Certifi, Inc’s Post

In today's world of healthcare, coverage and prior authorization requirements prove to be a necessary but significant challenge for health plans, providers, and patients. The requirements are esoteric and disjointed and create considerable administrative burdens which lead to denials or delays in care. That’s why at GenHealth.ai we have built the world's first prior auth and medical policy database that allows anyone to better understand the requirements and compare rules across plans. https://lnkd.in/gEt5veYH We've started by codifying the Local Coverage Determination (LCD) and National Coverage Determination (NCD) put out by CMS as well as other select health plans. https://lnkd.in/gRAtkZdk

According to Andis Robeznieks, senior news writer at the American Medical Association, two key elements of value-based care are patient attribution and benchmarking. Patient attribution helps you understand whose health you are responsible for, while benchmarking shows how well you're taking care of your attributed patients. Dr. Francis Mercado, from Virginia Mason Franciscan Health’s Franciscan Medical Group, emphasizes these points as essential for success in accountable care organizations (ACOs), like the Rainier Health Network. Dr. Mercado, who leads the Rainier Health Network ACO, found success by implementing best practices in care management and focusing on delivering high-quality care. He suggests voluntary attribution as an ideal mechanism, where the health system is responsible for patients who choose to be under its care. Benchmarking is also crucial, helping health systems track progress and adjust incentives over time to ensure they continue to be rewarded for providing excellent care. Collaborative relationships with payers and transparent feedback with physicians are equally important for success in value-based care. #ValueBasedCare #HealthcareManagement #AccountableCareOrganizations https://lnkd.in/gF7sCKBV

The upcoming playbook on Value-Based Care, developed with AHIP and NAACOs, includes real-world insights from AMA Health System Program members. Key elements include patient attribution & benchmarking, crucial for transforming healthcare. #ValueBasedCare #HealthcareTransformation https://hubs.la/Q02r5nwD0

Thoughts on healthcare from a physician

"As a family physician, I have experienced firsthand how burdensome the prior authorization process is for patients and physicians." 🚥 In BenefitsPRO, Dr. Mary Krebs, Medical Director of Primary Care at Cohere Health, explores green lighting, a more efficient, flexible approach that helps physicians and health plans solve for the burdens of #priorauthorization. 👉 Dr. Krebs outlines a number of key advantages of #greenlighting, from reduced paperwork to better patient outcomes. Read it now. ⤵

Happy to share this article which reinforces the need to include the patient perspective in care design to achieve results from changes such as Value Based Care. Change the model change the OUTCOMES. Change the Model unleash the capabilities of Staff, Patients, and Tech   Value-based care has faced hurdles in delivering on its promise, but there are opportunities for improvement. This commentary article highlights the missing patient perspective and other critical challenges that must be addressed for value-based care to make a significant impact. Learn more: Why Hasn’t Value-Based Care Delivered on Its Promise at Scale? #VirtualFirst#CrosstheChasm#PatientCentricCare #ValueBasedCare

I know from my work at CareAllies that the practices, hospitals, and health systems that have fully embraced #valuebasedcare and done so with partners that support them with tested and proven strategies, are seeing value-based approaches deliver on their promise. In fact, many are seeing even greater benefits when one considers not only the singular impact on patient health outcomes but also the paradigm shift that occurs when providers regain the joy of practicing medicine. The real issue involving health care’s experience with value-based care at scale is that it is not something you can dabble in. It requires a fundamental shift in thinking that permeates not only the delivery of care but also the processes that govern it – an endeavor that should not be undertaken lightly or done alone. AJMC - The American Journal of Managed Care https://bit.ly/4cWMDdN

Ursamin is committed to driving efficiency for #primarycarephysicians. In response to the rising costs highlighted in this insightful blog, we want to advocate for faster access to crucial information and the integration of shared care plans that seamlessly follow patients. Here's the article: https://lnkd.in/gPTC_R6a We see a near-term future where PCPs experience heightened data efficiency, ensuring better patient experiences without adding undue burdens. Let's embrace a healthcare landscape where collaboration is streamlined, and caregivers play a pivotal role in the patient's journey. #HealthcareEfficiency #PatientCentricCare

Becker's Healthcare Payer Issue asked 12 health care executives to share their insight on how their workforce will evolve due to AI and new technology. Abdou Bah, SVP, Medical Management, and chief health equity officer at EmblemHealth, responded with the quote below. Click the link for the full read. “At EmblemHealth, we expect the mix of our clinical and non-clinical roles to shift. We anticipate increased utilization of licensed clinical social workers to address behavioral health needs, community health workers, and community-based Care Navigators to assess and support our members with social determinants of health. The use of new technologies will accelerate the delivery of quality health care, allowing staff to increase focus on the highest impact actions and value-added services. We believe that long-term health is impacted by the things people do every day, the places where they live, and the resources available to them. We have 15 Neighborhood Care centers throughout New York City, and each features Customer Care Navigators who live in the communities they serve, providing in-person and virtual customer support, connections to community resources, and programming to help the entire community learn healthy behaviors.” 

What opportunities are there to improve #caremanagement by addressing #utilizationmanagement? A lot. Watch our webinar with experts from VirtualHealth (Tyann Alexander MBA, RN, CCM), Edifecs (Maxim Abramsky), and Itiliti Health (Michael Lunzer). https://bit.ly/47AIHM4