UT Southwestern Medical Center’s Post

Sometimes more care is the answer to lowering health care costs as Laura Martin Dillon and I shared in Medical Economics this week. https://lnkd.in/em5eE4aN #primarycare #aafp #ey #eyhealth #healthpolicy

In a pair of newly-released Forefront articles, Thomas Priselac of the Cedars Sinai Health System and Paul Ginsburg of the University of Southern California take on one of the most enduring debates in health care policy and financing: the role and significance of cost-shifting from public to private payers. Check out their differing perspectives and join in the discussion! You can read both pieces (Priselac, https://bit.ly/3PpkxwN Ginsburg, https://bit.ly/3Zr3Oxu) today.

Every medical decision should be made with risk vs benefit vs cost analysis in mind… if more patients had there own dollars and were educated about shared decision making using a risk/benefit/cost analysis this would begin to shift to giving agency back to whom it belongs…. The patient!

This is what happens when five of our nation’s top health policy experts tie together commonsense payment reforms that could greatly offset many off the access to care and workforce challenges before policymakers today. Great article - a must read. Spread the word!  

Speaking of Medicare Advantage (MA), these FAQs released by Centers for Medicare & Medicaid Services on the CY 2024 MA and Part D final rule are intriguing! https://lnkd.in/emnBJk7p For example, FAQ#2 discusses the use of artificial intelligence (AI) by MA plans. It states that an algorithm that determines coverage based on a larger data set instead of the individual patient's medical history, the physician’s recommendations, or clinical notes would not be compliant. Also, AI cannot be used to shift the coverage criteria over time. And, predictive algorithms or software tools cannot apply other internal coverage criteria that have not been explicitly made public and adopted in compliance with the evidentiary standard. Finally CMS notes that it is concerned that algorithms and many new artificial intelligence technologies can exacerbate discrimination and bias. CMS reminds MA plans about the prohibition of discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs and activities. MA organizations should, prior to implementing an algorithm or software tool, ensure that the tool is not perpetuating or exacerbating existing bias, or introducing new biases. https://lnkd.in/eHeF_3R3

As the rapidly shifting health care landscape brings mounting regulations, financial pressures, and other challenges, leaders at our recent Health Care Conference identified 3 priorities to focus on in 2024. Thanks for your insight, Chris P. https://lnkd.in/gaMEGUzJ

The end of the Public Health Emergency has many hospitals trying to manage the unintended consequences following the unraveling of the PHE waivers. Learn more in this insight to prepare your executive team for the implications.

Regs & Eggs from McDermott+Consulting is out! I, JEFFREY DAVIS, RETROACTIVELY DECLARE THE MONTH OF JANUARY IN THE YEAR 2024 TO BE KNOWN AS “MEDICARE ADVANTAGE MONTH.” Obviously, I don’t have the power to do that, but the health policy community did see a lot of activity in this space last month. In my view, the specific actions around Medicare Advantage (MA) align with three general priority areas for policymakers: prior authorization and utilization management, data and transparency, and payments to MA plans. Read the Regs & Eggs blog post for more on the "Medicare Advantage Month!" https://lnkd.in/dszyTcEi

Many see Medicare Advantage (MA) as a single option, but a recent study by Inovalon and Harvard reveals a hidden truth: MA plans are highly diverse. This diversity presents a golden opportunity for both health plans and beneficiaries. Explore how data can unlock the power of tailored MA plans: https://hubs.ly/Q02C2nCw0

Check out this article detailing some innovative approaches to working with Medicare Advantage implemented by St, Charles Health System. "We’re seeing large health systems using a similar playbook to analyze where the benefits are supposed to fall and go after them,” What is your approach? Do you have the right Partner to help get you there? Lets have a discussion with one of MEDOVENTs SMEs who have delivered proven results! https://lnkd.in/eMgU9DaB