Don’t Let Budget Cuts Wreck Medicare Reform

A quick insight into how Medicare is trying to address the social determinants of health, by including nonmedical services. These payments could be a new source of income for your community-based network, and the agencies you need to address your communities social determinants of health. Learn More

Sick and Struggling: High-Need Adults with Financial Difficulties Have Worse Access to the Quality C

A look at high-need patients and their perception to pay for medical services. If the patient doesn’t feel they can cover the cost of care they will tend to delay care, and use emergency rooms more often. Follow up with care providers is lower, leading to missed opportunities for communication, and preventative care programs. Providing a care program to provide medical and non-medical services has shown to reduce hospitalizations, and emergency department visits. Having payment systems through the federal government, states, and insurance providers encourage reimbursement for non-medical services, would be a great start in helping high-needs patients gain confidence in seeking treatment ea

Leveraging Medicaid to Address Social Determinants and Improve Child and Population Health

More evidence showing the need for community-based networks to work towards the root cause of healthcare issues the social determinants of health. Georgetown University Health Policy Institute Center for Children and Families, dives into how Medicaid should be leveraged to address the social determinants of health (SDOH). As well as what the framework should look like when addressing these issues. Learn More

The History, Evolution, and Future of Medicaid Accountable Care Organizations

ACO’s will become vital partners in working with community-based organizations. As states begin to move Medicaid models to include long-term services and supports (LTSS), community-based organizations will begin delivering the additional services to address the social determinants of health. The fragmented health care system cannot serve the high risk populations the same way in which community-based organizations already are. ACO’s are expected to be around for some time, and community-based organizations will be vital for the success of the ACO’s. Learn More

Medicaid Payment and Delivery Reform: Insights from Managed Care Plan Leaders in Medicaid Expansion

Managed care organizations (MCOs) are becoming vital when it comes to Medicaid payment and delivery reform. MCO’s are finding a new increased demand for the care they can offer, especially for those most vulnerable in their communities. As services begin moving away from a fee for service structure, MCO’s find themselves as a crucial part in delivering meaningful healthcare. However, along with the new found use for MCO’s comes the challenges of managing the network, and delivering measurable results. This study looks into some of the challenges MCO’s are facing today, how they are impacting the MCO industry, and where MCO’s are currently focusing their efforts. Learn More

Using Community Partnerships to Integrate Health and Social Services for High-Need, High-Cost Patien

Here you’ll find 5 common challenges managed care organizations commonly face while partnering. Also available by request is a, “a community playbook to address these challenges and to assist communities as they work to forge cross-sector partnerships.” This playbook is available via a special request at http://www.pccipieces.org/health-care-and-social-service-provider-partnerships-for-complex-patients/. Learn More

Accountable Health Communities Model

This is a model to help address the healthcare needs of a community, by collaborating between community-based organizations and healthcare providers. Managed care organizations (MCO) can have a direct impact when it relates to,, “Unmet health-related social needs, such as food insecurity and inadequate or unstable housing, may increase the risk of developing chronic conditions, reduce an individual’s ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization.” Read More.

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