Chris Esguerra, MD, MBA

🏥 Colorado’s recently passed SB24-168 bill mandates that the Colorado Department of Health Care Policy and Financing reimburse specific Medicaid members for using telehealth remote monitoring for outpatient services. Read more here: https://buff.ly/3XjquRg+ #Healthcare #HomeHealthcare #PatientSupport #DigitalHealthcare #PatientCare #Telehealth #HealthcareTechnology #CardiacDisease

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States now have opportunities to improve Medicaid coverage for incarcerated individuals, offering pre-release services & expanding eligibility. This article dissects CMS recommendations, proposing strategies for improved community connection & health care. https://ja.ma/45s4A0x

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The Health Resources and Services Administration (HRSAgov), HHS released new guidance about changes to the 2024 Uniform Data System (UDS) report. Under this new requirement FQHCs will now be required to report on the number of patients screened for their family planning needs. The new reporting requirement applies to patients seen after Jan. 1, 2024. When patients are screened for their reproductive health needs, it can prompt important conversations that may otherwise go undressed. This is an important step forward to ensure that contraceptive care is basic healthcare. We applaud HRSA for this important update! https://hubs.ly/Q02tp8Pp0

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Just released! Our #SDOH and #HealthEquity Workgroup has published "Recommendations for Determinant Capture," suggested guidelines for standardizing how domain risk is captured in #EHRs. "Absence of clear guidelines for risk assessment and standardized representation of risks in EHRs hinders effective data exchange to inform interactions at the point of care," writes the Workgroup. Click here to download: https://ow.ly/WTaj50RpvuC

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Sg2 has released its 2024 Impact of Change® Forecast! We're projecting continued constraints on patient access to emergency department and inpatient care. Led by an aging population and an increased incidence of chronic disease and conditions such as behavioral health, inpatient and outpatient volumes will continue to increase over the next decade, impacting how and where organizations deliver care. Learn more here: https://bit.ly/4eeJkPI

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In their new Forefront article, Abe Sutton and Gabriel Drapos from Honest Medical Group and Pearl Health argue that Medicare should pilot a data-driven, inference-based approach to establishing patient risk scores – and, therefore, budgets – for MA plans and value-based Accountable Care Organizations (ACOs). "RAF was originally created to ensure Medicare Advantage (MA) plans were not structurally incentivized to avoid enrolling sicker Medicare members. However, MA plans have been under increased scrutiny for “over-coding” patients – documenting conditions at a more acute or exacerbated level than may be clinically warranted. This increases costs to the system through artificially high premiums. Per a recent estimate, MA patients were 9.5 percent more expensive than comparable beneficiaries in Original Medicare." Read the full article here: https://bit.ly/4b4ZR6o

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How can CMS address over-coding, budget inflation, and administrative burden in Medicare Advantage and value-based care models? Gabe Drapos, Chief Operating and Compliance Officer at Pearl Health, and Abe Sutton, Co-Founder of Honest Medical Group and Investment Professional at Rubicon Founders, believe that switching from the current Risk Adjustment Factor (RAF) system to a data-driven inferred RAF system would help. Their recently-published Health Affairs article covers the challenges posed by our current RAF system, benefits and risks of transitioning to an inferred RAF system, and implementation recommendations to pilot and refine the new system before implementing it more broadly. Access the full article here: https://lnkd.in/dJH-BhB6 #valuebasedcare #accountablecareorganizations #medicareadvantage #healthcareinnovation #raf #medicare

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According to a recent Healthcare Dive report, over 20 million Medicaid beneficiaries have been disenrolled since redetermination began in early 2023--and a quarter of adults report still being uninsured. Even more concerning, children account for a large percentage of beneficiaries who have been disenrolled, often due to procedural issues, process misunderstandings, and system errors. This has caused doubt and frustration in populations and patients who have lost access to important care. If you are a payer in this space, how are you working to build back trust and enrollment in your community? What technologies and tools are you using to support these efforts?

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Explore the latest insights in health policy and health data with the Freedman HealthCare APCD Journal. Recent blog posts discuss state efforts to compare social risk measurement, how APCDs are starting to collect information on gym memberships and other supplemental benefits, and compelling ways to visualize public data on hospital price variation. The APCD Journal offers quick, compelling reads to keep you up to date. Give it a read at https://apcdjournal.com/ and let us know what we should write about next. 

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In their new Forefront article, Raj Ratwani, David Bates, and Jeffrey Gold from MedStar Health, Brigham and Women's Hospital, and Oregon Health & Science University argue that, as the evidence base for EHR contributions to diagnostic error grows, several actions should be taken to address this patient safety issue. "With the vast majority of health care providers adopting electronic health records (EHRs), these systems have become the primary source of nearly all patient information and, therefore, are central to a physician’s cognitive process during diagnosis. However, EHRs do not make reaching a correct diagnosis easy, and studies have identified usability challenges with EHRs and their contributions to patient safety issues in adults and children. These usability issues are broad, ranging from critical clinical information being difficult to find in the record to poor visual displays of patient information that obscure trends in test results. Recently, a systematic review identified EHR contributions to diagnostic error across the diagnostic process, with EHR issues spanning the gamut from usability to training. This was confirmed through analysis of legal claims." Read the full article here: https://bit.ly/3xRqq0E

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This NPR article about #CalAIM and its impact on nonprofits hits home. Who is really benefitting from CalAIM and #Medicaid innovation? So far, it's the cottage industry of companies that are implementing changes. The benefits haven't really trickled down to frontline nonprofit workers, and haven't made a dent yet on root causes of poverty and race and class inequity. #socialcare #sdoh #healthequity #socialimpact

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In our latest blog, Sarabeth Zemel discusses the support for utilizing Community Care Hubs in states' #Medicaid 1115 waivers as they work to address health related social needs (#HRSNs). Read more about the innovative strategies that states are implementing here: https://lnkd.in/g_xXDNQU #1115Waiver #NorthCarolina #NYS #CalAIM

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In their new Forefront article, Alex D. Federman, Isaac O. Longobardi, Heidi W. Steinecker, April Diaz, David G. Stevenson, and Kathy Bradley from the Icahn School of Medicine at Mount Sinai, the Moving Forward Coalition, EY, Marquis Companies, Vanderbilt University, and OUR MOTHERS VOICE discuss how they have identified four ways to increase the efficiency of the CMS nursing home survey process without sacrificing survey quality. "In recent years, due to the COVID-19 pandemic and other factors, many state survey agencies are months, if not years, behind. According to a Senate Special Committee on Aging report, nearly one in nine nursing homes have not had a survey in two years. Delayed surveys enable poor conditions to persist or worsen, putting nursing home residents at risk for serious harm and death. They also undermine the timeliness and reliability of the Centers for Medicare and Medicaid Services (CMS) Five-Star Quality Rating System, which is based partly on survey results." Read the full article here: https://bit.ly/4cljrMh

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Thoughtful, complete primer by Center for Health Care Strategies on how to develop primary care population-based payment models in Medicaid. Recommended reading for Medicaid policy makers, as well as those operating in the government program value-based space. I've spent a lot of time thinking through how to bring value-based care to Medicaid, feel like the authors identified most, if not all the key elements. I think risk adjustment, as identified in the primer, is what can move this from theory to reality. As we know states their need to close the books annually, so a key challenge is creating a risk adjustment methodology that meets VBC goals and keeps the program on budget. Appreciate the suggestions of both medical AND social risk adjustment as an approach. Loved this quote, "When developing a social risk adjustment methodology, it is important for states to understand their goals for the adjustment: Is it to predict costs as accurately as possible or increase investment in primary care? Could it be both? Or are there potentially other goals to consider?" Would Centers for Medicare & Medicaid Services ever consider have federal dollars pay for Medicaid risk adjustment?

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Today I'm both grateful and wondering how NPR, KFF Health News and the Newsom Administration missed an opportunity to promote the state TA Marketplace giving CBO's FREE expertise to sustain and scale their services. Just Whole Care is helping CBO's just like the ones named, provide and sustain intensive care coordination (aka ECM) and asthma remediation - as well as other services addressing physical, behavioral, and essential needs through integrated, equitable, trauma-informed care, impact measurement, and systems change. It's ALL thanks to the TA Marketplace (TAM) neglected by this piece. We're talking small, Black-owned CBO's leveling up with measurement-based, equitable care and new payment methods near overnight; at least by Medicaid standards. The TAM will be critical in light of difficult budget cuts the Administration proposed last week to maternal child health, behavioral health, and public health. (Thoughts to come as details arrive.) So let's make sure we and the media ALL give credit where it's due. The California Department of Health Care Services under Secretary Ghaly, Directors Baass and Sadwith, and leaders like Palav Babaria and at PCG’s Health team are CRUSHING it - resourcing and marshalling #healthequity expertise for diverse, marginalized California communities. And doing so, using a free-market approach, California style! 🤓💪🏼🚀 For more on the TAM: https://lnkd.in/ezHTk8F3 For more on how JWC helps TAM-funded CBO's: https://lnkd.in/eK-T2_7A #gratitudeistheattitude #mentalhealthishealth #SDOH are health. Thanks Lonnie Hirsch for highlighting this for me! https://lnkd.in/egiUiXKJ

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Wondering how to reduce healthcare disparities through data and collaboration? Watch our latest healing healthcare episode.

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As we explained previously, funding for the Patient-Centered Outcomes Research Institute (PCORI) was supposed to end with filings and fees for plan years that began before October 1, 2019. In the words of the great philosopher Emily Litella, “Never mind.” As part of the Bipartisan Budget Act of 2019, the PCORI annual filing and fees were reinstated for an additional 10 years, through 2029. That means that all employers (or their insurers in fully insured group health plans) must file the annual IRS Form 720 (instructions here) by July 31st of each year, regardless of their plan year. #PCORI #SHRM #Form720 https://kushner.co/3yOKdy4

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Yesterday, COGR submitted a letter in response to the Centers for Medicare & Medicaid Services (CMS) RFI on Research Data Request and Access Policy Changes.   The current CMS system permits researchers to obtain physical data extracts of CMS Research Identifiable File data (“RIF Data”) for use on institutional systems that meet CMS-prescribed data security standards. CMS has proposed changes that would prohibit the release of physical data, and instead require researchers to solely access RIF Data via CMS’ Chronic Conditions Warehouse Virtual Research Data Center (CCW VRDC).    This would harm important health-related research.   COGR’s response highlights how the proposed changes would severely curtail researchers’ ability to link RIF Data with other data sets and use the wide variety of analytical tools that are available at their institutions. These changes would impede both on-going federally funded research and the development of new research projects that are vital to improving patient outcomes and lowering healthcare costs.    COGR’s response also expresses strong concerns about proposed steep increases in fees that researchers will be required to pay to access the CCW VRDC. These increases will pose a substantial cost burden for all institutions and especially harm the ability of emerging research institutions and early-stage researchers to conduct research using CMS data.    Bottom Line: COGR urges CMS to reconsider the proposed changes and instead permit continued access to physical data while working with the research community, as necessary, to explore alternate mechanisms to address data security concerns. COGR Letter: https://lnkd.in/eRu6Mu27 CMS Request for Information: https://lnkd.in/egPMCyQE

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