Susan McClernon

Keep our rurals open but if you really want to help get the foreign equity owned GPO that sets the pricing for our hospitals BANNED from our state. Economies of scale are used by Vizient against Oklahoma rural hospitals. If you have 13 tiers, hidden tiers, and tier maxes…that’s not a contract, that a free for all nightmare of a scam we all fell for. Their awful written tiered agreements force our rurals to pay more for the exact same items that our large hospitals pay less for. Example box of gloves a large hospital system in the state will pay 6-8 bucks for a box of 250 exam gloves. That same box for a rural EMT? 24 bucks. There is no price transparency and you are forcing patients who live in rural areas to pay more because of the lack of infrastructure by the corporations serving them to effectively and economically get goods and services to these hospitals. And distributors who whine about the cost of delivering to rural hospitals all while posting BILLIONS in profit every quarter are the first on my 💩 list. Let’s keep our rurals open but let’s make them more profitable so that they can continue to add much needed services and gainfully employ more community members.

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The Office of the National Coordinator for Health IT is setting standards for SDOH data integration. See how this enhances patient care through better data interoperability: https://loom.ly/WpDXbtQ #HealthEquity #SDOH #HealthcareAnalytics #MedicalResearch #HealthcareReform #IQR #HealthPolicy

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A recent report has unsurprising findings about the challenges in accessing and assessing Medicaid HCBS, and includes a necessary call for improving how Medicaid HCBS is delivered! "A maze of federal legal authorities has resulted in inconsistent and inequitable access to [long-term] care among [Medicaid] beneficiaries and across geographies. The many programs are difficult to understand, even for researchers and regulators trying to measure outcomes." #Medicaid #longtermcare #caregiving #HCBS

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A new brief authored by Bailit Health Consultant Grace Flaherty for Milbank Memorial Fund entitled "Pinpointing Performance: Improving Health Care Cost Growth Target Attribution Reporting for Providers" https://lnkd.in/eSZKXzTs #Healthcare #CostGrowth BlogPost Overview: Healthcare costs have consistently outpaced inflation, significantly impacting budgets for governments, employers, and households while overshadowing other essential priorities. Several states have initiated cost growth target programs in response to rising healthcare affordability concerns and the need for increased transparency and accountability. These programs set annual limits on the permissible rate of increase in healthcare costs relative to income and economic growth and require reporting on spending growth at various levels, including large provider organizations like hospitals. However, accurately attributing expenditures to these providers poses challenges, which can result in unfair penalties or improper performance assessments, undermining trust in the system. This brief outlines these challenges, emphasizing Connecticut's approach, which uses tax identification numbers (TINs) for better attribution, along with methodologies from Massachusetts and Oregon. While all three strategies are valid, Connecticut's model particularly empowers provider organizations in defining their networks.

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Community First Services and Supports (CFSS) in Minnesota is an exciting new program that replaces the PCA (Personal Care Assistant) program and the Consumer Support Grant (CSG). It also offers additional benefits and advantages for care recipients. As you make the transition to CFSS, one of the most crucial decisions is choosing between the CFSS agency model and the CFSS budget model. Best Care is here to guide you through the process and help you make an informed choice that best suits your needs. Let’s explore each model's unique qualities to provide more insight into what might be the best fit for you. https://lnkd.in/gGM8PTys

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Under the CMS IQR program, hospitals must screen for social drivers of health starting in 2024. Learn about the impact of these measures in our blog: https://loom.ly/WpDXbtQ #HealthEquity #SDOH #HealthcareAnalytics #MedicalResearch #HealthcareReform #IQR #HealthPolicy

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The Primary Care Collaborative has released a new report, "Primary Care: The MVP of MSSP," to examine the performance of primary care accountable care organizations in the Medicare Shared Savings Program. Visting Fellow David Muhlestein co-authored and Assistant Research Director Frank W. McStay II reviewed the report, and both spoke during the release event. Read more here: https://duke.is/z/qbwz

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Last week, the Office of the National Coordinator for Health Information Technology (ONC) published the Health Data, Technology, and Interoperability (HTI-2) proposed rule for public comment, marking a significant step towards enhanced patient engagement, information sharing, and public health interoperability. Key highlights of this proposed rule include: • New certification criteria for public health and payers, supporting CMS’s Interoperability and Prior Authorization rule. • Introduction of certification criteria for a real-time prescription benefit tool. • Mandated adoption of USCDI version 4 by January 1, 2028. • Updated standards for clinical image exchange and multi-factor authentication. • Clarifications on information blocking regulations to address concerns around the sharing of reproductive health information. If you have questions about how this proposed rule may impact your revenue cycle organization, we welcome you to contact our team for a discussion! For ongoing news and best practices for enhancing your revenue cycle management operations, follow our page today!

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NEW PROPOSED RULE: Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2). We will be holding an overview info session on July 17 at 2:00 PM ET. Learn more about the proposed rule: https://lnkd.in/eCAgEU4v #ONCHTI2

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Managing Director and CEO, Dr. Andrew Ziskind, presented at The Health Management Academy Fall 2024 CEO Forum on "The Future of Value-Based Care” along with Dr. John Warner, MD, CEO of The Ohio State University Wexner Medical Center and Dr. Alan Kaplan, CEO of UW Health.    Andy addressed why enthusiasm for value-based contracting has waned despite a fundamental belief that population health is the right thing to be doing. Challenges include unmet financial goals, shifting CMMI benchmarks, and post-COVID operational focus on fee-for-service revenue. Yet, the need to redesign healthcare around population health remains crucial.   Key insights:   - Contracting strategies need to include unit cost increases as a condition of accepting risk. - Organizations managing risk need to disproportionately focus on a small number of high-impact areas such as narrow post-acute networks, complex case management, palliative and end-of-life care and high-cost drugs. - Provider-sponsored health plans need scale to remain viable. - The future lies in adapting to market shifts and building sustainable, scalable care strategies.   For more information on THMA conferences and upcoming events: https://lnkd.in/ejmdSp8P Explore BDC’s latest insights and resources to stay ahead in healthcare trends: https://lnkd.in/eEn8mPin   #BDCAdvisors #THMA #ValueBasedCare #HealthcareInnovation #Leadership #FutureOfHealthcare

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Harnessing the power of data can drive better decision-making and support health equity by addressing social determinants of health (SDOH). However, disconnected data and limited resources often hinder progress. A recent article from HIMSS states SDOH data connection is key to improving health outcomes. (https://lnkd.in/gbdJDe8m) Health Cities has also explored this connection— watch our expert panel discuss the transformative potential of data warehouses in improving community health outcomes ➡️ https://lnkd.in/g_8rh5mc #ABhealth #SDOH #HealthData

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👉The POLITICS around Midwifery in KS👈 TMaH Funding, KDHE, and KS Medicaid: Midwifery excluded from key conversations. 1. The KS ACNM Affiliate learned that the Kansas State Medicaid Association applied for CMS TMaH funding without ever being notified or asked to have input. If awarded, this federal 10-year grant totaling $17 million/state MUST include work with CNMs. Why were midwives left out of this key conversation? How was this even conceived as acceptable? 2. KS CNMs have independent practice authority thru two uniquely different routes, the BON and/or the BOHA. These two state titles and regulatory routes (nursing and medicine) use scope and language that contradict independent practice, yet both remain active regulations. You can be a CNM or a CNM-I. Talk about a hot legal mess if challenged. 3. A Sept ‘23 CMS statement positively suggests privileging nurse-midwives to admit patients to a hospital, “hospitals may develop policies to permit nurse midwives to be credentialed and privileged to admit and care for hospital inpatients in accordance with State licensure laws.” KS allows independent practice, yet have no hospitals that allow privilege’s to admit/discharge in the CNM name. https://lnkd.in/gvA-b6Ty 4. KS Medicaid submitted a request to CMS, effective October 1, 24 for CNM reimbursement to be 100% of the fee schedule. However, no CNMs were engaged in this conversation. Although this would finally raise the current reimbursement rate from 75% to 100% for OB global care only, not other services, there is lack of clarity on the word “select” CNM, AND if other requirements would be dropped as independently practicing providers in order to be reimbursed. See #5. https://lnkd.in/gSpbBgws 5. WHY is #4 key? On the KS BCBS application (the major carrier for Medicaid) if you are a Nurse Practitioner or PA the application form requests the Sponsoring Physician Name, NPI and Specialty. In addition, they require a signed collaborative agreement with the Sponsoring Physician. However, BCBS does not disclose this requirement. #GrowMidwives is aware of numerous CNM applications rejected by BCBS due to requiring a signed agreement. Awarding 100% of the fee schedule is MEANINGLESS of a sponsoring physician is still required by any Medicaid MCO! 6. And bizarrely, United Health Care (Medicaid MCO) in Kansas website notes for the patient that you can select care by a certified nurse midwife or licensed midwife? There is NO OTHER type of recognized, regulated, licensed “midwife” in KS other than the CNM. Who writes this??? https://lnkd.in/gdd6UcPE KS Medicaid and KDHE need to come out of the closet and speak with KS ACNM leadership. #enough #GrowMidwives #scalingupandsustainingmidwifery

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ICYMI #AdvancingHealth episode: “Health Equity at the Center of Rural Care” with Terry Scoggin, CEO of Titus Regional Medical Center discuss designing a system of care ensuring equitable patient access. Scoggin also shows how the AHA Health Equity Roadmap provided valuable resources to support their mission to transform the care of the community. Listen now: https://lnkd.in/eMtdPSyH #WeAreHealthCare

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The recent approval of Healthcare Transformation 1115 Demonstration Waiver, is giving Illinois the ability to use Medicaid dollars to focus on helping alleviate the root causes of health inequities.  At Advocatia, we also believe in taking a holistic approach to helping individuals improve their health, which is why we can screen for over 1,000 different programs. Each individual’s journey is unique and we understand that the right assistance can come in different forms. We’re helping break down barriers to ensure that each individual gets the assistance they need. https://lnkd.in/g7EBm-ET

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Happy #NationalRuralHealthDay! We would like to acknowledge the hard work and dedication of our peers at critical access hospitals and providers we have worked with in rural facilities across the continuum. Recently, we partnered with Missouri Hospital Association on facilitating a series of Community Forums on birth equity in maternal health deserts throughout Missouri. In Missouri, 11.2% of babies were born to women who live in rural counties, while 3.7% of maternity care providers practice in rural counties. Learn more at https://lnkd.in/gt2C7iXK. This project, among our other work with rural facilities, was a reminder of the unique challenges that rural health facilities face and how important the focus on improving rural health is. 🏥

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