Dr. Felicia McLeod Abram

"Rarely have the pathologies of the Medicare Physician Fee Schedule portended such poor outcomes for the future of U.S. healthcare as they do now." In a new Healthcare Financial Management Association (HFMA) blog, APG President and CEO Susan Dentzer describes the four main flaws in the Medicare Physician Fee Schedule. "Those of us hoping for a better system for paying physicians should keep pushing for alternative payment models." #valuebasedcare #Medicare #healthcarecosts Read the blog: https://lnkd.in/dGVE8dfM

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How virtual primary care can amplify value for providers and patients

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Medicare Advantage plans require an increased commitment to improving risk adjustment coding practices while optimizing medical record retrieval and interoperability. But health plans don’t have to handle these challenges alone! Watch our on-demand RISE webinar, where Cotiviti’s risk adjustment experts unravel trends shaping 2024 and beyond. https://bit.ly/49HsK7m #RiskAdjustment #HealthPlans

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Learn how data management can elevate value-based care. Discover how to overcome data management challenges and drive better patient outcomes. Learn about the latest VBC trends, including CMS's goal for 100% Medicare beneficiary coverage by 2030 and the projected $1 trillion market value. Don't miss out on key strategies to enhance interoperability, enable real-time data access, and integrate external data sources for comprehensive patient care. Read our latest blog post to transform your healthcare organization's approach to value-based care: https://buff.ly/3xIRbo4 #ValueBasedCare #HDMP #HealthDataManagement"

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With the CDC projecting that over 25% of the total adult population in the US will have MD-diagnosed arthritis by the year 2040, chronic MSK conditions are set to be frequent and costly—especially for Medicare members. Read our newest claims analysis of adults aged 65+ and find out how to save $3,289 per member per year. Download the report to get the full details: https://lnkd.in/gVz4Kdwc

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A new AHA report shows hospitals and health systems face mounting administrative burden and costs due to some commercial health insurer practices like prior authorization and denials. Meanwhile, health insurance premiums grew twice as fast as hospital prices in 2023. Read the report: https://ow.ly/1N6B50RAsom

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  Earlier this year, Centers for Medicare & Medicaid Services provided guidance encouraging #PACE organizations to start submitting risk adjustment data using the Encounter Data System.   Will the transition impact program risk scores or reimbursement? Read our blog post to find out and get answers to other key questions.   👉 Learn more: https://lnkd.in/eQ4dTmCQ #RiskAdjustment #ValueBasedCare

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Today's 📢 #HealthInsuranceNews 📢 comes out of 🌟 The Lone Star State 🌟of #Texas where contracting issues and provider challenges are shaking up the health insurance landscape in the state. 💡 Baylor Scott and White vs. Blue Cross Blue Shield (#BCBS): There's a standoff over #contract terms, potentially leading to Baylor Scott and White Health facilities going out-of-network (#OON) for Blue Cross Blue Shield of Texas policyholders by July 1. This affects various plans including ParPlan, Health Select, and Blue Choice PPO, among others. 💡 Medicaid Contract Disputes: The Texas Health and Human Services Commission's decision not to renew #Medicaid contracts for Cook Children's Health Plan and others has sparked controversy. Nearly ❗ 2 million ❗ #Texans may need to switch #plans unless the decision is reversed. 💡 Steward Health Care's Restructuring: Steward Health Care's bankruptcy filing and plans to sell more than 30 #hospitals could impact #healthcare access, particularly in #rural areas. Concerns are raised over potential hospital closures and the fate of healthcare workers' #benefits. #ACA #WhatTheHealth #MCG #SBM101 #SBMU https://lnkd.in/eurieiPD https://lnkd.in/dVBbUPrk

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HPO, short for Health Payers Organization, is designed to simplify the complexities of out-of-network claims. Not every provider participates in every network, so HPO steps in when your members access care from an out-of-network provider. Learn how HPO extends access to quality care while minimizing the hassle and costs associated with out-of-network claims. #HealthcareSolutions #HPO #HealthBenefit https://bit.ly/4bPCjTd

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Insurance Denials Strain NICU Operations and Physician Resources Insurance denials are posing significant challenges for Neonatal Intensive Care Units (NICUs) across the United States, leading to operational issues and increased physician burnout. As insurance companies frequently deny coverage for physician-recommended services, NICUs face difficulties with inpatient therapies, extended hospital stays, and patient transfers to less acute settings. This issue, highlighted by a recent survey from the Association of Academic Neonatology Division Directors, shows that 58% of respondents consider Peer-to-Peer (P2P) interactions and transfer denials as major problems. These denials consume physicians' time and detract from patient care. For more details please click the link! https://lnkd.in/ghunwtmv #marketaccess #reimbursement #pricing #hta #heor #healtheconomics #medicaldevices #pharmaceutical 

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Even more alarming, the CDC estimates that 1 in 3 adults with severe Chronic Kidney Disease (CKD) are unaware they have it… With our complimentary Comprehensive Data Analytics, Specialty Care Management can identify potential claimants before they escalate into multimillion-dollar claims, not only protecting the financial integrity of self-insured health plans, but also enhancing member wellbeing and preventing the need for dialysis with proven, clinical intervention. What’s more, our programs can be implemented off-cycle, are TPA agnostic, and carry zero initiation, PEPM, or other ancillary fees, common amongst competitors. Let’s get to work — https://lnkd.in/eF689G5r #ChronicKidneyDisease #RenalDialysis #CostContainment #SpecialtyCM

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Navigating health insurance terminology can be overwhelming, especially when understanding these terms is crucial for making informed decisions about healthcare coverage. Whether you’re updating your policy or just want to better understand your current plan, this guide can help translate the complex language of health insurance policies into straightforward, actionable insights for your patients.  ​ Learn more: https://lnkd.in/gBvjmNGE ​ ​ #HealthInsurance #ThinkgBG #BGreat 

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No two people’s health needs are the same. We must put patients first. Providers should be held accountable for the total cost of care and outcomes for their patients. Ask Congress to support #HealthCareTransformation & patient-first policies. Learn more: https://lnkd.in/g58BUfDb

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No two people’s health needs are the same. We must put patients first. Providers should be held accountable for the total cost of care and outcomes for their patients. Ask Congress to support #HealthCareTransformation & patient-first policies. Learn more: https://lnkd.in/g58BUfDb

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