David Kushan

Good article on the best states for healthcare. Kelly's re-post breaks this down into overall best, best access to healthcare, quality of healthcare and public health availability. Enjoy! https://lnkd.in/gNKtzQEu

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CVS Caremark is wielding its money and influence in an attempt to buy the Governor’s veto. Let’s send a powerful message. As an army of pharmacy professionals, allies and activists we can’t let this happen. Whether you’re a California resident or not please consider sending a letter or sharing this post in support of PBM reform. Urge Governor to Sign SB 966 The California Pharmacists Association along with the California Chronic Care Coalition, San Francisco AIDS Foundation, and the Los Angeles LGBT Center are fighting the PBMs/Health plans to save community pharmacy and they need our help. Despite a tremendous amount of opposition from the PBMs/Health plans, SB 966 cleared the Legislature without a single NO vote. Now, they are focusing their efforts on the Governor urging him to veto the bill. While the PBMs/Health plans have unlimited resources, what they don’t have is our commitment to patients. This is not just an independent pharmacy issue; pharmacies are closing all over the state including corporate chains. Every time a pharmacy closes, patients lose access, and pharmacists and technicians lose jobs. The PBMs/Health plans are claiming that this bill is just the greed of pharmacists wanting to charge more for medications. That is laughable. What they really want is to completely control the supply chain and move as many patients as possible to mail order severing the relationship between pharmacist and patient. This is an urgent matter; the Governor could act any day, and the opposition has direct access to him and will use their influence. We need volume. The last time we took on the PBMs, the Governor vetoed the bill – let’s fight hard to make sure this time he sides with patients and pharmacy! CVS Health American Pharmacists Association ASHP Dr. Maurice Shaw Bled Tanoe, PharmD, Lannie D. #pharmacy #Pharmacist #pharmacytechnician #pharmacylife #cvs #pharmacystudent https://lnkd.in/gsAZZtiy

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Bridging the gap between clinical and financial worlds is the goal of CDI and coding, but it’s much easier said than done. One way to reconcile this schism is through data—objective numbers that don’t lie, but can speak to both sides of this seemingly irreconcilable chasm. Associate Director of Coding and CDI at Yale New Haven Health (YNNH) Leif Laframboise believes in the power of data and uses it to structure the work of the coding and CDI departments under his oversight. But he marries that with a candidness and leadership style I admire, and an inner strength that has allowed him to persevere with a disability that might have ended the career of another. Leif is not just a data lover but an all-around good dude that I got to know a little bit during my ACDIS days, and I’m pleased to have him on this episode of Off the Record. We discuss: ·     An overview of the CDI and coding departments at YNNH ·     Broad departmental KPIs, with present on admission as a north star in a sea of competing quality programs ·     YNNH’s unique reporting structure to both finance and the chief medical officer, and how that works in practice ·     Why and how Leif embraces data—what he looks for, how he uses it to drive improvements, educate providers, and focus his team’s chart reviews ·     His thoughts on how CDI and coding must evolve with changing times ·     His disability and how he’s worked around it in a visible leadership role ·     Our first Foreigner selection on the OTR Spotify playlist (about time)

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#Nurses and #doctors are noticing firsthand that anemia is growing faster globally than we ever thought. They truly represent a new culture of first responders in this critical area of healthcare. We hope that medical colleges, #hospitals, and nursing associations will support awareness of the vital roles these healthcare professionals play in serving the public's needs. These healthcare providers, along with many companies, also represent the foundation of potential cures for anemia worldwide. Consider this: The smallest amount of air blown into a balloon will automatically increase its size and visibility. The relationship between healthcare providers and anemia needs to be seen on a much larger, broader scale—just like that balloon. This also enhances the dignity and respect they’ve always deserved. We can't afford to let this balloon deflate, as doing so would set us back significantly. Our work focuses on building bridges that bring healthcare providers closer to understanding the patient. We’ve created a meaningful insignia for doctors and nurses that fosters trust and understanding from the very first examination. This is a new concept for #anemia, and we anticipate new partnerships and ideas that will expedite awareness even further. Until then, we deeply appreciate all collective efforts—together, we will defeat public enemy number one: Anemia. UChicago Medicine Englewood Hospital Cleveland Clinic Mayo Clinic Geisinger Johns Hopkins Medicine Loma Linda University Health Hackensack Meridian Health Penn Medicine, University of Pennsylvania Health System Mount Sinai Health System NewYork-Presbyterian Hospital MedStar Washington Hospital Center American Society of Hematology American Nurses Association American Academy of Anesthesiologist Assistants UCLA Health Yale New Haven Health Jefferson Health NYC Health + Hospitals

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Value-based care (VBC) is reshaping healthcare by emphasizing outcomes and cost efficiency over volume. Originating from managed care models in the 1980s, VBC has evolved with a strong focus on refining payment models, enhancing care coordination, and improving patient outcomes. Key players, including clinical data registries, ACOs, and payers, are crucial to this transformation. By collaborating, sharing data, and aligning incentives, these stakeholders drive advancements in care quality and efficiency. Learn more about how these collaborations can enhance VBC in this Health IT Answers article. https://lnkd.in/gxSPZAgM

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Walmart Exits Healthcare Market: RPM Steps Up to Fill the Gap... Walmart's departure from the healthcare market, including its virtual health care services, will leave a void in care services for underserved communities. While hospitals and primary care providers (PCPs) remain the backbone of our healthcare ecosystem, their resilience is rooted in the trust relationships they've built with patients. This trust is a cornerstone of effective care, and RPM can help hospitals and PCPs extend their reach. RPM uses digital technologies to monitor patients' vital signs, health data, and other relevant information remotely, enabling healthcare providers to deliver timely interventions and preventive care. By leveraging RPM, we can: - Increase access to care for underserved communities - Detect health issues early, preventing complications - Deliver personalized care plans - Reduce healthcare costs - Empower patients to take a more active role in their healthcare As we move forward, RPM can help address the disparities in healthcare access and ensure that everyone has access to quality care, regardless of their zip code or background. Let's harness the power of RPM to create a more equitable and accessible healthcare ecosystem! #RemotePatientMonitoring #Telehealth #DigitalHealth #HealthcareAccess https://lnkd.in/eD7CcaEm

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It strikes me as very important that the court did not rule on geographic restrictions for #340B covered entities. Contract Pharmacy geographic restrictions will: 1. Reduce access for patients 2. Restrict innovation related to patient engagement and access, 3. Likely increase costs to patients, and 4. Create a non-competitive business environment that will likely result in higher dispensing fees. There is no evidence that “remote” pharmacies harm program integrity. More detail on follow on posts on each of these points. Health Resources and Services Administration (HRSAgov), HHS Centers for Medicare & Medicaid Services National Association of Community Health Centers (NACHC) PhRMA #340B #CoveredEntities Advocates for Community Health

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Inpatient CDI and coding are complex, especially when multiple teams struggle to capture all the appropriate DRGs, CCs, and MCCs. But there’s a better way. With VISION Clinical Validation Technology™, you can simplify your CDI process and significantly improve your hospital’s financial performance—by up to 10X. Hospitals that implement VISION achieve a final denial rate of less than 1%* with our proven, AI-data-driven technology that ensures accurate documentation, validates DRGs, and minimizes denials. Discover how VISION is transforming hospital CDI programs nationwide https://hubs.li/Q02PMjfr0 *with our comprehensive program #CorroHealth #CDIWeek2024 #ACDIS #CDI #Healthcare

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Great read! Are prior authorizations wreaking havoc at your hospital? They are a hot topic for most health care leaders. Contact me at Omega Healthcare Management Services and see how we can help elevate some of the extra work put on your employees. #priorauthorizations #rcm #revenuecycle #healthcaretechnology #patientaccess

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Prior Authorization is always changing and it never gets boring. Check the article for in-depth review.

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From Pitchbook... * We estimate that PE-backed healthcare providers account for just 3.3% of the US provider ecosystem, with a cumulative $118b in annual revenue compared with around $3.5T total care provision spend nationally. For perspective, Optum Health's 2023 revenue was around $95 billion. * Although the "inventory" of PE-backed companies has grown from 350 companies in 2017 to 648 currently, the annual rate of growth in that inventory has slowed over the same period, from around 25% to less than 1%. PE investment in healthcare providers has declined as a proportion of overall PE deal activity since 2018. * Steward Healthcare headlines notwithstanding, current deal activity in US hospitals and skilled nursing facilities is virtually zero. Hospital and SNF deals account for <1% of PE healthcare services deals since 2022.

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Health plans are navigating challenges from Medicaid redeterminations, funding shifts, and changing demographics in Medicare Advantage. While some plans struggle with financial strain and risk adjustments, others are thriving, achieving strong performance in both Medicaid and MA Star ratings. What sets these high-performing plans apart? Stellation Care’s Competitive Intelligence Insights offers health plans the strategic advantage they need, providing data-driven insights into performance drivers that support targeted, sustainable improvements in member outcomes, network efficiency, and financial stability. Plans looking to thrive despite current pressures should consider reaching out to Stellation Care. Their expertise in data-first solutions empowers payers to make informed, proactive decisions in a constantly evolving market. For a deeper look at how a strategic, data-driven approach can help your plan navigate today’s healthcare landscape, reach out to Michelle and the team at Stellation Care on LinkedIn or via email at [email protected] #MedicareAdvantage #Medicaid #CompetitiveIntelligence #HealthcareInnovation #NetworkOptimization

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You can get rich off Medicaid Sound weird? Look at Centene: Q2 2024 (Q3 drops soon) $80.2B revenue $2.3B net income $10.7B stock buy backs $1.7B cash from operations Not too shabby But they don't have to be the only ones I spoke with a physician recently 85% of her patients are Medicaid She makes good money in her private practice How? Working collections Making sure patients get well visits Making sure patients get their vaccines The other part people don't talk about enough? They pay fast Speed on lower margin can be much more financially advantageous than slower, higher margin payments Not to mention there are ways to make perceived lower reimbursements higher margin Serving those in need while building a financially successful practice isn't just possible, it's critical P.S. If you are interested in seeing more of how the money flows in healthcare and how the business works, you'll love The Healthcare Breakdown, where I breakdown the business of healthcare so you can run that practice you've been dreaming about Check it out here: https://lnkd.in/gVRtQGZN See you out there!

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The California Office of Health Care Affordability has recently approved a requirement that all healthcare providers report their annual operating expenses. If those expenses increase more than 3.5% (eventually lowering to 3%) in a year, that provider will be fined, ironically increasing their expenses. The state claims this regulation is aimed at protecting consumers from high healthcare costs. This is the same State of California that recently raised all healthcare workers' minimum wage to $25 per hour (up from $15.50).  For our health system, that results in a $30 million annual cost increase and a 7.5% increase in our salary costs. This is also the same state that passed an unfunded mandate that requires our system to spend about $1 billion to replace a hospital building that they feel is at risk from damage in an earthquake. And it’s also the same state that increased the cap on medical malpractice lawsuits…and has authorized utility companies to raise their rates 15% per year.  So, with all of these unfunded requirements and policies that dramatically increase providers' costs beyond their control, how exactly does the state suggest that we limit our expense growth to 3% per year?  Healthcare cost inflation has already been running at more than 5% before any of these new requirements took effect. Perhaps if California wants to get serious about reducing the cost of healthcare they might look at the managed care plans. The most recent data I could find from the California Health Care Foundation indicates that California managed care companies made $222 billion in 2020. What direct value did these companies provide to the health of our communities? Meanwhile, hospitals and physicians are providing direct patient care and struggling to survive- especially systems like Kaweah Health that serve a high percentage of Medi-Cal (Medicaid) and Medicare patients.  On a side note, the governor did sign a new managed care organization tax into law this year, which was promised to increase Medi-Cal reimbursements to providers, but all signs suggest that he now intends to use those proceeds (nearly $7 billion) to fill holes in his budget's general fund deficit and will not be providing Medi-Cal rate increases. I would humbly suggest that if the state is genuinely concerned about its residents' cost of living, they might look at the state income tax (highest in the country), its gas prices (highest in the country), the essentially unaffordable housing costs, or countless other factors that will have a larger impact on individuals' pockets than beating up healthcare providers with laws that don't make any sense. #hospitals #california #healthcare

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