Inclusive Alliance’s Post

NYC Care isn’t just a program for New Yorkers- it’s a blueprint for how municipalities nation-wide can improve access to care for the uninsured. This month, NYC Care Executive Director Jonathan Jiménez, MD, co-authored an academic article in the Journal of Public Health Management and Practice (JPHMP) along with NYC Health + Hospitals President and CEO Dr. Mitchell Katz, Theodore Long, MD, MHS, and Marielle Kress entitled, “NYC Care: A Large Health Care Access Program for Uninsured New York City Residents”. The article describes the program, it’s implementation, and it’s outcomes for the roughly 135,000 New Yorkers enrolled. NYC Care had 119,203 members at the end of June 2023. Fifty-eight percent had not seen a primary care doctor in the NYC Health + Hospitals system in the prior 36 months. In total, 76,439 had completed 1 or more primary care visits; 53.1% of enrollees with diabetes had improved hemoglobin A 1c , and 73.4% of enrollees with hypertension had improved blood pressure control after 6 months of enrollment. NYC Care demonstrates that municipalities can improve access to care for the uninsured by simplifying steps to affordable health care services, connecting patients directly to patient-centered medical homes, and improving the patient experience. Through this robust, comprehensive, and accessible health care access program, coupled with comprehensive public awareness campaigns and partnerships with community-based organizations, other municipalities can join in improving the health outcomes of those excluded from health insurance. Read the article, and learn about NYC Care by visiting NYCCare.NYC.

Super interesting read! The most surprising finding for me was the cost per person for this program vs. the cost of employee based health insurance per month. This could be a model for how the US can expand affordability in health care, including physical therapy. Of course there will always be flaws and room for improvement, but I'm proud to work for a system with an active plan to increase access to health & well being.

With all the new MedTech and availability of care, access to affordable healthcare is still a great challenge for many. Those who experience chronic health conditions face an even greater burden with a need for constant care but often go without due to the inability to pay for care and necessary prescriptions. Recent surveys showed that 96% of those surveyed report having health insurance but numbers dropped when it comes to affordability of prescriptions with a more dramatic drop in access to treatment through healthcare plans. We are long overdue for policy changes to increase healthcare access. #AffordableHealthcare #HealthcarePlans #HealthInsurance

West Virginia Health Right is hosting its "We Care West Virginia Day" in Charleston, offering a free clinic to those who can't afford healthcare. The event, taking place on Saturday, provides various medical services without requiring proof of income, health records, or documentation. While the state's poorest residents qualify for Medicaid, the clinic also aims to support the working class, many of whom earn too much for Medicaid but struggle with high-deductible insurance plans that are financially burdensome. CEO Angie Settle highlighted that some individuals have insurance but avoid using it due to unaffordable deductibles. The clinic provides services such as dental care, eye exams, female health exams, flu vaccines, behavioral health services, and Narcan training. With over 150 volunteers, the event offers care outside regular working hours to ensure accessibility. Health Right serves over 45,000 individuals across 34 counties, emphasizing a community-driven approach to healthcare. The clinic begins at 8 a.m. on East Washington Street. I fully support West Virginia Health Right’s efforts to provide accessible healthcare, and our team of professionals is ready to assist healthcare entities in implementing similar programs. Together, we can create impactful solutions that prioritize communities, ensuring vital healthcare services reach those who need them most. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner West Virginia Public Broadcasting

🚨 Breaking News! CMS Finalizes Rule to Expand Access to Health Information and Improve Prior Authorization Process In a major move, the Centers for Medicare & Medicaid Services (CMS) has officially announced the finalization of the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). This rule impacts various healthcare entities, including Medicare Advantage organizations, Medicaid programs, and issuers of Qualified Health Plans. Key impacts: •  Prior authorization processes for medical items and services will be streamlined, cutting patient, provider, and payer burdens with an estimated $15 billion in savings over the next decade. •  Specific timeframes set for prior authorization decisions, ensuring 72-hour decisions for urgent requests and seven days for non-urgent requests from 2026 onwards. •  Impacted payers must provide specific reasons for prior authorization denials, promoting resubmission or appeals. •  All impacted payers mandated to publicly report prior authorization metrics for increased transparency. Read the full release here: https://lnkd.in/e6VuyPra

Calling all #raredisease #advocates interested in #Medicare Advantage (MA) plans!#CMS, the Centers for Medicare & Medicaid Services, wants to hear from you! MA plans have become increasingly popular in recent years. More than half of all Medicare beneficiaries are now enrolled in MA plans. This trend is expected to continue, and the government is expected to pay MA health insurance companies over $7 trillion over the next decade. The goal of this request for information (RFI) is to help ensure that: * MA plans best meet the needs of people with Medicare * Beneficiaries have timely access to care * MA plans appropriately use taxpayer funds, and * The market has healthy competition Specifically, CMS wants to hear your experience with MA plans and would love data on topics including: *beneficiary access to care including provider directories and networks; * prior authorization and utilization management, including denials of care and beneficiary experience with appeals processes as well as use and reliance on algorithms; *cost and utilization of different supplemental benefits; *all aspects of MA marketing and consumer decision-making; *care quality and outcomes, including value-based care arrangements and health equity; * healthy competition in the market, including the impact of mergers and acquisitions, high levels of enrollment concentration, and the effects of vertical integration, * Medicare Advantage prescription drug plans (MAPDs); and * impacts on special populations such as individuals dually eligible for Medicare and Medicaid, individuals with end stage renal disease (ESRD), and other enrollees with complex conditions. Comments are due in 120 days. See the full RFI here: https://lnkd.in/eCU36keX

"Fee-for-service health care is hurting patients and driving up costs. The lack of accountability in the fee-for-service system allows doctors, hospitals, insurance companies, and pharmaceutical companies to point the finger at one another when things go wrong. The result? Patients are at risk and prices skyrocket. Due to fee-for-service, some patients get too much care, some do not get enough, and others get the wrong care. They all get inflated bills. The United States deserves a better health care system—one that is accountable for quality and costs." #valuebasedhealthcare #innovativepayments #phc

The coverage of our study by Riz Hatton @Becker's Healthcare: According to a 2023 analysis by Blue Health Intelligence, the Blue Cross Blue Shield Association's data analytics company, procedures done in HOPDs can cost 58% more than a physician's office or ASC. Facility fees for colonoscopy procedures covered by private health insurance are 55% more at hospitals compared with those at ASCs as of May 2023, according to a study published in JAMA Health Forum. link to our study: https://lnkd.in/e_NDv5Fd The Johns Hopkins University - Carey Business School Johns Hopkins Bloomberg School of Public Health

Discover the Future of Healthcare with Old Mutual's Pharmacy First Program! At Old Mutual, we're passionate about empowering you to prioritize your health. That's why we're excited about our Pharmacy First program, meant to revolutionize the way you access care for common ailments. Gone are the days of lengthy waits and unnecessary hospital visits. With Pharmacy First, your local pharmacy becomes your go-to destination for prompt, effective, and affordable treatment. Here's how it works: Step 1: Visit a Partner Pharmacy: When you're feeling under the weather with a common ailment, head to any of the accredited pharmacies. Step 2: Easy Verification: Provide your Old Mutual Health membership details for swift verification. Step 3: Personalized Care: There is a dedicated care team, comprising clinicians, nurses, and pharmacists, who will guide you to a designated consultation room for a thorough assessment. Step 4: Comprehensive Assessment: Receive clinical examinations and rapid tests, if necessary, ensuring accurate diagnoses. Step 5: Tailored Treatment: Based on your assessment, receive personalized treatment and medication, if required. All this in one convenient visit. What's more, you will be able to pay for your Pharmacy First visit using your Old Mutual health insurance. Why not save time and money? Choose one of the participating pharmacies near you as your first point of care. Take the first step towards a healthier, more efficient healthcare experience today. For more information and answers to frequently asked questions, visit our website. https://lnkd.in/d2jZahw3 #ExpertCare #PharmacyFirst #UnlockingPossibilities