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Register for MCG Health's Sept. 5 webinar, "Identifying Key Requirements for Payers and Providers in the Centers for Medicare & Medicaid Services' Interoperability and Prior Authorization Final Rule (CMS-0057-F) and the U.S. Department of Health and Human Services (HHS) HTI-2 Proposed Rule." MCG technology experts, Rajesh Godavarthi and Daniel Cawood will explore the new certification criteria, #interoperability standards, and the overall impact on #priorauthorization processes. This insightful session will provide #healthcare professionals with a concise understanding of the regulatory changes designed to reduce administrative burdens. Learn more: https://lnkd.in/g365f-6x

The major developments introduced by the HTI-2 proposed rule aim to improve patient engagement and data sharing to create a more integrated, efficient, and secure #HealthIT ecosystem. 1️⃣ Advancement of the @Centers for Medicare & Medicaid Services (CMS) Electronic Prior Authorization Initiative 2️⃣ Improve Public Health Data Modernization 3️⃣ Major Updates to Technology and Standards 4️⃣ Empower Real-Time Prescription Benefit Tools 5️⃣ Clarifies Information Blocking Regulations Read more! https://loom.ly/l6L6Zx8 #DataModernization #Interoperability #HealthcareInnovation

MCG Health #interoperability experts, Rajesh Godavarthi and Daniel Cawood, have written a new article on the scope and key elements of the Centers for Medicare & Medicaid Services' Interoperability and Prior Authorization Final Rule (CMS-0057-F). This includes (1) an analysis of the implementation/impact of prior auth APIs, (2) a practical guide for #automation processes, and (3) recommended timelines for payers to prepare for the adoption of the new technologies. Read more: https://bit.ly/4e48f8n

An insightful read from Paul Mango on the impact of the key trends unfolding as a result of the 2025 Medicare Advantage rate reductions, Medicaid redetermination, and subsidies extended through the Inflation Reduction Act (IRA). He notes that “the biggest carriers are moving aggressively to trim their losses and consistently reported that they will now favor margin over growth.” Solutions, like Arine’s AI platform, that lower total cost of care and improve outcomes through medication optimization, are critical to controlling margins, not only with Medicare Advantage, but with the commercial and ACA Marketplace plans that are seeing their member bases (and utilization) grow. https://hubs.li/Q02zvYwB0

California's Senate Bill 1419 is setting a powerful precedent by mandating the implementation of FHIR APIs for all licensed health plans, going beyond federal requirements. This enables a more robust and inclusive interoperability ecosystem where everyone benefits.  By mandating participation from commercial plans, states are facilitating coordinated care and enabling a wider range of use cases, such as: 1. Comprehensive patient records:  Patients can have a complete picture of their health history, regardless of their insurance provider, demographics and coverage.  2. Improved care transitions: Fluid data exchange between payers and providers ensures continuity of care, especially during transitions between hospitals and other settings. 3. Enhanced population health management: Health plans and public health agencies can gain deeper insights into population health trends and identify areas for intervention. State-level initiatives like California's SB 1419 demonstrate the power of collaboration between federal and state governments to drive meaningful change in healthcare.  We, at Health Chain, are excited to see more states join this movement and contribute to a truly interoperable healthcare system in the US.  #SB1419 #FHIR #HealthDataExchange #Interoperability #CaliforniaHealthcare #PatientEmpowerment #DigitalHealth #HealthChain Sudheen (Sudheendra) Kumar 

Are you a policymaker looking for exclusive sessions, hands-on workshops, and digital health insights tailored for you? You're Invited to #ViVE2024! This is your chance to be part of a transformative experience explicitly tailored for policymakers like you. Here's why👇 ✅ Policy Impact Sessions: Dive into discussions about healthcare regulation, digital health law, and policy development. ✅ Healthcare Innovation Insights: Learn about cutting-edge technologies and their implications for policy. ✅ Effective Policy Implementation: Explore strategies for implementing policies that enhance healthcare delivery and patient outcomes. 🔥Must-Attend Sessions for policymakers: 🗓️ AI: The Good, The Bad, and the Governed (February 26th) 🗓️ The Providers Strike Back (February 26th) 🗓️ Privacy, HIPAA and CPT Codes, Uncoded (February 26th) 🗓️ Payers Insights Program (February 25th) 🌐 Can’t-Miss Speakers: 🗣️ Dr. Shereef Elnahal, Department of Veteran Affairs (VA) 🗣️ Dr. Micky Tripathi, U.S. Department of Health and Human Services 🗣️ Andrea Fletcher, Center for Medicare & Medicaid Services ...and more! Learn more about ViVE 2024 and why it's a game-changer for policymakers 👉 https://ow.ly/zppj50Qy2j9 #healthcarepolicy #policymakers #healthcare

It's no secret that #valuebasedcare (VBC) still suffers from adoption. In my recent podcast discussion with Carm Huntress from Credo , I uncovered four key factors that are impacting the acceleration and adoption of VBC: 1. Partial Risk Arrangements: Inconsistent demands from different payers and entities leads to workflow and mind-share bifurcation and threatens adoption of VBC models. 2. Full Risk Models: This model is essential for overcoming adoption barriers in VBC, but is widely recognized as extremely challenging to manage. 3. Regulatory Role: The importance of regulation in creating a unified approach to value-based care, drawing on the example of Israel's single-payer system for efficiency. 4. Population Segments and Spending: Inconsistencies in value-based arrangements for the commercial world and for programs under governmental control, such as those under 65 and on Medicaid, contribute significantly to healthcare costs. In summary, for anything below full risk, value-based care is still in its early stages and faces significant challenges in broader adoption. That is why technology infrastructure that can empower providers to transition to these arrangements is critical to achieving widespread VBC adoption. What would you add to this list? #payers #providers #healthcareinnovation #valuebasedcare #vbc

In the "Obstacles to Value-Based Behavioral Healthcare" panel at #BHT2023, Shana Hoffman (Lucet), Samantha F. Chafin, MBA (Florida Blue), and Wendy Zhao Hiltner (SCAN Health Plan) discussed Medicare Advantage's role in promoting value-based arrangements, the challenges of adopting technology in behavioral healthcare, and the benefits of collaboration between payers, providers, and employers to create more effective and integrated behavioral health services. Some of the solutions mentioned include using technology and data to enable more proactive identification and engagement with members, implementing value-based care arrangements that allow providers to be compensated based on overall outcomes, and focusing on collaboration and data sharing. Watch the full session from #BHT2023 here: https://lnkd.in/gRtevQcD #medicareadvantage #valuebasedcare

It’s that time of year again –  the annual risk adjustment reset Imagine a world where every January 1st brings a clean bill of health. While that's still a fantasy in medicine, it's a reality in risk adjustment, where each patient starts the new year as 'whole' on paper, regardless of their actual condition. Why the annual reset? ⭐ Our health can improve or worsen year-to-year. ⭐ Centers for Medicare & Medicaid Services (CMS) requires health plans to annually report their patients’ conditions. ⭐ The reset and annual reporting help ensure that healthcare delivery is aligned with patient needs. The risk adjustment reset, while overwhelming, is vital for reevaluating patients' current health status and guaranteeing the accurate allocation of resources. Here are a few examples that highlight why the reset is so important: ⭐ Formerly acute conditions that are now improved or resolved altogether ⭐ Updating the status of patients from an active cancer diagnosis to remission ⭐ Recording new diagnoses, such as the onset of diabetes The start of the year is busy for care teams, but accurate and annual reporting is non-negotiable. Providers are encouraged to capture all patient conditions at the first encounter, though they have the whole year. As we step in 2024, let's embrace this annual reset as a commitment to patient-focused and efficient healthcare. It’s our chance to ensure every patient's needs are met accurately and effectively. #Healthcare2024 #PatientCare #NewYearNewGoals #RiskAdjustmentReset

As Dana mentions, the reset can be overwhelming, but it doesn't have to be if you have the right processes and technology in place to standardize your organization's approach to risk adjustment. It should be baked into the provider's workflow, at every visit! #optimizedworkflow #riskadjustment #efficiency