Wright Lassiter III

A very nice article highlighting and summarizing 'real world' insights and strategies for success in #MedicareAdvantage by leading healthcare organizations, including Henry Ford Health. Worth the read!

22

"Ascension’s NPS now rivals top consumer brands like Disney and Delta Air Lines, reflecting our commitment to exceptional service." How do we do it? 🤔 👉 We are reimagining our consumer experience by embracing a comprehensive, proactive and innovative approach. 👉 By breaking free from traditional models of patient experience and adopting a modernized approach aligned with evolving expectations, we aim to transform our experience — powered by our exceptional people. 👉 Every interaction, across all touchpoints — human, physical and digital — is guided by a deep understanding of consumer behaviors, attitudes and needs. Take a look at our newly released Ascension Ministry in Action report to learn more about how we are reimaging the Consumer and Patient Experience, and our other innovative strategies. It's an exciting journey! 🚀 Ascension #patientexperience #consumerexperience #datadrivenexperiences #personalization

86

4 Comments

Managing prior authorizations across all lines of business is easier when you have a single source of truth. PA Checkpoint becomes that source of truth for our clients - listen to BCBS of Minnesota share their experience: #PriorAuthorization #AIinHealthcare #ItilitiHealth

11

The third part of our Care at Home series digs into the benefits of leveraging vendors or building out internal capabilities, and how to get clinician buy-in. Read more here > https://owy.mn/4chC2sA #OWHealth

1

KH's most recent Flash Report unveils promising signs of financial performance, with a notable slowing of margin decline. The widening gap between lower and higher performing organizations highlights the focus on long-term investment and innovation in high-performing orgs. Lower performing organizations must focus on enhancing efficiencies and reworking key elements like their operating model and portfolio management. Explore the insights in the report here: [National Hospital Flash Report May 2024 Metrics](https://lnkd.in/ggUcyDPh). For resources to boost performance, visit us at https://lnkd.in/enBa3Tp

23

The highest increase since 2012 highlights the pressing need for further action to curb increases in medical cost trend. Insurers should prepare for tougher contract negotiations as providers strive to enhance their financial standing and offset stagnant Medicare and Medicaid reimbursement rates.

33

3 Comments

Medicare Advantage & Part D Star Ratings Released!   Proud to share that at Press Ganey, we support 100% of all 5-Star plans and 77% of all 4, 4.5, and 5-Star plans.   Here are some of the industry insights from the 2025 Ratings: ➡️ 5-Star MAPD plans dropped from 38 in 2024 to just 7 in 2025. ➡️ 4-Star or higher plans fell from 44% to 40% YoY. ➡️ 62% of members will be in 4-Star+ plans, down from 76% last year. ➡️ Over 5 years, CAHPS has remained steady, but with declines in Getting Needed Care and Prescription Drugs. ➡️ HOS trends have also stayed steady, despite year-to-year fluctuations.   If you’re looking to boost your CAHPS or HOS as part of your Stars strategy, we’re ready to help! Using our healthcare expertise and Book of Business experience data, we can help you identify specific insights and opportunities to tackle your Stars agenda. Be on the lookout for our first member experience trends report later in 2024. 

120

2 Comments

Interested in the CMS Medicare Shared Savings Program (MSSP), but not sure where to start? Check out this Sg2 expert blog post on how MSSP provides a structure for intentional strategic exploration and learnings, even for systems not fully committed to value-based care.

3

Yesterday, the leaders of the BCBSM Collaborative Quality Initiatives met to review their work and share ideas for clinical quality improvement. These CQIs have significantly improved the clinical landscape in Michigan and beyond, preventing complications, shortening recovery times and improving outcomes. Learn more > https://cqis.org/ #quality #clinicalquality #collaboration Michigan CQIs

69

1 Comment

When a multifacility academic health system in the Midwest faced an extensive cancer registry backlog of abstracting, they partnered with Omega Healthcare to reduce bottlenecks and improve processes. Read this case study to learn how we improved the workflow and overall data extraction process for the health system: https://buff.ly/3oXpljJ #CancerCare #CancerRegistry #CancerManagement

10

2 Comments

Health plan strategist and executive coach Dominick Bizzarro believes that an agile approach to strategic planning can help turn regulations like the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) from something done TO you to something done FOR you. #Interoperability #digitalhealthinnovation

24

3 Comments

Over 50% of U.S. hospitals are in the red. 📉 Rising costs, reimbursement cuts, and cyberattacks are driving financial challenges across the healthcare industry. What does this mean for patient care? Get the insights here 👇

1

$36 per minute...that is what 60 seconds of operating room time costs a typical hospital. With 60-70% of your hospital's revenue tied to perioperative services, it is mission critical to ensure a robust operating system is in place. Value Capture LLC can help your perioperative team design and implement an effective, sustainable system to support the efficient use of resources and ensure best-in-class quality, all while growing volume. Click on the link below to learn more. #operationalexcellence #perioperativeservices

1

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.

6

1 Comment

Can payers and providers really be friends? @BenGrabski and @JohnFryer share their perspectives on collaborative value-based care in this new podcast episode from @Lumeris! In this podcast interview, we explore challenges and opportunities in the Medicare Advantage landscape, highlighting the importance of collaborative payer relationships, consumer-centric innovations, and care delivery transformation. Ben and John share valuable insights on leveraging AI, navigating strategic inflection points, and building a win-win model to empower health systems and providers in achieving value-based care. Here are just some of the key takeaways from the discussion: 1. At Lumeris, our North Star is always to improve patient outcomes and provider experience. This will allow us to sustain (and thrive) through multiple market cycles. 2. Many in our industry (our competitors) see changes in risk adjustment as an existential crisis. And they should in those businesses because value-based care isn’t just about coding. 3. We must empower our partners with people, process, and technology (using just technology to solve problems will never be successful). 4. Systems can no longer continue to afford to build new assets and or keep up with their existing physical plant and property within the reimbursement environment that exists today. 5. Building win-win payer-provider relationships is key to success in VBC.

2

Major Changes Coming For The KC Market 📢 Blue KC to Exit Medicare Advantage Market by 2025 Due to Regulatory Demands 📢 Blue Cross and Blue Shield of Kansas City (Blue KC) has announced its departure from the Medicare Advantage (MA) market by the end of 2024, citing increased regulatory demands and financial pressures as primary reasons for the decision. The company will shift its focus to employer-sponsored health plans, Medicare supplement plans, and Affordable Care Act plans while ensuring uninterrupted, quality service to current MA members through 2024. With a smaller MA membership base, Blue KC finds it challenging to compete economically at scale, leading to the difficult but necessary market exit. In a statement, Blue KC's President and CEO, Erin Stucky, expressed disappointment, saying, “We explored every alternative path for our MA members and are disappointed we must exit this line of business.” This move aligns with industry trends, as other insurers, like Oscar Health, have also exited the MA market due to similar challenges, including the impact of regulatory changes such as the CMS's benchmark payment adjustments on the profitability of MA plans for smaller insurers. #Healthcare #MedicareAdvantage #BlueKC #RegulatoryChallenges #InsuranceIndustry #HealthPlans #CMS #MarketExit

3

1 Comment

Great defense of “private equity medicine” from former CMS administrator Leslie Norwalk. Though few clinicians fully understand it, PEM has become a popular bogeyman for a wide range of complaints about US health care. A few key takeaways: ·      All health care organizations require working capital. They should be judged on their behavior, rather than their source of capital. ·      Pushing health care organizations to more expensive sources of capital (e.g,, high interest loans) doesn’t serve anyone’s interests (except the banks). ·      The financial successes of private equity-backed companies accrue to everyone with a 401K or a mutual fund, not just a small number of wall street elites. ·      Reducing competition in health care (based on investment class) only accelerates market consolidation by integrated health systems, and the higher prices that come with it.

34

7 Comments