Jeff Sommer

ICYMI! Our latest #MassDataGov industry updates cover critical topics in healthcare policy and innovation: 🔹 Denny Brennan, MHDC's Executive Director, shares his insights on the use of standardized forms for #PriorAuthorization in Massachusetts, reviewing the impact of a new state law affecting long-term care. 🔹 Janice Karin, MHDC's Director of Policy, Technology, and Innovation, gives a quick overview of the newly finalized #MentalHealthParity rule, explaining its implications for providers and patients alike. 🔹 Interested in #QualityMeasures? Janice also points out a free Centers for Medicare & Medicaid Services course focused on post-acute care measures—great for anyone interested in improving healthcare outcomes! Watch/listen to the full update: https://ow.ly/EHmR50Tlwsk

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As Congress reconvenes, the New England Council urges action on three bipartisan priorities: extending telehealth access, revitalizing the Affordable Connectivity Program, and expanding eDelivery for secure financial information. These measures are vital for New England’s economy and quality of life. Read more from my new op-ed:

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Now that New York has officially been accepted to cohort three of the AHEAD program the twelve hospitals in downstate New York required to engage at a minimum in Medicaid global budget have only a bit over two years to: 1. Stand up a clinically integrated network 2. Aggregate and:or hire a large primary care base and align high performing specialists 3.. Apply for and launch a MSSP ACO 4. Stand up a population health management infrastrucure and care model capable of powering success in both global budget and global risk 5. Develop win-win value based payment contractual, operational, clinical and referral workflows with select high performing community led IPAs/CINs/ACOs As Mr Brault says below, the clock is ticking.

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"Businesses will also explore alternative approaches, such as direct contracting with centers of excellence and steering employees toward high-value providers. The focus on cost control will also extend to innovative care delivery models, such as value-based care, advanced primary care programs, and chronic disease management initiatives that promise measurable impacts. Investments in these areas are seen as critical to addressing the dual challenges of rising costs and increasing demand for high-quality care."

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If you only plan to attend one healthcare cost trends webinar in Q4, make it this one. Insights, context, and commentary await.

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AccendoWave - A Pain #Data Company Health plans obligated to pay reasonable costs for workers’ care are grappling with wide price ranges in newly disclosed hospital data, which shows some employers pay thousands of dollars more for the same services in the same facility. For instance, employer plans with at least 10,000 members paid prices varying from more than $5,500 to less than $1,000 for a common gastrointestinal procedure at Palm Beach Gardens Medical Center in Palm Beach Gardens, Fla., according to March 2024 data compiled for Bloomberg Law by Turquoise Health, a price transparency platform that works with health-care industry stakeholders and consumers. A Top 4 Global Health Equity Solution and Top 15 Global Remote Monitoring Company, AccendoWave, benchmarks objective brain wave pain data (specialty, gender, age) and has nine #pain databases: Emergency Department, Maternal Health, Oncology, MSK, Medical Surgical, ICU, Women, Adults, Seniors to eliminate bias, improve outcomes and reduce health care costs. If desired, AccendoWave can also create customized pain databases for partners that can be accessed on the Datavant platform.

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Want some free consulting on a blazing hot topic in our industry (not called AI)? Read on and please reach out if you want to discuss more!

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Medicaid Strategies for Long-Term Coverage Improvement In preparation for Medicaid’s 60th anniversary, a new ACAP report discusses strategies for enhancing Medicaid coverage and addressing equity gaps. Key areas include expanding access and adapting to the changing healthcare landscape. https://hubs.la/Q02Xyv4x0

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In my opinion these are significant topics that must be addressed and it won’t be an easy task but if we can get to a place and have a discussion where all voices are heard and perhaps have the ability to listen objectively then we have a chance to make some adjustments and begin to better understand the conditions and all the possible outcomes because ignoring these critical questions will never solve anything but addressing them will at least make it a real problem then an invisible solution. The HHS-OIG, or Health and Human Services Office of Inspector General, is a federal agency tasked with combating fraud, waste, and abuse in HHS programs, including Medicare and Medicaid. It employs around 1,600 individuals dedicated to government oversight and improving the efficiency of HHS programs. #unitedseniorassociation #usa #hss #oig #cms #eldercare #seniorhealth #hssoig #fda #RPM #healthcare #HHSOIG #healthcareoversight #nursinghomes #healthcarefraud #medicaid #medicare #seniorcitizen #healthpolicy #ADA #community #patientcare #safety #compliance #kloekorby

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The 2025 proposed CMS rule has some exciting news for #digitaltherapeutic devices. The proposed rule represents a significant advancement in expanding access to behavioral health services and DANA Brain Vital stands ready to play a pivotal role in this new era by providing objective outcome measurements on the efficacy of therapeutic interventions on cognitive function. Our advanced capabilities ensure that digital therapeutic companies can confidently demonstrate the impact of their products, thus meeting CMS requirements and optimizing patient care. DANA seamlessly integrates into existing application platforms, eliminating the need for it to be used as a separate application. This streamlined integration simplifies the process for digital therapeutic companies and enhances the overall user experience.  Moreover, DANA offers additional revenue opportunities for digital therapeutic clients by enabling them to leverage existing billing codes for therapeutic monitoring. https://lnkd.in/g2WT-22e

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Centers for Medicare & Medicaid Services released their annual report on Quality Measure Development Plan, outlining their commitment to reducing the reporting burden on quality measures while improving care for all. The report describes CMS' vision for a quality measurement system that reflects national priorities and supports clinicians reporting to the QPP. The QPP has incorporated the Universal Foundation of Measures into MIPS, including 10 adult and six pediatric measures, aligning quality measures across reporting programs. The creation of MIPS Value Pathways (MVPs) has streamlined the measure inventory and simplified reporting by bundling clinically relevant measures. CMS has also taken pivotal steps toward seamless exchange of healthcare information and transition to digital quality measures (dQMs) by encouraging electronic clinical quality measures (eCQMs) and the conversion of measures to the Fast Healthcare Interoperability Resources® (FHIR®) standard. Read the full report here: https://lnkd.in/eqFcvRzA. Contact me if you need help breaking things down. #CMS #BurdenReduction #MIPS #eCQM #dQM #valuebasedcared #QPP #QualityMeasureDevelopmentPlan #meaningfulmeasures #CMSMDP #cascadeofmeaningfulmeasures #universalfoundation #healthequity #CMSNationalQualityStrategy

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Are you a hospital serving Medicare and Medicaid in Vermont, Maryland, Connecticut, or Hawaii? CMS just announced that these are the first states to be accepted to participate into the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. The blog link below provides information about this initiative and how to prepare for success. Don’t miss out – read more here: https://lnkd.in/g9zi29AJ #HealthcareInnovation #ValueBasedCare #GlobalBudget #AHEADModel #CMS

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Are you a hospital serving Medicare and Medicaid in Vermont, Maryland, Connecticut, or Hawaii? CMS just announced that these are the first states to be accepted to participate into the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. The blog link below provides information about this initiative and how to prepare for success, written by COPE Health Solutions leaders Steven Hefter, Lindsey Patton and Allen Miller. Don’t miss out – read more here: https://lnkd.in/g9zi29AJ #HealthcareInnovation #ValueBasedCare #GlobalBudget #AHEADModel #CMS

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The Medicaid Leadership Exchange podcast shares insights on how states are working to achieve better outcomes for individuals served by Medicaid, and creative approaches used to address #healthdisparities. Via CHCS and NAMD - https://hubs.la/Q02DVp3g0

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NEW bundled payment model alert! CMS announced Transforming Episode Accountability Model or TEAM - a new bundled payment model starting in 2026. Many equity-oriented features in TEAM: - tracks for safety-net hospitals - social risk adjustment (though details TBD) - mandatory design --> think more uniform participation and care redesign insights that apply to historically marginalized and low SES benes too - quality measures including PROMs (but not quite getting to pre/post to also inch toward appropriateness) Check out a more comprehensive discussion in this article, written together with Joshua M. Liao, Austin Kilaru and other Parity Center team members! https://lnkd.in/eETfWwj2

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A new blog from AHRQ and the National Committee for Quality Assurance (NCQA), discusses a new landmark addition to AHRQ's inventory of digital healthcare resources: A Practical Guide for Implementing the Digital Healthcare Equity Framework. Learn how AHRQ is continuing its commitment to fund and disseminate research that addresses healthcare inequities with this new framework, designed to ensure that developers and users of digital healthcare technologies address vital needs across patient populations. https://lnkd.in/eSRcBbqa

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A new blog from AHRQ and the National Committee for Quality Assurance (NCQA), discusses a new landmark addition to AHRQ's inventory of digital healthcare resources: A Practical Guide for Implementing the Digital Healthcare Equity Framework. Learn how AHRQ is continuing its commitment to fund and disseminate research that addresses healthcare inequities with this new framework, designed to ensure that developers and users of digital healthcare technologies address vital needs across patient populations. https://lnkd.in/eSRcBbqa

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A new blog from AHRQ and the National Committee for Quality Assurance (NCQA), discusses a new landmark addition to AHRQ's inventory of digital healthcare resources: A Practical Guide for Implementing the Digital Healthcare Equity Framework. Learn how AHRQ is continuing its commitment to fund and disseminate research that addresses healthcare inequities with this new framework, designed to ensure that developers and users of digital healthcare technologies address vital needs across patient populations. https://lnkd.in/eSRcBbqa

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