While at Good Shepherd Fairview Home my final project for my internship was to make a presentation to give to leadership about the Medicaid Redesign in New York State. I did research about Governor Cuomo and the Medicaid redesign team that he instated to redesign New York’s Medicaid program in January 2011 to ensure that it was sustainable. The main goal of the presentation was to inform the staff about how things will change when managed care organizations will be present.
As part of the Strong Start for Mothers and Newborns effort, the CMS Innovation Center hosted a webinar to discuss why it is important to reduce early elective deliveries and share best practices on how reducing early elective deliveries improves the health of mothers and newborns across the country. Individuals representing the American College of Obstetricians and Gynecologists, the March of Dimes, providers and payers conveyed examples of successes and how reducing early elective deliveries can be accomplished. All interested parties were invited to attend this event.
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CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
New York State is in the process of undergoing an unprecedented transformation of its healthcare system through the implementation of the $6 billion Delivery System Reform Incentive Payment (DSRIP) program. Why? New York must not only reduce the vast cost of care, but it must also assure that individuals’ care is optimized through better collaboration. DSRIP will require comprehensive networks of providers to work together in Performing Provider Systems (PPSs), delivering population-based healthcare to Medicaid beneficiaries and uninsured New Yorkers. Through this process, the State intends to transform New York’s healthcare safety net, improve healthcare quality, and increase sustainability through payment reform. Success in the DSRIP program will require innovative strategies in communication, patient care, data analytics, and many other areas. Technology must therefore be foundational to a solid PPS platform. This panel of leading PPS participants and tech solutions providers will examine the vital role that healthcare technologies will play in DSRIP implementation, and the potential for DSRIP to accelerate the introduction of new, innovative technologies into New York’s healthcare delivery system.
• Jordanna Davis - Principal, Sachs Policy Group
• Stan Berkow - Co-Founder & CEO, Sense Health
• David Cohen, MD, MSc - Executive Vice President, Clinical Affairs & Affiliations; Chair, Department of Population Health, Maimonides Medical Center
• Lori Evans Bernstein - President, GSI Health
• Stephen Rosenthal - President & Chief Operating Officer, CMO, The Care Management Company of Montefiore Medical Center
New York eHealth Collaborative Digital Health Conference
November 17, 2014
While at Good Shepherd Fairview Home my final project for my internship was to make a presentation to give to leadership about the Medicaid Redesign in New York State. I did research about Governor Cuomo and the Medicaid redesign team that he instated to redesign New York’s Medicaid program in January 2011 to ensure that it was sustainable. The main goal of the presentation was to inform the staff about how things will change when managed care organizations will be present.
As part of the Strong Start for Mothers and Newborns effort, the CMS Innovation Center hosted a webinar to discuss why it is important to reduce early elective deliveries and share best practices on how reducing early elective deliveries improves the health of mothers and newborns across the country. Individuals representing the American College of Obstetricians and Gynecologists, the March of Dimes, providers and payers conveyed examples of successes and how reducing early elective deliveries can be accomplished. All interested parties were invited to attend this event.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
New York State is in the process of undergoing an unprecedented transformation of its healthcare system through the implementation of the $6 billion Delivery System Reform Incentive Payment (DSRIP) program. Why? New York must not only reduce the vast cost of care, but it must also assure that individuals’ care is optimized through better collaboration. DSRIP will require comprehensive networks of providers to work together in Performing Provider Systems (PPSs), delivering population-based healthcare to Medicaid beneficiaries and uninsured New Yorkers. Through this process, the State intends to transform New York’s healthcare safety net, improve healthcare quality, and increase sustainability through payment reform. Success in the DSRIP program will require innovative strategies in communication, patient care, data analytics, and many other areas. Technology must therefore be foundational to a solid PPS platform. This panel of leading PPS participants and tech solutions providers will examine the vital role that healthcare technologies will play in DSRIP implementation, and the potential for DSRIP to accelerate the introduction of new, innovative technologies into New York’s healthcare delivery system.
• Jordanna Davis - Principal, Sachs Policy Group
• Stan Berkow - Co-Founder & CEO, Sense Health
• David Cohen, MD, MSc - Executive Vice President, Clinical Affairs & Affiliations; Chair, Department of Population Health, Maimonides Medical Center
• Lori Evans Bernstein - President, GSI Health
• Stephen Rosenthal - President & Chief Operating Officer, CMO, The Care Management Company of Montefiore Medical Center
New York eHealth Collaborative Digital Health Conference
November 17, 2014
The 10th Annual Utah Health Services Research Conference: Clinical and Economic Impact of a Pharmacist-Led Diabetes Collaborative Drug Therapy Management Program in a Medicaid ACO Setting. By: Eman Biltaji; C McAdam Marx; M. Yoo; B. Jennings; J. Leiser - University of Utah College of Pharmacy
Health Services Research Conference: March 16, 2015
Patient Centered Research Methods Core, University of Utah, CCTS
The past decade has seen a growing appreciation of the importance of private healthcare providers as the first, and often only, source of healthcare in many countries. This has led to a range of interventions aimed at engaging these providers to deliver standardized public health goods and services. One partnership modality, called clinical social franchising, applies commercial principles to achieve this goal.
In 2012, 74 clinical social franchising programs were operational in 40 countries. The programmes included networks of 66,000+ providers that delivered franchised clinical and health services for family planning; maternal, newborn and child health; and to diagnose and treat TB, malaria and/or HIV. Millions of people received services. The scale and overall health impact of these programs is documented in the Clinical Social Franchising Compendium, 2013 (http://bit.ly/10nVT25).
This approach to engaging private purveyors of health and clinical services is gaining traction worldwide. The evidence base for this approach is also increasing, with studies now addressing health impact, quality of care, new usership of formal medical services, cost-effectiveness and equity.
This webinar will explain how clinical social franchising works, how it is being adapted in different countries and the evidence for its relevance as a public health approach.
Stephen Morgan, M.D.
Senior Vice President, Chief Medical Information Officer
Carilion Clinic
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
A detailed approach to an integrated health care system in Scotland presented by Dr. Anne Hendry from National Clinical Lead for Integrated Care.
Source Page:
http://www-01.ibm.com/software/city-operations/curam-research-institute/curam-roundtable/index.html
CMS Innovation Center, Center for Medicaid and CHIP Services staff will be hosting a webinar that will discuss how applicants can work with States and the role of States in the Strong Start funding opportunity. A series of follow up webinars will provide more in-depth information about other aspects of this initiative.
More at: http://innovations.cms.gov/resources/Strong-Start-Webinar-State-Partnerships.html
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Staff from the CMS Innovation Center and the Center for Medicare and CHIP Services hosted a webinar that provided an overview of the Strong Start initiative and the application process and requirements for the Medicaid funding opportunity.
More at: http://innovations.cms.gov/resources/StrongStart_overview.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The 10th Annual Utah Health Services Research Conference: Clinical and Economic Impact of a Pharmacist-Led Diabetes Collaborative Drug Therapy Management Program in a Medicaid ACO Setting. By: Eman Biltaji; C McAdam Marx; M. Yoo; B. Jennings; J. Leiser - University of Utah College of Pharmacy
Health Services Research Conference: March 16, 2015
Patient Centered Research Methods Core, University of Utah, CCTS
The past decade has seen a growing appreciation of the importance of private healthcare providers as the first, and often only, source of healthcare in many countries. This has led to a range of interventions aimed at engaging these providers to deliver standardized public health goods and services. One partnership modality, called clinical social franchising, applies commercial principles to achieve this goal.
In 2012, 74 clinical social franchising programs were operational in 40 countries. The programmes included networks of 66,000+ providers that delivered franchised clinical and health services for family planning; maternal, newborn and child health; and to diagnose and treat TB, malaria and/or HIV. Millions of people received services. The scale and overall health impact of these programs is documented in the Clinical Social Franchising Compendium, 2013 (http://bit.ly/10nVT25).
This approach to engaging private purveyors of health and clinical services is gaining traction worldwide. The evidence base for this approach is also increasing, with studies now addressing health impact, quality of care, new usership of formal medical services, cost-effectiveness and equity.
This webinar will explain how clinical social franchising works, how it is being adapted in different countries and the evidence for its relevance as a public health approach.
Stephen Morgan, M.D.
Senior Vice President, Chief Medical Information Officer
Carilion Clinic
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
A detailed approach to an integrated health care system in Scotland presented by Dr. Anne Hendry from National Clinical Lead for Integrated Care.
Source Page:
http://www-01.ibm.com/software/city-operations/curam-research-institute/curam-roundtable/index.html
CMS Innovation Center, Center for Medicaid and CHIP Services staff will be hosting a webinar that will discuss how applicants can work with States and the role of States in the Strong Start funding opportunity. A series of follow up webinars will provide more in-depth information about other aspects of this initiative.
More at: http://innovations.cms.gov/resources/Strong-Start-Webinar-State-Partnerships.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Staff from the CMS Innovation Center and the Center for Medicare and CHIP Services hosted a webinar that provided an overview of the Strong Start initiative and the application process and requirements for the Medicaid funding opportunity.
More at: http://innovations.cms.gov/resources/StrongStart_overview.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Because everyone matters.
IBM Health and Social Programs Summit, October 2014
Craig Rhinehart’s Blog
Insights from NASHP Conference in Atlanta
Trick or Treating for State Healthcare Innovation Treats
http://craigrhinehart.com
Reducing Health Disparities: The Journey of Brightpoint HealthBrightpoint Health
Brightpoint Health's CEO and President, Paul Vitale and Chief Clinical Officer, Dr. Barbara Zeller, share Brightpoint's journey, strategies and best practices to reduce health disparities in New York City's high-need neighborhoods.
Keynote Presentation delivered by Marvin O’Quinn, Executive Vice President and Chief Operating Officer, Dignity Health at the marcus evans National Healthcare CXO Summit Spring 2018 held in Orlando FL
eHealth business opportunities and things to consider when entering the USA m...getslidesdeck
For the GET Project Dave Whitlinger, Executive Director New York eHealth Collaborative was invited to be the guest speaker on an international Webinar to look at eHealth business opportunities and things to consider when entering the USA market.
Strategic priorities in Patient Safety. Philip Hassen. IV International Conference on Patient Safety. (Madrid, Ministry of Health and Consumer Affairs, 2008)
A preliminary proposal for an application to the Health Care Innovation Challenge sponsored by CMS. Focus of this proposal include gestational diabetes, maternal obesity, postpartum weight loss, and as well as patient engagement / health literacy
Providers know that successful care coordination is key to enhancing patient outcomes and better personalizing their experience. At its root, care coordination starts with effective communication, and healthcare organizations are increasingly turning to innovative technology solutions to solve their needs. To improve their care teams’ communication, coordination, and data capture capabilities, two of New York City’s leading healthcare organizations worked with two cutting edge tech solutions providers to design and implement innovative pilots as a part of the New York Digital Health Accelerator program. Utilizing real-life case studies, the panelists will discuss the design and implementation of the pilots, and lessons learned from their participation in the program.
• Anuj Desai - Vice President of Market Development, New York eHealth Collaborative
• Joseph Mayer, MD - Founder & CEO, Cureatr Inc.
• Patricia Meisner, MS, MBA - CEO & Co-Founder, ActualMeds
• Ken Ong, MD, MPH - Chief Medical Informatics Officer, New York Hospital Queens
• Victoria Tiase, MSN, RN - Director, Informatics Strategy, NewYork-Presbyterian Hospital
New York eHealth Collaborative Digital Health Conference
November 17, 2014
How do medicaid waivers expand the possibilities of whole person care 032117Jennifer D.
With the changing landscape in healthcare right now it's important to know how Medicaid Waivers and Whole Person Care can help secure positive outcomes.
Key Principles and Approaches to Populaiton Health mManagement - HAS Session 21Health Catalyst
Population Health Management is in its early stages of maturity, suffering from inconsistent definitions and understanding, and is overhyped by vendors and ill-defined by the industry. And yet, many systems are moving forward in innovative pioneering ways to address this growing trend. In this session, you will hear from two very different, successful health systems: a physician-led group and a large integrated delivery system. They will share their best practices, learnings, and different approaches to population health management.
Presented by Carol Roye, EdD, CPNP, RN, Professor of Nursing, Assistant Dean for Research, Hunter College School of Nursing at the 2013 National Chlamydia Coalition Meeting
A brief update on the National Chlamydia Coalition by Ashley Coffield, MPA, Senior Fellow, Partnership for Prevention. Presented at the 2012 National Chlamydia Coalition meeting.
Presented by Michael Horberg, MD, MAS, FACP, FIDSA,
Executive Director Research, Mid-Atlantic Permanente Medical Group, Director, HIV/AIDS Kaiser Permanente, at the 2012 National Chlamydia Coalition meeting.
Presented by Richard Crosby, PhD, DDI Endowed Professor and Chair, Department of Health Behavior, University of Kentucky at the 2012 National Chlamydia Coalition meeting.
Presented by Marc Garufi, Chief, Public Health Branch, Office of Management and Budget (OMB), Executive Office of the President at the 2012 National Chlamydia Coalition meeting.
Presented by Jo Valentine, MSW, Associate Director, Office of Health Equity, Division of STD Prevention, CDC, at the 2012 National Chlamydia Coalition meeting
A brief update on the National Chlamydia Coalition by Ashley Coffield, MPA, Senior Fellow, Partnership for Prevention. Presented at the 2012 National Chlamydia Coalition meeting.
1. Perspectives on Performance in Health
Plans: Planning of Measures, Health Plan
Practice, and Possibilities for Increasing
Chlamydia Screening Rates
A Health Plan Case Study
Ken Bence, M.H.A., M.B.A.
Director of Public Health
Presentation to the National Chlamydia Coalition
February 20, 2013
1
4. Overview for Today
• Brief introduction to Medica
• Minnesota Medicaid Managed Care
• Why Chlamydia?
• Programs & Interventions
• Ideas to Adopt/Adapt
4
5. Medica Health Plans
Started as a physician-owned plan in
1975
Part of Allina (integrated health system)
1994-2001
A full service insurer
Commercial group, Medicare, Medicaid, TPA
Medica Service Area (MSA)
and Individual plans and services
Open access, PPO, HMO, tiered and care
system networks
A regional plan + national reach
96% of area physicians
Nearly 27,000 regional physicians and
healthcare professionals, >615,000 nationally
More than 240 regional hospitals, >5,000
nationally
UnitedHealth Group National Network Coverage
5
6. Mission
Vision
We do much more than finance care and process claims
We encourage prevention, fitness and wellness
We encourage members to get needed tests and care
We work with providers to improve outcomes, safety and efficiency
6
7. Medica Today
2nd largest Minnesota health insurer
Primary business is in MN, ND, SD and WI
National coverage alliance with other insurers
More than 1.6 million members
Employer-based group coverage
Leased networks and services
Individual-Family
Medicare
Medicaid
Health Management
Nonprofit
$3.8 billion annual premium adjusted revenue in 2011
90% of premiums go to care
7
8. Corporate Giving
• Mission is to fund community-based initiatives and programs that support the
needs of Medica’s customers and the greater community by improving their
health and removing barriers to health care services
• Grants awarded to 501(c)(3) or governmental organizations throughout Medica’s
service area
• Awarded over 600 grants totaling more than $12 million since 2003
• Annual funding priorities posted each March 1st
• 2012 Funding Priorities:
Behavioral Health - Filling the Gaps
Reducing Inappropriate Emergency Room Utilization, Hospital Admissions & Readmissions
Primary Care and Preventive Health Services for People with Disabilities
Early Childhood Health
Organizational Core Mission Support
• www.medicafoundation.org
8
10. Minnesota’s Healthcare Landscape
• A system of NON-PROFIT providers & payers, BY LAW
• All licensed health plans MUST participate in state healthcare
programs, BY LAW
• All Medica providers MUST participate in all product lines, BY
CONTRACT
Hospitals & Health Systems Health Plans
10
11. Minnesota’s Medicaid Managed Care Model
Medical Assistance (MA)
• Minnesota’s version of traditional Medicaid, based on income
• State/federal funding, administered by Department of Human Services
(DHS)
• Covers kids < 21, pregnant women
• May also cover qualifying adults with kids, disabled
MinnesotaCare
• For families and children above the Medicaid income limits, even if
they have access to insurance (“working poor”)
• State subsidized, sliding-scale premiums
Minnesota’s Medicaid Expansion
• Brings adults without kids into MA, federally funded 11
12. Collaboration Plans
• Mandated in statute since 1995
• All HMOs shall file a plan every five years with the Commissioner
of Health
• Describes the actions the plan intends to take to contribute to
achieving one or more high-priority public health goals
• Must be jointly developed with LPH and other community
organizations providing health services within the same service
area as the plan
• All HMOs shall file reports updating progress on their plan
• Current plan (2010-2014) was done collaboratively with all plans
together, through agreement with the Department of Health 12
15. Environmental Factors
• Infections on the rise in Minnesota, especially urban/suburban
• Growing awareness of disparities
• Priority for Metro local public health
• Collaboration plans
• Emerging privacy considerations
• Urine test available
• Later, Expedited Partner Therapy (2008)
• Became one of the State’s quality metrics for prevention
Provider Factors
• Inconsistencies among providers, despite clear preventive
health guidelines
• MN Community Measurement
• Patients may be going elsewhere to avoid
insurance claims
• Discomfort taking sexual histories
15
17. First, we studied the problem!
• Chart audits
• Literature review
• Physician consultations
• Department of Human Services study
Our Findings:
• The problem is multi-faceted
• A comprehensive solution is needed
• Our leverage points:
• Providers
• Enrollees/patients
• General
• Targeted
17
18. So we made a plan….
Provider-directed Initiatives
Financial incentive for primary care providers,
added to existing program (PIP)
Tool kits for clinics
• Chlamydia screening & treatment guidelines
• Chlamydia statistics & coding recommendations
• Fact sheets, forms, wallet cards & posters
• Chlamydia care path(s)
• “Diagnosis and Treatment of Chlamydia in Pregnancy”
• Comparison of Chlamydia Testing Technologies
• Guide to Sexual History Taking
• Online Chlamydia Course (California STD/HIV Prevention Center)
with CMEs
• Journal articles
• MN Family Planning and STD Hotline information
Clinic-level data
Newsletter articles
Consultation
18
19. Member-directed Initiatives
• Clinical case managers provided with scripting for appropriate
members
• Medica CallLink® 24/7 nurse line reminders for appropriate callers
• Referral resources provided to customer service representatives
• Information included in preventive health mailings
• Chlamydia screenings added to The Way to Better
HealthSM member incentive program – for males too!
• Targeted mailings to males & females,
including vouchers
• Newsletter articles – “It’s Your Health”
19
23. Healthcare Reform!
• More people insured
• First dollar preventive care
coverage
• Reproductive health care
debates
• Confusion
23
24. And more of the same….
Working through partnerships
• A new PIP:
• Collaborative, 4 health plans working together
• Will work with clinics to support their efforts
• Developed a new provider tool kit
• Will support the MN Chlamydia Partnership to promote the State
strategy
• Total Cost of Care arrangements with key healthcare systems
• Aligned with State Health Care Home and other alternative payer
arrangements
• Promotes relationships with primary care
• Encourages provider organizations to innovate
• Primary Care Designation project in State Public Programs
• Enhanced community outreach
• “Triple Aim”
24
At Medica 12 years, first 4 with responsibility for HEDIS reportingDeveloped strong ties with public health community
Mission: includes health improvementVision: includes innovation
Several grants over the years have supported STD screening and treatment
State Public Programs = MedicaidMedica serves 46 counties, just over halfBulk of our counties include all state public programs, others carve out specific programsMA & MinnesotaCare (and to an extent SNBC) include the age groups pertinent to Chlamydia
Hospitals & Health Systems are the bigger players, most are based in the Metro with service areas extending to different parts of the stateMedica & Allina used to be combinedHealthPartners & Sanford straddle the line, include both provider and payerPark Nicollet and HealthPartners just combinedHealthPartners and Essentia just received NCQA accreditation as an ACO, among the first 6PreferredOne commercial only, Ucare and MHP government programs only
This helped to set up Minnesota’s collaborative environment
Rates not acceptable, below national benchmarks
Importance of partnerships
Packaged into a Performance Improvement Project (PIP) as specified in contract with DHS 2006-8Partnership
Initiatives added between 2004-2010
Starting in 2008, exceeded national average for Medicaid, still behind the national 90th %ileMinnesota statewide average around 50% (claims)
Young adults can now stay on parents’ plan up to age 26