH
The document discusses AltaMed's Patient Centered Medical Home (PCMH) model and its Program of All-Inclusive Care for the Elderly (PACE).
AltaMed uses a team-based care coordination approach in its PCMH model, with teams including nurses, health coaches, behavioral health specialists, pharmacists and others supporting primary care providers. For its PACE program, AltaMed provides comprehensive medical and social services to elderly patients to allow them to remain in their communities. Data shows AltaMed's PACE program achieves lower costs, utilization and mortality compared to other models through its integrated care approach.
Access to Health Care and Andersen Model
The document discusses the Andersen Model of health care access. The model conceptualizes access as being determined by population characteristics (contextual and individual factors) that predispose people to use services or enable/impede their use. These include demographic, social, health beliefs, and enabling resources factors. The model also considers people's need (perceived and evaluated by professionals) and how this influences health behaviors and outcomes. It provides a framework for examining equitable access to care based on need rather than social characteristics or enabling resources.
ISBJeevan
The document discusses challenges with access to primary healthcare in India, particularly in rural areas. It notes a lack of medical infrastructure and insufficient investments have led to high out-of-pocket healthcare expenses. Other challenges include underutilization of existing resources, inadequate healthcare workforce numbers, and pressure on rural infrastructure from population growth. Solutions proposed include expanding government health insurance, improving primary healthcare centers, and public-private partnerships to increase coverage and efficiency.
IntJournalofIntCare2014
This document summarizes a study evaluating the implementation of an integrated care policy called Partners in Recovery (PIR) for people with severe and complex mental illness in Western Sydney, Australia. PIR aims to improve coordination of clinical and other support services for these individuals. The study is prospectively evaluating PIR's impact on individual recovery outcomes, service delivery processes, and system integration over three years. Preliminary findings after the first year will describe any indications of improved system integration found so far and factors facilitating or impeding the integration process. The study setting presents challenges as the target population and their needs were previously unknown, requiring discovery during implementation. However, this practice-based enactment also allows for positive innovation and regional variation in services.
SPOR-PIHCIN Research Day - PIHCIN SPARK
June 27/2017 - SPOR-PIHCI Network presentations from the pre-CAHSPR conference day in Toronto, Ontario
Sharing Practical Advances in Research Knowledge-
Translating Findings to Action from PIHCIN Research
MPN Workshop Jan 20, 2017
In this workshop we explored the ten requirements required of CIHR SPOR PIHCI grants and how to fulfill them.
System Innovation in California: The Impact of MHSA
Presented by Telecare's President and CEO, Anne Bakar for Senator David Pan's (D-SAC) global mental health forum on February 28, 2018.
Health Homes Require More Than EHRs
Electronic health records have limitations for supporting effective population health management and care coordination required by health homes. While EHRs are designed for documenting care within provider systems, health homes require sophisticated technology to perform functions like comprehensive care planning, collecting a wide range of health data, and supporting continuous care workflows across multiple provider systems. Unlike EHRs, health management systems can enroll and track populations, establish networks, coordinate referrals, perform utilization review, and monitor quality/outcomes on a larger scale.
Four Strategies for Compassionate, Complete Behavioral Healthcare
This document discusses strategies for improving behavioral healthcare. It advocates for integrating behavioral and physical healthcare to provide more holistic care for patients' overall needs. Barriers between primary and behavioral care need to be bridged to close gaps in patient care. An electronic health record can help providers treat all of a patient's needs by creating a single, integrated care record to improve information sharing between providers.
Patient Engagement Presentation - MPN Network Forum April 18, 2017
April 18, 2017
In April we held a Network Forum on engaging policymakers and patients/public effectively and appropriately. We would like to give a warm thanks to both Carolyn Shimmin, Patient Engagement expert of CHI's Knowledge Translation team, and Marcia Thomson, Assistant Deputy Minister of Manitoba Health, Seniors and Active Living for their presentations. Below you can see Carolyn's presentation - to see more of her work on patient engagement and to learn more about knowledge translation at CHI, please check out the blog Knowledge Nudge here. If you would like more information, helpful tools or advice about patient/public engagement in research, please contact Carolyn Shimmin at cshimmin@exchange.hsc.mb.ca
Medical home Navy
Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, Where patients take a leading role and responsibility. Objective: To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine
whether access, quality, and cost impacts differ by chronic condition status. Design, setting, and patients: This study
conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Results: Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care.
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The Healthcare Quality Coalition wrote to CMS Administrator Berwick to provide feedback on the proposed Medicare Shared Savings Program and ACO regulations. The coalition supports the goals of improved care coordination and reduced costs through alternative payment models like ACOs. However, the letter outlines several concerns with the proposed rule, including that it requires reporting on too many quality measures in year one, does not adequately account for patient acuity, and may not provide sufficient incentives for high-quality organizations to participate. The coalition urges CMS to address these issues in the final rule.
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Business Strategies in Healthcare (1).pdf
The healthcare industry is a vast and complex ecosystem that provides medical services, manufactures medical equipment and pharmaceuticals, and develops healthcare technology. Given its critical role in society, the strategies businesses employ within this sector are very important.
These strategies determine the success of individual companies and impact the overall quality, accessibility, and affordability of healthcare. This article explores key business strategies in healthcare, focusing on innovation, patient-centric care, strategic partnerships, and technology integration.
White Paper - Building Your ACO and Healthcare IT’s Role
The tools needed to capture, organize, and share healthcare data are truly evolving at the speed of light. Patient Centered Medical Homes play a vital role in the path toward accountable care and technology, staff, and workflow transformation are necessary to achieve PCMH recognition. This transformation allows healthcare providers to deliver higher quality coordinated care by streamlining and rationalizing the patient experience.
TASP White Paper Monitoring the CAP
The document discusses challenges that health systems face in managing costs under new bundled payment programs and global budgets. It provides an example from a pilot program in Maryland where costs have been capped and prices set in an effort to cut Medicare spending. The document outlines some of the key areas health systems need to address in both acute and post-acute care settings, such as optimizing patient mix and readmission rates, in order to successfully meet budget targets and quality measures. It provides details on specific strategies used by one Maryland health system to improve performance, such as reducing readmission rates from over 23% to less than 7%.
fti_whitepaper_just say yes v3
This document summarizes an initiative by Duke Medicine's Private Diagnostic Clinic to improve patient access and appointment availability across several departments. It discusses:
1. FTI Consulting partnering with Duke to develop new governance structures and use analytics to increase appointments.
2. Two key elements of the project - a new appointment management framework and an "Access Algorithm" tool to measure and score access.
3. Recommendations to consolidate resources into a new "Access Practices Team" to oversee scheduling and hold departments accountable to access standards.
4. The "Access Algorithm" used 12 metrics like lag times, no-show rates, and utilization to score and compare access across specialties and identify areas for
The Evolution of Physician Group from Patient Centric Medical Homes
A Quest to Achieve Higher Quality and Bend the Employers Health Care Cost Curves. Medical Clinic of North Texas (MCNT) enjoys a stellar FY 2010 performance with Total Medical Cost trend for their managed population 2.4% better than market. We tried to understand the journey and the drivers behind the success of Medical Clinic of North Texas from its early years and its future direction.
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Webinar: Comprehensive Primary Care Plus - Interested Payer OverviewCenters for Medicare & Medicaid Services (CMS)
The document describes the Comprehensive Primary Care Plus (CPC+) initiative, which aims to strengthen primary care through multi-payer partnerships and alternative payment models. It has three main goals: 1) allow practices to provide more comprehensive care, 2) accommodate practices at different transformation levels, and 3) achieve better care, smarter spending and healthier people. CPC+ will run in up to 20 regions over 5 years, selecting practices to participate in one of two tracks. It emphasizes the importance of aligning Medicare, Medicaid, and commercial payers to support practice transformation.How Do Organizations in Healthcare Measure the Value Proposition?
How Do Organizations Measure the Value Proposition? Both the numerator (Quality) and denominator (Cost) must be measured to demonstrate value.
Clinical Integration
A Clinically Integrated Network (CIN) is a selective partnership of physicians collaborating with
hospital(s) and other providers to deliver evidence-based care, improve quality and efficiency,
manage populations and demonstrate value to the market. Once these objectives are met, the network may contract on behalf of participants
Home Health Grouping Model
Overhauling the current Medicare Home health reimbursement system, the CMS has finalized a new payment system called Home Health Grouping Model. HHGM aims to eliminate the use of therapy service thresholds and concentrate on the clinical characteristics and other patient information. Check out the whitepaper to know all about the changes- additions, deletions and modifications in the new payment system.
PPS SAS Messaging vFinal
This document discusses Edifecs' Population Payment Strategic Solution (PPSS) which helps health plans transition to value-based reimbursement models. PPSS uses population payment products and domain expertise to identify target populations, design programs, administer pilots, and monitor programs. It addresses challenges like performing data analysis, identifying quality metrics, modeling spending scenarios, and monitoring incentives. The solution analyzes claims, clinical and financial data to assist with accountable care programs from the pilot stage to ongoing administration.
ACSG DIRECT TO EMPLOYER WHITE PAPER MARCH 15
This document describes a population health management system that medical providers can access to manage healthcare for self-insured employers. It allows providers to take control of healthcare delivery and costs in their community. The system has been in place for over 12 years and has successfully reduced healthcare trends and costs for over 1 million members. It provides tools for providers to identify high-risk patients, implement treatment regimens, monitor compliance, and share in savings through gainsharing arrangements with employers. Medical providers who implement this turn-key system can diversify their payer mix and increase revenues.
ACSG DIRECT TO EMPLOYER WHITE PAPER MARCH 15
This document describes a population health management system that medical providers can access to manage healthcare for self-insured employers. It allows providers to take on insurance-like roles without assuming insurance risk. The system utilizes over a decade of data on over 1 million members to analyze healthcare costs and outcomes. Medical providers are incentivized through gain-sharing agreements where they receive a portion of savings if healthcare budgets are kept lower than projected. The system aims to reduce costs through coordinated care, recruiting high quality/low cost providers, and promoting wellness. It has achieved healthcare cost reductions of up to 32% for some employers that have used the system.
Employer Sponsored Medical Clinics white paper
Employer-sponsored medical clinics have evolved from providing only basic convenience care to playing a larger role in actively managing chronic conditions to help control employers' health care costs. Successful clinics are integrated into the employer's data-driven health strategy and hold the clinic accountable for meeting cost and productivity goals. Different clinic models provide varying levels of services from basic care to full primary care management. For an on-site clinic to be effective, employers need to analyze their claims data to identify conditions driving costs and those amenable to improved management. The Affordable Care Act has prompted some employers to reconsider clinics to help manage costs and improve access to care.
Linking Compensation to Payment Incentives
In an article for Healthcare Executive, Don Seymour, Kevin Talbot, and Chad Stutelberg share their insight on developing compensation strategies that link executive and physician compensation models to acute care outcome-based payment methodologies.
LUMERIS_GEN.WMLD.01-16v1
Lumeris provides population health management services to help organizations adapt their business models to improve financial and clinical outcomes through value-based arrangements. It has over 10 years of experience in this area and focuses on enabling Population Health Services Organizations. Lumeris identifies 22 core competencies across areas like consumer engagement, care delivery, operations excellence, and business alignment that are critical for PHSOs to achieve the Triple Aim Plus One of better health outcomes, lower costs, improved experience, and physician satisfaction.
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NCQA_Future Vision for Medicare Value-Based Payments Final
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This whitepaper elucidates the nature and necessity of PE. It also explores the components of a winning PE strategy.
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This document discusses case management in healthcare. It defines case management and describes the case management process and goals. It discusses challenges in case management like workflow issues. It also discusses how technology is changing case management by enabling better communication between patients and providers through EHRs, apps, and remote monitoring. New models for case management focus on keeping patients connected to care after leaving healthcare settings to improve outcomes.
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Dr. Hemanth is a healthcare IT consultant with experience designing, integrating, and implementing various healthcare solutions including EHR systems, patient portals, quality reporting, population health analytics, and care coordination. As a clinician, he is passionate about creating IT solutions that help providers focus on patient care amid changing regulations. He has successfully delivered solutions across multiple product lines for healthcare organizations.
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The CMS has upped the focus on certified EHR technology in a bid to ramp up the interoperability of Healthcare IT systems. This makes the tracking of changes in EHR regulatory requirements, paramount for providers and hospitals. In this whitepaper, we cover, the 2019 EHR changes in detail.
CMS’s Data Element Library
To help advance and support Electronic Health Record (EHR) interoperability in long-term and post-acute settings, the Centers for Medicare and Medicaid Services (CMS) has unveiled the Data Element Library (DEL). DEL is an initiative to structurize the assessment information to ensure interoperability and reuse, thus leading to better coordination. This whitepaper will help you understand how DEL promotes the smooth exchange of patient information from one provider setting to the next.
TEFCA- Trusted Exchange Frame work and Common Agreement
Sanjay Patil is a healthcare IT consultant with extensive experience successfully delivering large-scale custom development projects, application integration, content management, portal solutions, and implementing healthcare business solutions. He has been actively involved in meaningful use initiatives and is passionate about creating IT solutions for providers regarding different regulatory programs. Patil has worked on delivering solutions across product lines such as EMR, EHR, care coordination, and patient engagement.
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Pharmacy Benefit Managers
Pharmacy Benefit Managers (PBMs) are professionals that administer prescription drug plans for payers, employers, and CMS programs .
Utilization Management in Population Health Management
Utilization Management is an integral part of the US healthcare ecosystem used by health insurers or Pharmacy Benefit Managers (PBMs) to evaluate the appropriateness, medical necessity, and efficiency of healthcare services rendered to patients.
Opioid Crisis in health care industry
Opioid over consumption is not only affecting the health of the beneficiaries but also creating
a lot of loss for payers and providers. To ensure the safety of patients and reduce the financial
loss from opioid crisis, hospitals and pharmaceuticals should adopt measures to monitor and
track opioid prescription and consumption. Using and integrating data across platforms with
the help of technology, this epidemic could be eradicated for a healthy future.
Qualified Health Plans
A Qualified Health Plan (QHP) is an insurance plan certified by the Health Insurance Marketplace that provides essential health benefits and follows cost sharing limits. QHPs are categorized into platinum, gold, silver, and bronze tiers based on the percentage of expected health care costs covered. The document discusses the benefits and costs associated with each metal tier and concludes that Nalashaa can assist payers in smoothly implementing QHP certification requirements and processes.
Population Health Management
PHM is a systematic way of gathering, analysing and managing at-risk patients’ data through tools such as Utilization Management, Case Management, Disease Management, Portals etc.
Healthcare organizations need to have technological capabilities within their care delivery processes to effectively use data to manage the cost and quality of care. To pursue more aggressive risk-based reimbursement models, these capabilities need to be expanded strategically and proportionately.
Blue Button 2.0
Even though EHRs have replaced paper health records aiming to make data management more convenient, managing health records is still an apprehension for patients. With the introduction of BlueButton 2.0, patients will have access to 4 years of their health record. This gives the patients more confidence in their health care and make data more comprehensive and easily accessible. By facilitating access to patient health history, it has the potential to drive down Medicare spending and improve health outcomes.
Enabling Cloud Deployment
While traditional IT landscapes were common, the widespread adoption of cloud computing allows organizations to be more cost-
Blockchain- Transforming Healthcare Ecosystem
Blockchain has the potential to transform healthcare industry by improving the safety and privacy associated with data transmission. This also promotes patient centricity where patients have the control over and could manage their data. Blockchain technology creates unique opportunities to reduce complexities and costs associated with data transmission, enable trustless collaboration between stakeholders, and provide secure and private platform for data transmission.
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Home Health Compliance Handbook
- 1. 1 CMS Compliance Handbook for Home Health Agencies
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