Erik Cardenas

Here's a shocker -- the AHA and the FAH are pushing back against Medicare's mandatory hospital-based bundled payment program. The hospital associations are asking for more time to get ready for a program that will start in 19 months.... It's laughable, of course, but what else should we expect from the agents of the status quo? For those who hadn't kept up, Medicare announced the Transforming Episode Accountability Model several months ago and it's finally going through the end of the rulemaking process. So what's TEAM? A slimmed down version of the Medicare Bundled Payment Model (BPCI and its successor BPCIA) that has been in place for over a decade. There's nothing new about TEAM except that it only covers a handful of inpatient stays and the accountability is reduced to 30 days post discharge instead of 90. Four years ago a dozen or so highly respected leaders in the industry recommended that CMS institute a "DRG+30" across the board. Not just for five DRGs, but all DRGs. And here we are, four years later, and TEAM is set to start in 2026....yes, 2026, not 2025. The first cohort of the original program launched in April 2013, more than 11 years ago. By the time TEAM starts it will have been close to 13 years. Isn't that enough time to get ready Chip Kahn???? All of the published analyses on the Medicare Bundled Payment program showed the same source of savings -- post-acute care. And the savings never negatively impacted outcomes. So it's logical that Medicare makes this mandatory. What's not logical is that it's taken so much time to get to this decision. So let's just get on with it because the taxpayers deserve it and so do Medicare beneficiaries. #TEAM, #BundledPayments, #CMMI

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In order to transform US healthcare the first step is to SEPARATE primary care from secondary/tertiary care. Reposition PC in our society as ESSENTIAL PUBLIC HEALTH. United States-Primary Care (US-PC) should be viewed as an independent system. All people in the US should be incentivized to regularly engage with US-PC. Eliminate ALL BARRIERS for all people in the US in establishing and remaining in continuous, relational care with a #neighborhoodprimarycare team. US-PC does not require insurance. US-PC is FREE at the level of service and lavishly available in our neighborhoods. #neighborhoodprimarycare is a #civicduty The oversight of US-PC is streamlined and lean. Oversight is done by the peer licensure boards that each state ALREADY HAS for each of its licensed healthcare professions. US-PC should be high-quality, primary care. High-quality primary care is the care provided by interprofessional teams reflective of the neighborhood served and capable/equipped to address whole person health needs across the lifespan (sociological, psychological, biological, and spiritual). https://lnkd.in/gFZ-EEJX Private-public partnerships in neighborhoods, towns, and cities develop the new US-PC system. The federal government has a role in funding grants to facilitate, pilot and spread the new locally-owned model for primary care for all. The federal government ensures success of the locally-powered US-PC efforts in a supportive not a directive way. #neighborhoodprimarycare is a #civicduty that is the responsibility of the local community. US-PC can be conceivably operationalized within the next 5 years. Ludmila Praslova, Ph.D., SHRM-SCP, Âû's #canarycode can help us think through this new concept of US-PC. When we strategically plan our healthcare system with the primary intention to support the least powered and most disadvantaged among us - this planning efficiently/effectively helps ALL of us! US-PC is a public good. Provide US-PC with ZERO barrier! Heal our healthcare system with "Main Street" AND Public Health sense! Interested in the thoughtful reflections from our relational, intergenerational, and interprofessional primary care community.

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Are you still working on a synchronous healthcare platform? Looking at how healthcare is trending, synchronous telehealth and synchronous care are crowded out by asynchronous care. Healthcare has always been divided between those who have and those who have little. Knowing what you're building and who you're building it for should dictate what kind of interaction you optimize for.

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In this blog post written for Health Tech Idaho by Jason Hudson, Rourke Yeakley, MD and I break down in simple, easy to understand principles of why we need to switch away from historical #feeforservice healthcare billing and care delivery. Enjoy!

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Primary care is the cornerstone of community health, yet our system consistently underinvests in primary care. Providers and patients acutely feel the primary care workforce shortage. Let's create a better primary care system for our communities by investing, reforming, and innovating in primary care! #primarycare #populationhealth #qualityhealthcare #primarycareshortage #valuebasedcare https://lnkd.in/e9wydDJB

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Looking to enhance your practice's approach to integrated #behavioralhealth care? The AMA's updated BHI Compendium offers comprehensive guidance, including eight new building blocks for seamless implementation.

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As healthcare costs continue to rise it is imperative for health plans to have a strong network strategy to manage cost of care. At CareCentrix we partner with our health plan clients and provider network to support goals for improved plan and provider performance with patient care at the forefront.

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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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HEALTH CARE TRANSFORMATION SUMMIT: June 10-11 Explore the present and future of health care at our Inaugural Health Care Transformation Summit. This will be a comprehensive gathering of Indiana’s largest health care stakeholders to foster ideas and solutions to improve health care outcomes, increase access, and decrease costs for patients, providers and employers. Attendees will gain perspective on the short- and long-term evolution of the health care industry, including the impacts on today’s workplace. This is a unique opportunity to understand where we are today and where we’re going in the future. Panel topics include: - Employer Strategies - Obesity in the Workplace - Ensuring Access to Pharmacy Benefits and Supply Chain Security - Innovative Models of Health Care - Rural Health Care and the Role of Hospitals in the Future of Health Care - Role of Insurance Companies in the Future of Health Care - Emerging Models and Technology in Health Care - Price Transparency - Preventative Care and Precision Medications Presented by CVS Health. Register: https://lnkd.in/gAkVkDQ4 #healthcare #healthcaretransformation #healthcaresummit

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HEALTH CARE TRANSFORMATION SUMMIT: June 10-11 Explore the present and future of health care at our Inaugural Health Care Transformation Summit. This will be a comprehensive gathering of Indiana’s largest health care stakeholders to foster ideas and solutions to improve health care outcomes, increase access, and decrease costs for patients, providers and employers. Attendees will gain perspective on the short- and long-term evolution of the health care industry, including the impacts on today’s workplace. This is a unique opportunity to understand where we are today and where we’re going in the future. Panel topics include: - Employer Strategies - Obesity in the Workplace - Ensuring Access to Pharmacy Benefits and Supply Chain Security - Innovative Models of Health Care - Rural Health Care and the Role of Hospitals in the Future of Health Care - Role of Insurance Companies in the Future of Health Care - Emerging Models and Technology in Health Care - Price Transparency - Preventative Care and Precision Medications Presented by CVS Health. Register: https://lnkd.in/g7CesAPv #healthcare #healthcaretransformation

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Here's a quote from one of the authors of the recent Yale, UofW-Madison, Harvard, U of Chicago, the IRS and Treasury Department study: “We can use our analysis to estimate the effect of hospital mergers,” said Stuart Craig, an assistant professor at the University of Wisconsin-Madison Business School. “Our results show that a hospital merger that raised prices by 5% would result in $32 million in lost wages, 203 lost jobs, a $6.8 million reduction in federal tax revenue, and a death from suicide or overdose of a worker outside the health sector.” The study also showed that because rising health care prices leads firms to let go of workers, a knock-on effect of hospital mergers is that they lead to increases in government spending on unemployment insurance and reductions in the tax revenue collected by the federal government. Read more here. Please. We've said for years that the system is unsustainable. This study shows very clearly that we have reached that point. When rising costs lead to unemployment and suicide, in addition to simply more generalized misery, we've reached the break point, and keeping business as usual fuels this burning pyre of human hope. Unfortunately, we know that almost all carriers have been complicit in these price increases. Yes, mergers help tilt the negotiating power, but when your profitability is proportional to the misery that's created, you're not really motivated to put the fire out. And that's why the carriers happily fuel the burning pyre. And who fuels their growing pile of cash? Employers who have to lay off employees; employees who lose their jobs so that others can still receive health benefits; families that can no longer afford anything. This outcome is not inescapable. Quite the contrary. But it does require having the courage to make different choices.

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Integrating Primary Care, Behavioral Health, Social Determinants of Health (SDOH), and Care Coordination represents a paradigm shift in healthcare delivery. This holistic approach acknowledges the multifaceted nature of health, recognizing that a patient's well-being extends beyond the physical symptoms and includes mental health and social factors such as housing, food, education, and employment. Providers can offer more personalized and effective care plans by addressing these components collectively. Care coordination is the glue that holds this integrated model together. It ensures that all aspects of a patient's care are harmonized, with clear communication between different healthcare providers and the patient. This coordination is particularly crucial for patients with complex health needs requiring services from multiple healthcare sectors. In the evolving healthcare landscape, integrating Primary Care, Behavioral Health, Social Determinants of Health (SDOH), and Care Coordination stands out as a beacon of comprehensive patient-centered care. This approach ensures that every individual receives the holistic support they need to thrive while strengthening their trust and relationship with their healthcare teams.

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Cohere Health's Medical Director of Primary Care, Dr. Mary Krebs, wrote a recent piece for Healthcare Business Today on driving more equitable healthcare with AI-powered prior authorization. "Innovation and equity are now at the forefront of healthcare. By harnessing the power of SDOH data and building a system that incentivizes addressing social factors, we can move closer to a future where healthcare is equitable. Health plans can play a critical role in reaching this goal." 💡 Learn more from Dr. Krebs 👉 https://lnkd.in/efEryU7g

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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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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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As a health plan built by Community Health Centers (CHCs) to improve the health of their patients and communities, Community Health Plan of Washington (CHPW) has always been passionately committed to advancing health equity. Our ongoing efforts in 2023 reflected our dedication to creating a more just and inclusive health care system so that all people, regardless of background or circumstances, can live their healthiest lives. CHPW, our parent organization Community Health Network of Washington and its network of CHCs, and the Washington State Health Care Authority (HCA) entered the third year of the Equity Learning Collaborative Program, exploring ways to transform care by addressing health disparities. As part of the program, CHPW provided each participating CHC up to $50,000 in up-front capacity building funds each year to support projects aimed at closing health disparities based on their specifc local needs. To date, CHPW has provided nearly $2.3 million over a three-year period. Examples of notable projects undertaken with CHCs: • Expanding obstetrics services to improve access in rural communities (Family Health Centers) • Hiring a medical-legal partnership attorney to reduce social barriers attorney to reduce social barriers (Peninsula Community Health Services) • Eliminating barriers to cervical cancer screening for patients experiencing screening for patients experiencing housing insecurity (Yakima Neighborhood Health Services) • Beginning construction of a facility offering hygiene services for people experiencing homelessness (Unity Care NW) Building on success: “Being a part of the Equity Learning Collaborative Program with the CHCs has been one of my greatest career experiences at CHPW,” said Kayla Salazar Poncet, CHPW Manager of Equity Quality Performance. “I love hearing about the projects we are funding but seeing the health equity commitment across the network is truly what tells me this program is a success.” Laying a framework for equity: CHPW also achieved Health Equity Accreditation from the National Committee for Quality Assurance (NCQA), the industry quality accreditation organization that sets the standards for evaluating quality for health care organizations. The accreditation is recognized as a seal of approval in the health care industry and attests to an organization’s commitment to equitable health care and health outcomes. “The accreditation requires us to really look across our organization and ensure that we are delivering on high-quality, equitable health care to our members and where we are not, to address those gaps,” Poncet said. Read more about our work in communities throughout Washington State in the CHPW 2023 Annual Power of Community Report: https://lnkd.in/gUQ5dUeu #MyCHPW #PowerOfCommunity

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At TPN.health we are a mission-first company. Our goal is to improve patient outcomes.That means, every decision, every piece of code, and every product we launch is rooted in answering these questions: How does this serve our mission? How does what we're building improve behavioral health outcomes? How can we positively impact and create change in our industry?

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In recent years palliative care has been gaining ground, as more payers, providers and patients begin to realize what these services can do for them in terms of reducing costs and improving outcomes. Therefore, we can expect continued demand for palliative care, the slow evolution of payment models that could support further growth and more partnerships among providers across the continuum designed to boost utilization and slash expenditures. https://buff.ly/3QjwGEv #PalliativeCare #PalliativeCareServices

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🚨 40% of Hospitals Are Losing Money! (Source: Kaufman Hall) 🚨 https://lnkd.in/eEenrkWG While many will shrug and say it is not a big deal because it is the smaller hospitals that are unprofitable, but the reality is much more significant. These hospitals often serve as the largest employers in their communities. When a rural hospital closes, it doesn't just impact healthcare; it devastates local businesses, the broader economy, and the health of that community. Moreover, the presence of a nearby hospital is a critical factor for businesses scouting new locations. Companies know they can't attract top talent if the nearest hospital is in the next county or town. Unfortunately, these hospitals are frequently overlooked by vendors, making it harder for them to thrive. At VantageHealth.ai (and our sister company CompliantHealth.com), we are committed to addressing these challenges. Our value-added solutions aim to move hospitals from red to black through improved revenue streams, reduced costs, increased compliance, and enhanced patient engagement. Let's work together to support these vital institutions and ensure they continue to serve their communities effectively. #Healthcare #RuralHealth #HospitalManagement #CommunityImpact #HealthcareInnovation

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