Colleen Rooney

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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HHS has released its final rule on disincentives for information blocking. This includes considerations for each of hospital/CAH providers under the Promoting Interoperability Program, individual providers through MIPS, and for ACOs under the Medicare Shared Savings program. From the following press release, “This final rule is designed to ensure we always have access to our own health information and that our care teams have the benefit of this information to guide their decisions." #hhs #interoperability #informationblocking #ONC https://lnkd.in/gNQm69CC

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Another section of the #FinalRule has been released by #CMS aimed at enhancing #access to and #transparency of #Medicaid services, including #HCBS. This rule pairs with two other final rules published in April 2024 that focus on improving Medicaid #eligibility and access to Medicaid services. This rule is focused on an #FFS system, but the impact could involve changes to underlying FFS rates in base #data for #ratesetting and program #oversight in #MLTSS. Dianne Heffron and Meredith Mayer of Mercer US Government have conducted a review of the proposed and finalized rules. https://bit.ly/3QuGRXe

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There's still time to sign up for Plug In to Technology! I was able to work with Christopher Copsey on his Connections article (just published today! link below) around creating affinity scores, so I know this presentation, and the others will be fantastic. This is your opportunity to learn how to harness the power of technology in the nonprofit sector, including AI and its impact on fundraising and prospect identification. Plus, uncover the secrets of successful CRM conversions, change management and consolidation, concluding with the essential skill of building metrics for your CRM. As prospect development delves further into how technology can help our organizations succeed, Plug In to Technology will surely help you become a more rounded member of your team! https://lnkd.in/grASQdgM

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Great review of the ins and outs of what a Certified EHR really means. In the US, EHR certification is a fifteen-year legacy, with the cruft of legislation and regulation piling up to form a convoluted knot.

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WebMD Health Services' Center for Research has recently completed some exciting new research surrounding #EmployeeExperience and #WellBeing. Next Wednesday, June 26th @ 10AM PT and 1PM ET they are hosting a webinar to share valuable insights uncovered when navigating workplace dynamics and enhancing employee engagement. A few key takeaways from the session will include: - Understanding current factors influencing the employee experience - Exploring employee perceptions on well-being and burnout - Learning practical insights to enhance your workforce strategies Don't miss this opportunity to gain fresh perspectives on fostering a positive work environment and improving overall employee satisfaction. Register now to benefit from scientific evidence-based research and real-world case studies. https://lnkd.in/gnQbBGJh #EmployeeExperience #Wellbeing #Webinar

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And why? With the EPIC vs Particle Health debate, the business-side of the situation is just being pushed even more towards the front. TEFCA participation is voluntary. Regional HIE participation is voluntary. Even Care Everywhere is voluntary for EPIC-using systems. You know what is mandatory? Patient access. Why are we depending on competing businesses to make it work? The patient has the most at stake and has the most interest in information flowing and getting the best outcome. Give them the power to participate. The framework is already there. IYKYK, but that's what we do at Primary Record and that's why we do it.

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Interested in learning more about the new Medicaid managed care rules? Sellers Dorsey is hosting a webinar on Monday, May 20th at 1pmET where our experts will discuss the implications of the new rule as well as key considerations for states, providers, managed care plans, and others in the healthcare industry. Click on the link below to register. If you are a provider and benefit from Medicaid financing initiatives like directed payment programs (DPPs) there are important changes in store. https://lnkd.in/eR3h5HSA

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well worth the read if you are in managed healthcare.

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Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation

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This recent article from the National Association of Medicaid Directors (NAMD) highlights just how challenging it can be for state Medicaid programs to improve and innovate their service delivery models. As the article states, these projects "can take as long as five years to implement" from start to finish. With such a drawn-out timeline, it's crucial for states to have the right strategies and technology solutions in place to drive improvements and meet their goals for population health and wellness. The path to meaningful Medicaid reform may be long, but we're committed to helping state agencies accelerate progress with rapid ROI to immediate impact. https://lnkd.in/er_TWYqn #Medicaid, #HHSIT, #systemsofengagement https://lnkd.in/e_drbdRF

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Happy to share my new research showing that growth in #340B provider participation over the past decade was associated with a significant ($32 billion annually!) increase in overall per-enrollee Medicaid spending. The 340B program leads to distortions in provider behavior that appear to reverberate across the system. Read the full report to learn about the impact of 340B and the program’s cost to taxpayers: https://bit.ly/4c4p3dG 

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I am happy to share Sellers Dorsey's slide deck summary of the Medicaid managed care rule CMS released on April 22nd. This contains a terrific overview of the rule's impacts on Medicaid financing and how such initiatives will need to be designed in the future. https://lnkd.in/eEPKgkWa

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AccendoWave - A Pain #Data Company More recently, the federal government has begun using the QIS program and QRS parameters to advance health equity. Federal rules now require all marketplace insurers to adopt a strategy for reducing health disparities and to stratify certain clinical data by race and ethnicity. While state-based marketplaces (SBMs) have authority to supplement these federal minimum QIS and QRS standards with state-specific quality rules, most have hewed closely to the federal default approach. California and Washington are notable exceptions. Each has implemented a customized QIS program and robust data collection standards to identify and reduce racial and ethnic health disparities. Time to Focus on - #Pain not being Believed. A Root Cause Health Equity Problem. 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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The CMS Innovation Center (CMMI) announced the Transforming Episode Accountability Model, a proposed mandatory episode-based bundled payment model, is slated to begin in January 2026. It is among a list of alternative payment models supporting CMS's goal to have all Medicare beneficiaries in an accountable care relationship by 2030. The five-year model structure marks significant changes from previous versions and reflects how the approach to bundled payments is evolving.

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There’s a lot of hype around Qualified Health Information Networks, or #QHINs. And while they have a lot to offer healthcare, what do they mean for you specifically? Check out 17 scenarios for EHRs, pharmacies and payers where QHINs prove their worth https://ow.ly/Pjr830sCWRg

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EXCITING NEWS IN HEALTH POLICY!!! The Centers for Medicare and Medicaid Services propose introducing baseline requirements for hospitals and critical access hospitals (CAH) in obstetrical services, marking a pivotal step towards revolutionizing maternal healthcare. The proposed rule can drive robust maternal quality improvement initiatives that set foundational standards for the organization, staffing, and care delivery within obstetrical units. Safeguarding emergency services readiness and establishing seamless transfer protocols for obstetrical patients can significantly enhance the quality and safety of maternal care. Furthermore, the rule requires annual staff training on evidence-based maternal health practices and cultural competencies, equipping healthcare professionals with the knowledge and skills to provide compassionate, high-quality care to every mother. This policy intervention promises to elevate the standard of maternal health services nationwide, ultimately saving thousands of lives and improving outcomes for countless families. https://lnkd.in/eAPr6Tg9 #MaternalHealth #QualityCare #HealthcareReform #SafeDeliveries #MaternalWellness #CompassionateCare

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🔎 Senators See Possible Conflicts of Interest in Health Care Pricing Tools The chairmen of two Senate committees overseeing health policy, Ron Wyden of Oregon and Bernie Sanders of Vermont, are looking into the practices of data analytics firm MultiPlan. Concerned about companies prioritizing their own profits over patient well-being, the senators are investigating MultiPlan's business model, which recommends lower payments to medical providers. This model could lead to a conflict of interest, as MultiPlan and insurers can collect higher fees when payouts are lower. The senators have called on MultiPlan to discuss their investigation and address concerns raised by a recent New York Times article. Read the full article here: Senators See Possible Conflicts of Interest in Health Care Pricing Tools MultiPlan has stated that they are working with the Senate committees to explain the complexities patients face when choosing high-priced care outside their networks, emphasizing their commitment to making healthcare transparent, fair, and affordable for all. This inquiry reflects the growing scrutiny of MultiPlan, which has faced allegations of anticompetitive behavior and collusion with insurers to fix prices. The Department of Labor also has ongoing investigations into the type of pricing services provided by MultiPlan. The attention on MultiPlan highlights the importance of employer-based health insurance, which is the most common way Americans receive coverage. Employers are increasingly looking into the cost of administering their plans and are frustrated by limited access to claims data. Legislation has been introduced to address this issue, requiring insurers to provide employers with claims data. As the investigation unfolds, it remains to be seen how MultiPlan and insurers will address concerns and ensure that patient well-being is prioritized over profits. #HealthCarePricing #PatientAdvocacy #HealthInsurance #DataAnalytics #SenateCommittees

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