Arminé Papouchian, MBA, FLMI

We can help make safe discharge plans if your loved one is being discharged from the hospital and you think they need more time to recover. If you need assistance we are here to help. Please call us directly. To reach us in California are direct line is 209-200-8222 To reach us for your Tennessee loved ones our direct line is 615-806-1973 Let us help make a safe discharge plan for your loved one. Reducing Hospital Readmissions Many patients discharged from a hospital return within 30 days for the same or related health conditions. This can rack up unnecessary expenses and cause further health issues - both of which are preventable. It's helpful to meet with the hospital discharge planner shortly before you are set to leave the hospital to make sure you have everything you need for a safe transition home. This includes all necessary medications, directions on how the medications are to be taken, specific instructions on physical limitations and dietary recommendations. Make sure to obtain information regarding follow-up physician visits, so nothing is overlooked. Patients often have trouble performing the regular activities of daily living following a hospital discharge. Injuries and ailments may make it difficult just to get out of bed and take care of personal hygiene and nutritional needs. It might be necessary to get help with these needs and other home care tasks following discharge. Some daily living activities caregivers can assist with following hospital discharge include: Bathing and dressing Going to the bathroom or incontinence care Laundry and linens Dusting and vacuuming Meal planning and preparation Errand assistance Attending follow-up appointments Extra care will allow you to focus on resting and recovering, rather than home and personal care tasks. Receiving extra care is also advantageous after fall injuries, as many people strain themselves and prolong the amount of time it takes to recover. Having assistance with tasks can greatly factor into reducing hospital readmissions and ease your mind, as everything is still being taken care of.

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CalPERS has announced a new contract with Blue Shield of California and it is being touted as revolutionary and groundbreaking. I'm highly skeptical. Starting in 2025, with a new five-year contract with Blue Shield of California and Included Health, 75% of these vendor's fees will be performance-based and at risk. But juxtaposed against CalPERS' annual health care expenditure—$3.4 billion for the Anthem population alone in 2022—this strategy might not be as transformative as touted. As CalPERS’ annual healthcare costs continue to rise, the "fees at risk," amounting to roughly $123.73 million annually, represent just a small slice of the massive overall spending pie. A conservative estimate dictates that administrative fees in toto account for less than 4% of CalPERS' annual healthcare expenditure Why am I skeptical? While vendor fees are tied to meeting specific cost containment and quality metrics, there is an established risk corridor of +/- 1.5%, over and above an actuarily set trend, that will provide a safety net to these vendors substantially limits their "risk" of losing out on fees. The cost trend targets are set conservatively, beginning with a reduction of just 1% from a 2025 trend that will be set by an actuary, and only tapering down to 3% by 2029. Such cautious targets, set by actuaries, suggest an approach that leans more towards maintaining the status quo rather than aggressively cutting costs. And as always, the devil is in the details... what is excluded from the contract's performance calculations? They acknowledge the exclusion of high-cost claimants, and the existence of other exclusions... all of which tend to put a thumb on the scale of the vendors hitting their targets while leaving CalPers exposed. As a hypothetical, suppose external factors lead to a total healthcare cost growth of 8% in 2025, exceeding the benchmark growth rate set at 4%. This results in a 4% cost overrun on the projected annual expenditure of $3.5 billion. This $140 million overrun, under the terms of the contract, may result in the vendors losing a portion of their fees since the cost growth exceeded the benchmark, including any amounts beyond the +/- 1.5% risk corridor. But make no mistake, the vendors are not covering the full freight of this miss directly. If they fail to meet the benchmark by more than this risk corridor, the maximum penalty they face is the loss of up to 75% of their fees, depending upon the specific contract terms. Is the penalty substantial to the vendor? Absolutely. Is CalPERS made whole if the vendors fail to hit their contractually guaranteed metrics? No. While innovative on paper and fundamentally better than most TPA contracts and financial guarantees, I am not convinced this fundamentally alters the financial or healthcare quality landscape for members. "Teaching to the test" is an analogy that comes to mind.

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California hospitals sue Anthem Blue Cross over discharge delays Author :: Rylee Wilson The California Hospital Association is alleging Anthem Blue Cross of California violated the state's patient safety laws by failing to facilitate members' transfer to post-acute care. In a lawsuit filed in Los Angeles County court April 23, the association alleged Anthem is causing patients to "languish in hospitals when they are ready for post-acute care." In the complaint, the association alleged around 4,500 patients are waiting in California hospitals and emergency departments for their insurer to approve post-acute care. Anthem is a "key offender," the association alleged. According to the CHA, in some cases, Anthem has discontinued coverage for ongoing hospital care before the provider and insurer have agreed on a post-discharge treatment plan for the patient. Anthem fails to identify or arrange in-network post-acute care facilities for patients, and "does not timely respond — or respond at all — to requests for authorization for post-acute care for its members," the CHA alleged. In one example the CHA provided in the lawsuit, an Anthem Blue Cross member was admitted to a hospital, and Anthem authorized four days of inpatient care. The patient was discharged to post-acute care after four days but remained in the hospital for 28 more days after Anthem "failed to arrange" care for the patient, the association alleged. Anthem denied payment for the 28 days the patient spent in the hospital waiting for a bed in a post-acute care facility, the CHA alleged. The California Hospital Association represents more than 400 hospitals in the state. Anthem, a subsidiary of Elevance Health, has 7.9 million members in California, according to its website. It is the second-largest insurer in the state, behind Kaiser Permanente, according to CalMatters. In its complaint, the CHA asked a judge to issue an injunction barring Anthem from denying payment for inpatient care before reaching an agreement with providers on a post-acute care plan for patients. "Regrettably, far too many insurance companies that put their bottom lines over patient care are violating these essential patient protection laws every day, hurting patients, hospitals and the public good," CHA President and CEO Carmela Coyle said in a news release. "By filing this lawsuit, we are asking the court to put a stop to these illegal practices and force insurers to do what is best for patients." California law does not specify how quickly insurers must authorize post-acute care, the state's Department of Managed Health Care told CalMatters. Complaints about delayed care are handled on a case-by-case basis. .

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Enhanced Care Management (ECM) is a whole-person healthcare approach that improves care coordination and outcomes for California’s most vulnerable populations. This statewide benefit addresses the complex needs of high-risk members, from those experiencing homelessness to individuals with #MentalHealth and substance use disorders. Read the full CareThreads blog to learn how ECM provides dedicated care managers and leverages tools for efficient service delivery, ensuring timely interventions and better health outcomes for Californians: https://okt.to/n6Gx5N

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Listen to the latest episode and learn how innovation and compassion for a community is improving oral health in Oregon!

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Loneliness is a pervasive, unintended consequence of remote work. A new WSJ article has some important takeaways: /1/ 📈 Recent Cigna poll of 10,000 Americans revealed that the percentage of U.S. adults identifying as lonely has risen to 58% from 46% in 2018. Cigna estimates that loneliness is responsible for a $154 billion annual cost to companies due to absenteeism. /2/ 📅 2023 survey: "People who described themselves as “very lonely” tended to have heavier meeting loads than less-lonely staffers." /3/ 🗣️ Jessica Methot, PhD of Rutgers University: "Office chitchat, sometimes an unwanted distraction, seems to provide more benefits than many people realize." Sarah Wright, PhD of New Zealand’s University of Canterbury: “More and more, though, we’re seeing it’s these day-to-day weak ties and frequency of [interactions] with people that matters.” 👉 Read the full article: https://lnkd.in/e-TgkVzj

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There is great news in the shocking findings from the FTC. The easiest thing for an employer to shift from a profiteering PBM (all of the mega PBMs) to a high value PBM. Literally, lives are on the line. 10's of millions of Americans don't fill prescriptions or they cut pills/insulin doses due to cost. Tragic stories are in the news all the time about someone dying due to self-rationing because of Rx costs. If you want to meet the high-value orgs in the Rx arena, there's no better place than #RosettaFest where they gather DisclosedRx A-S Medication Solutions TrueScripts Management Services Costco Wholesale Health Solutions, HaloScrips Liviniti EHIM, Inc. US-RX Care Serve You Rx Vivid Clear Rx ScriptSourcing, LLC Kroger Prescription Plans, Inc. Ventegra

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This article sheds more light on the #healthcare access challenge we’re facing in the U.S. Expanding access to care is one of our highest priorities at Sutter Health so we can help more patients lead better, healthier lives and make it quicker for them to receive care. This includes adding clinical capacity by growing our workforce – including the number of #physicians affiliated with our system. We’re not only recruiting today’s physicians, we’re investing in tomorrow’s through a significant commitment to and expansion of our Graduate Medical Education programs, which will ultimately train 1,000 residents and fellows a year. We’re also expanding our presence in the communities we serve by building new care centers, enhancing our existing facilities to ensure they best meet the needs of those we serve, and using #digital tools to make our care more accessible. It’s a big challenge and there’s much more to be done, but we’re making real progress thanks to great work by teams across our organization and our focus on making it easier for patients to navigate their care and engage with us when, where and how they want!

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Caregiving is a noble journey, but it's essential to prioritize your well-being along the way! These tips help to avoid caregiver burnout. Learn more at OasisSeniorAdvisors.com

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Caregiving is a noble journey, but it's essential to prioritize your well-being along the way! These tips help to avoid caregiver burnout. Learn more at OasisSeniorAdvisors.com

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Because only 11% of opioid use disorder (OUD) get treatment, last year 112,000 opioid overdose deaths occurred at a $1.5 trillion cost to the U.S. economy. From a fiscal perspective. Medicaid covers 70% of OUD. Getting treatment to the other 90% who need treatment would reduce healthcare utilization which would be far less that the $13.3 million each death cost. ($1.5 trillion/112,000 deaths). If an additional 25% patients were to get treatment, $375 million could potentially be saved. If Medicaid managed care coverage increased coverage of OUD we could save money From a human life perspective, we have medications that can reduce the overdose death rate by over 50% but only 1/3 of OUD clinics and 1% of jails prescribe them. If we could securely deliver, store, dispense, and destroy unused pill with iPill, patients would gain greater access to treatment, barriers to care would be reduced, and caregivers would be less hesitant too prescribe these medications for fear of abuse, diversion, and accidental overdoses. If Medicaid managed care coverage increased coverage of OUD we could save lives too.

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California becomes the latest state to attempt the fool’s errand of telling #healthcare interested parties to restrain their margins (#hospitals, #physicians, #pharma, #homehealth, device makers, etc) in the interest of the #TripleAim or else! Wish state legislators the best of luck as policymakers attempt to tame the state’s half Trillion dollar healthcare economy. Never forget Uwe’s Cosmic Rule of Healthcare: “every dollar of healthcare spending = someone else’s dollar of healthcare revenue”. The effort “will require a sustained wrestling match with a sprawling, often dysfunctional health system and powerful industry players who have lots of experience fighting one another and the state.” I’ll say! Heard predicted at a healthcare conference many years ago by Senator Ron Wyden of Oregon “True meaningful #healthcarereform will never happen at the state level”. Add California to the growing list of states to prove him correct. #healthcarecosts #healthcarevalue #valuebasedhealthcare #patientcenteredcare #PrimaryCare #HealthEquity

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🌟 Excited to Share: Top-Flight Behavioral Healthcare for All! 🌟 We are thrilled to announce the publication of an important piece on the Innovation in Behavioral Health (IBH) pilot program. This initiative aims to provide coordinated care for mental health conditions and substance use disorders, linking Medicare and Medicaid beneficiaries with community-based providers. This comprehensive approach addresses both physical and mental health, as well as social factors like food insecurity and housing instability. A huge shoutout to Dede Kennedy and the NABIP Mental Health Working Group for their incredible efforts. This article was a collaborative effort, with invaluable guidance of the NABIP Consumer Bill of Rights. Two key highlights: • Expanding Coverage: Extending IBH to those with employer-sponsored insurance could increase access and save taxpayers money. • Integrated Approach: Patients will receive health screenings, outpatient care, specialist referrals, and ongoing monitoring, ensuring holistic support. Key Recommendations: • Consistent Care: Ensuring ongoing care to prevent relapse and maintain health improvements. • Adding Dental and Vision Care: Essential for full recovery and community integration. • Employer Marketplace: Expanding the IBH model to include those with employer-sponsored coverage would ensure more people benefit from this comprehensive care approach and could help prevent relapse by maintaining access to critical coordinated care. Go NABIP team! 💪 #MentalHealth #IBHProgram #NABIP #BehavioralHealth #CMS Centers for Medicare & Medicaid Services Modern Healthcare

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If you’re interested in quality caregiving, here’s another helpful resource I highly recommend checking out: the Washington State Department of Health. This resource provides a wealth of information and support for those seeking to ensure the highest standards in home care services. 1. Certified Homecare Aides & Certified Nursing Assistants (CNAs): The Washington State Department of Health offers detailed guidelines and certification processes for homecare aides and CNAs, ensuring that caregivers are well-trained and qualified to provide excellent care. 2. Fingerprint Background Checks: To maintain safety and trust, the department mandates fingerprint background checks for all caregivers. This thorough screening process helps to ensure that only individuals with clean records are allowed to provide care. 3. Regular Employment Checks: The department also conducts regular employment checks to verify the ongoing qualifications and performance of caregivers. This continuous monitoring helps to maintain high standards in the caregiving profession. I encourage you to bookmark this valuable resource for future reference. For more information or if you have any questions, please feel free to contact us by calling 360-883-3569. We are here to assist you with any inquiries you may have regarding caregiving services. #HomeCare #CertifiedCaregivers #AgingSupport #Caregiving #InHomeCare #CaseManagement #Community #VanWA #ClarkCountyWA

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Hospitals raking in profits often do so despite losing money on maternity care -- the service has long been deemed a money-loser. That's in part because Medi-Cal California's public insurance program, which covers half of all births statewide, has had the fifth lowest reimbursement rate for obstetrics in the country, according to the Kaiser Family Foundation. Private insurance pays roughly five times more for an uncomplicated vaginal delivery. Simply put, when for-profit hospitals look at the bottom line and choose to make cuts, one of the first services to disappear is usually maternity care. https://lnkd.in/e8gQJYq2

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