Some states are working with their Medicaid managed care organizations and community partners to coordinate care for justice-involved individuals prior to release with the goal of improving continuity of care and smoothing community transitions.
Addiction is a national crisis. Deaths from drug overdose, suicide and alcoholic liver diseases—referred to as “diseases of despair”—are at the highest levels in U.S. history. Read one father’s personal experience with the loss of his son and his efforts to ensure that addiction is treated with the same efficacy as other chronic diseases.
As healthcare moves toward the full embrace of value-based care models, utilization management is increasingly leveraged as a means to not only manage costs but to ensure quality and manage risk as well.
Medecision has integrated the Change Healthcare InterQual Connect medical review service into the iExchange provider data-entry solution. This press release was originally issued by Change Healthcare and appears on their website: https://www.changehealthcare.com/press-room/press-releases/detail/medecision-integrates-change-healthcare-interqual-connect-solution-into-iexchange-provider-portal
Data can help health plans identify medically at-risk members and intervene with the appropriate prevention and wellness programs to keep them as healthy as possible and avoid a costly trip to the doctor or emergency room.
Healthcare organizations need consumers actively involved in their own care in order to dramatically improve outcomes. As such, healthcare organizations, including health plans, need to forge partnerships with consumers.
A combination of technological advancements and increasing clinical evidence has created a clearer understanding of how much the environment in which people are born, grow, live, work and age impacts their health.
When patients don’t follow doctors’ orders, the consequences are dire. Health plans can help by understanding the specific challenges that members are facing – and then intervening to enable them to overcome medication adherence barriers.
Population health initiatives typically assume that members can participate in their own care on a basic level, yet those assumptions may not hold true for Medicare and Medicaid members. Their lives typically differ from the lives of those with commercial insurance, which makes cost-effective care management uniquely challenging—and even more important.
The open window to apply for CMS’ Bundled Payments for Care Improvement (BPCI)-Advanced closed on June 24, 2019, but there’s still plenty of opportunity for health systems to move forward with value-based care and care management initiatives — and the care redesign they represent.