Evaluating the Forces Shaping Healthcare in 2024, and what it means for leaders of health plans, life sciences, and digital health and other healthcare organizations

With 2024 underway, healthcare leaders must navigate an overwhelming array of challenges, from declining patient health and quality of care, to regulatory shifts and new market entrants.

Advisory Board's new report cuts through the noise to highlight the pivotal shifts happening in healthcare and what leaders must know to stay ahead, including:

• How healthcare organizations are evolving strategy amid the shift to ecosystem-based care
• How new technologies will shift care team roles
• How high-cost, bespoke therapies will shift traditional healthcare management

Under the Biden administration, the Centers for Medicare & Medicaid Services published a health equity framework that drastically changed the playing field for health plans and other risk-bearing entities.

In the wake of these changes, how can health plans, accountable care organizations, and other similar stakeholders successfully create and administer social determinants of health interventions as a means to advance health equity?

On this episode, Epstein Becker Green attorneys Jackie Selby, Kevin Malone, and Marjorie Scher discuss the recent national focus on health equity, the actionable interventions behind the concept, and the responsibility of stakeholders in making care delivery more equitable.

What trends in state laws and regulations have emerged in the post-public health emergency (PHE) era, and how do these changes impact telehealth stakeholders?

At the federal level, many telehealth-related flexibilities have been extended through December 31, 2024, whereas, at the state level, there are wide variations in approach. Many states have continued to push the boundaries of existing telehealth policies, yet no two states are exactly alike in their approach to defining and regulating telehealth.

On this episode, Epstein Becker Green attorneys Amy Lerman, Audrey Davis, and Avery Schumacher discuss emerging trends in state laws and regulations post-PHE as well as federal regulatory and enforcement developments that set the stage for states.

From wholesale revisions of the merger guidelines to significant amendments to the Hart-Scott-Rodino premerger notification forms, the Federal Trade Commission (FTC) and the Department of Justice (DOJ) have proposed significant changes that, if adopted, will have profound effects on merger review and enforcement for the foreseeable future.

What might these changes mean for hospitals, health systems, and other stakeholders in the health care industry?

On this episode, Epstein Becker Green attorneys Trish Wagner, John Steren, Jeremy Morris, and Will Walters dive into the latest developments in health care antitrust law and analyze the FTC’s and DOJ’s views on mergers in health care markets.

This CMS Hospice Provider Webinar addresses what providers need to know bbout Calendar Year (CY) 2024. The agenda includes: 
- Overview
- Hospice Benefit Component
- Returning Policies and Requirements for CY 2024
- CY 2024 Medicare Advantage Organization (MAO) Participants
- Billing and Claims Processes
- VBID Evaluation Report – Hospice Benefit Component
- Contacting the VBID Model Team

This 90 minute webinar eatures a panel of experts discusses the future of the public option in the U.S. healthcare system. Faculty includes John Baackes, CEO, L.A. Care Health Plan, Liz Hagan, Director of Policy Solutions, United States of Care, and Richard M. Scheffler, Professor of Health Economics, UC Berkeley. 

Although a public option health plan was stricken from the Affordable Care Act shortly before it was enacted in 2010, the idea never went away. Both Washington State and Colorado offer public option health plans on their ACA-compliant exchanges. A dozen more states – including healthcare influencers such as Minnesota and Nevada – either plan to offer public option plans on their exchanges, or are closely studying the situation.

Although the public option plans are different as originally conceived for the ACA, they still follow the same principal of a health plan with premiums and benefits closely regulated by the state government, with the intent of offering premiums lower than those offered by commercial payers.

Washington and Colorado’s experiences with the public option have had their share of teething pains, but regulators in both states are determined to offer such coverage for the foreseeable future. And with many other states potentially offering public option plans soon, this concept could not only be reborn and rejuvenated, but exert tremendous influence on healthcare delivery and payment in the future.

This session discusses:

• A brief history of the public option and why it has made a comeback
• What the public option looks like in Colorado and Washington State and what has been accomplished to date
• Issues with the new public option plans
• Which states are considering public option plans and their motivations
• The benefit and premium structure of public option plans
• How commercial payers are responding to – and participating in – public option coverage
• How hospitals, medical groups and other providers are responding to public option plans
• The structure and offerings of future public option plans

Access and convenience are the new benchmarks for organizations, even in healthcare. Yet, many make technology-focused decisions instead of prioritizing experience. Join us as we delve into the possibilities this evolving standard offers healthcare, from AI to telehealth, ROI to vendor relationships.

Key takeaways:

• Start with the customer experience and let technology follow, just like Steve Jobs advised.
• Focus on integrating AI where it adds value and don't feel pressured to develop a stand-alone AI strategy.
• Take an incremental innovation approach to drive meaningful change in healthcare organizations.

This webinar was recorded on Wednesday, October 25, 2023 and features a panel of distinguished healthcare labor experts examining the current workforce challenges in healthcare delivery, and how it might be addressed in the coming years. Faculty includes Eric Dickerson of Kaye/Bassman International, Matthew Fontana of the global law firm Faegre Drinker, and Elizabeth DuBois of COPE Health Solutions. 

The labor market in the United States has been tight in recent years, but perhaps no other sector is tighter than healthcare. The Health Resources Services Administration recently concluded that the U.S. needs more than 38,000 more physicians, dentists and mental health professionals than the number currently employed. The Bureau of Labor Statistics says there are currently more than 200,000 job openings for nurses, and that more than 30,000 new advanced practice nurses (nurse practitioners, nurse anesthetists, etc.) are needed every year through 2030 just to keep up with demand. The current workforce itself is traumatized, coping with such issues as job burnout and potential violence from patients and their family members

That the workforce shortage is chronic and current labor conditions are demanding at best means that providers and recruiters must think outside the box. As simply filling the positions is no longer feasible, they must work on creating education-to-labor pipelines. And they must also contend with dramatic changes to the workforce since the COVID-19 pandemic and factor in changes such as telemedicine and hybrid work arrangements.

“Core” per member administrative expenses in Medicaid-focused plans grew by 2.4% in 2022, slower than the growth in 2021 at 2.6%. The Account and Membership Administration accelerated to an increase of 5.7% in 2022, up from an increase of 1.3% in 2021.

This analysis is based on the twenty-first annual edition of our performance benchmarks for Medicaid-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of about 1,000 health benefit organization years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to all Medicaid-focused plans possessing the ability to compile high-quality, segmented financial and operational data. This analysis of Medicaid plans is based on a peer group of fifteen plans who collectively served 15.5 million people in comprehensive products. Ten of this year’s participants also participated in the prior year. The average plan participating in the Medicaid Sherlock Benchmarks this year served 1.0 million people under comprehensive products and the median membership was 675,000. The geographic reach of this universe extended from coast to coast.

A group of drugs known as glucagon-like peptides 1 (GLP-1) were originally developed to better manage diabetes. But GLP-1 drugs such as Ozempic, Mounjaro and Wegovy have more recently been used to combat obesity, with some users reporting weight loss of 60 pounds or more that remains permanent so long as they continue taking the medication. A new study released by the manufacturer of Wegovy also concluded that using the drug for weight loss reduces the risk of serious cardiovascular episodes by about 20%. Manufacturers are also formulating new GLP-1s that may be even more effective in achieving dramatic and permanent weight loss.

That begs the question: Will these drugs play a role in value-based care for patients with chronic conditions such as obesity, or will the cost of GLP-1s take such a proposition off the table?

Learning Objectives:

• What are GLP-1 drugs and how do they work?
• The GLP-1 price/cost curve
• The impact of GLP-1 on the health of patients/users
• Who is being prescribed GLP-1 drugs?
• How GLP-1s have been contributing to overall healthcare costs in the U.S.
• Will GLP-1 drugs impact the volumes of bariatric surgery?
• Employer, payer and provider opinions and responses to the use of GLP-1s for weight control
• What the future holds for GLP-1 drugs and value-based cared

Medicare-Focused plans experienced a 1.9% increase in administrative expenses from 2021 to 2022 compared with a 0.6% increase in the prior year. The largest cluster of functions, Account and Membership Administration, increased by 3.7%, shown in Figure 1. This is a more modest growth than reported by the Blue Cross Blue Shield and Independent / Provider – Sponsored universes despite Sales and Marketing growth being faster.

Eleven plans participated in the 2023 edition of the Medicare Sherlock Benchmarks, reflecting 2022 results. The participating plans collectively served 1.7 million Medicare Advantage members. These single state or regional plans served 16.4% of Medicare Advantage not served by the five largest share plans. An average of 30% of revenues of these companies were in Medicare Advantage and Medicare SNP (“Special Needs Plans”) products, exceeded 20% of revenues in all cases, and was the plurality product in several cases. Eight plans participated in both the 2022 and 2021 benchmarking cycles and these were used for trend purposes.

This analysis is based on the twentieth annual edition of our performance benchmarks for Medicare-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of approximately 1,000 health benefit organization years.

CMS webinar regarding the Making Care Primary (MCP) Application process and timeline.

CMS is partnering with state Medicaid agencies and other payers in MCP states to align MCP and state programs. While CMS is implementing MCP for Medicare beneficiaries, other payers are encouraged to partner with CMS to realize the goals and elements of improved primary care across all patients, including those covered by Medicaid, commercial, and other payers. 

This webinar discusses the CMS payer partnership program for Makling Primary Care, the MCP model features, and next steps for payers interested in partnerships.

This 90 minute webinar features Katherine Hempstead of the Robert Wood Johnson Foundation, Robert Saunders of the Margolis Center for Health Policy at Duke University and Ronald Vance of Alvarez & Marsal Healthcare discussing how payers and providers might stand to benefit from the MCP model, and what concerns might need to be addressed as part of this HealthExecWire webinar event, What to Make of CMS’s New “Making Care Primary” Model.

Learning Objectives:

• Understanding the components of the Making Care Primary model, and how both providers and payers may benefit.
• How the MCP model might impact existing and future value-based care models.
• What may be required to participate in the MCP model initiative.
• What incentives CMS will be paying to participants, and what level of performance is expected.
• How findings from the MCP model might apply to providers and payers, whether MCP participants or not.

In July, the Centers for Medicare & Medicaid Services made significant headway in its implementation of the drug pricing provisions of the Inflation Reduction Act (IRA).

How can stakeholders respond to, implement, and comply with all these new provisions? On this episode, hear from special guest Sylvia Yu, Vice President and Senior Counsel of Federal Programs at PhRMA.

Sylvia and Epstein Becker Green attorneys Connie Wilkinson and Alexis Boaz discuss the recent updates on the quickly moving implementation of the drug pricing provisions under the IRA and the industry’s response.

Independent / Provider - Sponsored plan cost growth sharply accelerated in 2022 based on the results of 9 continuously participating plans in the Sherlock Benchmarks. Total per member costs increased from an increase of 1.9% to an increase of 6.7%. After holding the universe’s product mix constant, the real cost growth was 7.5%, compared to a 4.2% increase in 2021.

This analysis is based on the twenty-sixth annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by October, approximately 1,000 health benefit organization years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, participation is open to all Independent / Provider - Sponsored Plans possessing the ability to compile high-quality, segmented financial and operational data. We surveyed the participants to populate the Sherlock Benchmarks and this summary.

The Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization one year ago overturned 50 years of legal precedent protecting the constitutional right to abortion in the United States, leaving the question of whether and how to regulate abortion to individual states.

What has happened since and what is to come?

On this episode, Epstein Becker Green attorneys Amy Dow, Erin Sutton, and Jessika Tuazon examine how the Dobbs decision has impacted the legal landscape for patient access to abortion, discuss the challenges facing the health care industry, and explore how industries can manage their compliance efforts moving forward as the legal landscape continues to evolve.

Blue Cross Blue Shield cost growth sharply accelerated in 2022 based on the results of 14 continuously participating Plans in the Sherlock Benchmarks. Total per member costs increased from a 0% increase to an increase of 7.2%. After holding the product mix constant, the real cost growth was exactly the same, 7.2%, compared to a 0.4% decline in 2021.

The Sherlock Benchmarks are the health plan industry’s metrics informing the management of administrative activities. They are based on validated surveys of health plans serving 60 million Americans and provide costs and their drivers on key administrative activities.

Like the diversity of the industry itself, merger and acquisition (M&A) transactions in health care take many forms, varying in size and complexity.

While buyers tend to focus on several things as part of those transactions, securing key employees post-closing is an important but sometimes overlooked issue.

What are some important factors to consider when entering a transaction in a human capital-intensive industry like health care? On this special crossover episode of Diagnosing Health Care and Spilling Secrets, Epstein Becker Green attorneys Kate Rigby, Erik Weibust, Dan Fahey, and Tim Murphy talk about the different types of health care M&A transactions and the importance of securing key employees post-closing.

On April 21, 2023, the U.S. Supreme Court ruled to preserve access to the prescription abortion drug mifepristone. However, while the case continues in the U.S. Court of Appeals for the Fifth Circuit, the future of mifepristone—and the U.S. Food and Drug Administration’s authority to approve new drugs—will continue to be debated on appeal.

On this episode, Epstein Becker Green attorneys Erin Sutton, Delia Deschaine, and Avery Schumacher analyze the ongoing legal battle over mifepristone and discuss implications for industry stakeholders, including drug manufacturers, distributors, providers, and patients.

The Inflation Reduction Act (IRA), signed into law in August 2022, included significant and controversial drug-pricing provisions.

What key compliance issues must industry stakeholders consider as these provisions are put into effect?

On this episode, Epstein Becker Green attorneys Leslie Norwalk, Connie Wilkinson, and Alexis Boaz discuss key considerations for the health care and life sciences industry as the Centers for Medicare & Medicaid Services works its way through the initial stages of implementation of the Medicare Drug Price Negotiation Program and the Medicare Prescription Drug Inflation Rebate Program under the IRA.

The Federal Reserve’s steady increase of interest rates and the slowed economic growth have increased fiscal pressure on health care providers, leaving many to look for ways to bridge budget shortfalls through injections of capital, asset sales, or other strategic transactions. 

What options are there for providers moving forward?

On this episode, Epstein Becker Green attorneys John Tishler, Ryan Cochran, and Tim Murphy discuss how the changing economic climate has impacted the 2023 deal cycle and forecast the trends we expect to see this year.

Please join us  for this sixty-minute webinar in which Dr. Andrew Ziskind and Alan Trimakas of BDC Advisors explore the challenges and opportunities of value-based care and the role that CINs can play in improving patient outcomes and reducing costs. The evolution of the CIN model will be discussed, including its early focus on care coordination and its expansion to include a variety of stakeholders. The challenges facing CINs, including how to measure and demonstrate value, and how to optimize their operations and processes will be explored.  This means focusing on the 3-5 high impact areas that generate true value.   

The Medicare Shared Services Program (MSSP) offers significant benefits for patients, providers, AND payers. But there are substantial hurdles to implementation.

The Biden administration has announced its ambitious goal of “having all people with Traditional Medicare in an accountable care relationship with a health care provider by 2030.” Achieving this goal will require short- and long-term changes for a broad spectrum of healthcare professionals. To help you understand what’s happening - and what’s GOING to happen - HealthExecWire has teamed up with two top Washington attorneys on a new interactive webinar: MSSP, ACOs and You. 

Philo and Kevin will be answering these questions and more:

• What are the latest changes to the MSSP?
• How does CMS get us from the current system to an all-ACO model?
• What does this mean for providers in current Medicare value-based payment models?
• In what ways will the present ACO REACH program change?
• Will the patient experience be impacted?
• Integration of specialty care into ACOs – how will this be accomplished?

An Overview of Calendar Year (CY) 2024 Request for Applications (RFAs), Hospice Benefit Component Payment Methodology, and Application Process. The agenda includes:

Overview of VBID Model • What’s New for CY 2024? • CY 2024 Preliminary Hospice Benefit Component Payment Methodology • CY 2024 Application Timeline & Process • CMS Technical Assistance and Applicant Resources

Changes are on the horizon for provisions of the Program of All-Inclusive Care for the Elderly (PACE) that haven’t been updated in over a decade.

What exactly is PACE and how will new proposed rule modifications affect PACE plans moving forward?

On this episode, hear from special guest Wendy Edwards, Director of Internal Operations at BluePeak Advisors.

Wendy and Epstein Becker Green attorneys Lynn Shapiro Snyder, Kevin Malone, and Helaine Fingold explore the ins and outs of PACE, the changes in recent years that have made PACE available to for-profit companies, and the specifics of the provisions in the pending federal proposed rule.

With the recent midterm elections changing the composition of Congress, and the Biden administration’s first opportunities to advance its policy priorities from the very beginning of the rulemaking process, what are the key health care developments to watch out for in 2023?

On this episode, Epstein Becker Green attorneys Ted Kennedy, Jr.; Alexis Boaz; and Philo Hall discuss the current landscape of health care policy from both the legislative and regulatory perspectives and analyze which key health care issues may arise.

Following the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, some states have banned abortion in all or most circumstances and many more have enacted new restrictions or enforced old ones.

What must providers and health care leaders understand about this patchwork of laws, the ongoing enforcement activity, and protecting their organization’s interests?

On this episode, Epstein Becker Green attorneys Jenny Nelson Carney, Stuart Gerson, Erin Sutton, and Dan Fahey discuss the post-Dobbs legislative landscape as well as the ongoing enforcement actions in the states that prohibit all or most abortions and abortion-related services.

We’re looking at how the past 50 years of health law will impact health care in the next 50 years. On this episode, Epstein Becker Green attorneys Mark Lutes; Lynn Shapiro Snyder; Ted Kennedy, Jr.; and Nivedita Patel talk about the past, present, and future solutions to a fundamental question: How can the United States manage health care spending while continuing to provide access to high-quality health care products and services?

Health plans know that the Medicare Advantage market is a crowded space—and that competition is fierce to attract seniors' attention. Success in Medicare Advantage is dependent on your ability to stand out—and grow—despite this crowded market. Join us as we explore three crucial levers to driving growth in Medicare Advantage products: crafting a desirable product, leaning on sales and marketing to enroll more members, and increasing the profitability of your current membership. This session will leave you with an understanding of not just where we're seeing growth in the Medicare Advantage space, but also why seniors choose MA over other products, how they receive and process information when shopping for MA plans, and where to improve marketing and outreach to prospective members. 

“Core” per member administrative expenses in Medicaid-focused plans grew by 2.6% in 2021, a deceleration from 2020’s increase of 5.8%. Similarly, the Account and Membership Administration decelerated by 4.2 percentage points, from 5.5% to 1.3%. The rates of change reflected here hold both surveyed plans and their product mix constant in each year-over-year comparison. Cost trends in 2021 for both Core and Account and Membership Administration were below average, both of which were approximately 4%, since 2010. The cost trends for 2021 discussed are based on the results of ten continuous plans serving 11.2 million members in comprehensive products, of which 6.3 million were Medicaid or CHIP.

This analysis is based on the twentieth annual edition of our performance benchmarks for Medicaid-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of 963 health plan years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to all Medicaid-focused plans possessing the ability to compile high-quality, segmented financial and operational data.

President Joe Biden, in an interview with CBS’ “60 Minutes,” declared the covid-19 pandemic “over,” stoking confusion for members of his administration trying to persuade Congress to provide more funding to fight the virus and the public to get the latest boosters. Meanwhile, concerns about a return of medical inflation is helping boost insurance premiums even as private companies race to get their piece of the health pie. Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Lauren Weber of KHN join KHN’s Julie Rovner to discuss these issues and more. Also, for extra credit, the panelists suggest their favorite health policy stories they think you should read, too.

Administrative expenses for Medicare-focused plans increased by 0.6% from 2020 to 2021. The largest cluster of functions, Account and Membership Administration, increased by 0.3%. Ten plans participated in the 2022 edition of the Medicare Sherlock Benchmarks, measuring 2021 data. The ten participating plans collectively served 12.3 million members. A median of 34% of revenues of these companies were in Medicare Advantage and Medicare SNP (“Special Needs Plans”) products. Eight plans participated in both the 2021 and 2022 benchmarking cycles and these were used for trend purposes.

This analysis is based on the nineteenth annual edition of our performance benchmarks for Medicare-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of 963 health plan years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to all Medicare-focused plans possessing the ability to compile high-quality, segmented financial and operational data. This 19th analysis of Medicare plans is based on a peer group of 10 plans who collectively serve 12.3 million people. Of the ten plans, eight were repeat participants from a year ago.

Since the beginning of 2022, prices for construction services and materials have seen significant increases. How have these increases impacted the advancement of both new and ongoing health care construction projects?

On this episode of our Owner’s Outlook series, hear from special guest Clint Russell, Vice President of Capital Deployment – Construction and Equipment at HCA Healthcare.

Clint and Epstein Becker Green construction attorney Chris Dunn talk about where costs are increasing, what might lie ahead, and how owners and providers can navigate a way forward for projects in the health care market.

The Value-Based Insurance Design (VBID) Model team at the Center for Medicare and Medicaid Innovation (CMMI) and the Administration of Community Living (ACL) led a discussion on how VBID flexibilities are being leveraged to improve equity in transportation access at our Health Equity Incubation Program webinar event held on Thursday, September 15, 2022.

This event, the third in VBID’s series of Heath Equity Incubation Program (HEIP) webinars, began with an overview of the vital need and opportunity to address transportation barriers for Medicare beneficiaries as a means to improve health equity and beneficiary experience. The session started with a presentation by a panel of national experts highlighting the trends in transportation access, the economic and health burdens of transportation barriers, and evidence-based strategies to reduce transportation barriers. Next, the VBID Model team summarized how flexibilities in the VBID Model can be used to improve access and equity in care of enrollees facing transportation barriers. The webinar also featured a panel of leaders from UnitedHealth Group and Medical Card System to discuss their programmatic strategies, successes and challenges in using VBID flexibilities to improve transportation access for their enrollees. Following the panel discussion, the session concluded with an opportunity for attendees to ask questions.

A new report from the Commonwealth Fund Commission on a National Public Health System calls for a major overhaul of the way the U.S. organizes, funds, and communicates about public health, particularly in the harsh spotlight of the covid-19 pandemic. In this special episode of KHN’s “What the Health?” host Julie Rovner and KHN’s correspondent Lauren Weber interview the commission’s chair, Dr. Margaret Hamburg, former commissioner of the U.S. Food and Drug Administration, about how to fix what ails public health.

Social determinants of health (SDoH) are the environmental conditions in patients’ lives – which can be social, economic, or physical – that contribute to or detract from health. Such factors can explain up to 60% of an individual’s health status.

In this webinar, Suzanne Doran and Emily Ferguson, Managing Editor and Associate Managing Editor for post-acute and case management content at MCG Health, dive into the expanding body of evidence supporting interventions to address SDoH. The presentation will cover foundational initiatives and activities designed to address SDoH, recent evidence for how SDoH impact different patient populations, and specific interventions to address SDoH such as food insecurity, inadequate transportation, and housing insecurity.

This 20th analysis of IPS plans is based on a peer group of fifteen Independent / Provider – Sponsored plans who collectively serve approximately 10.6 million people with Comprehensive products. In addition to the Comprehensive members, these plans also served 253,000 Managed Long Term Services and Supports members. We believe this universe to be quite robust. Participants in this year’s study serve about 52% of all membership in plans served by non-staff model plans of the Alliance of Community Health Plans and 35% of all membership served by commercial members of the Health Plan Alliance. The plans were geographically disbursed, serving 24 states.

Administrative expenses for the Independent / Provider – Sponsored plans increased in 2021 after experiencing a decline in 2020, but the rate of increase remained much lower than two years ago. Total expenses grew by 4.2%, which was higher than 2018 but well below the increase in 2019. The key area Account and Membership Administration, which composes 36% of total expenses, increased by 3.2%, but this was the second slowest rate since 2014.

This analysis is based on the twenty-fifth annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by year end, more than 960 health plan years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, participation in this set is open to Independent / Provider – Sponsored plans possessing the ability to compile high-quality, segmented financial and operational data.

A rapidly changing landscape for abortion has left patients, providers, employers, and lawmakers alike wondering what is and is not legal and what to do next. Meanwhile, Democrats in Congress have resumed negotiations on legislation to lower drug prices and, potentially, continue expanded insurance subsidies for the Affordable Care Act. Alice Miranda Ollstein of Politico, Tami Luhby of CNN, and Sandhya Raman of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too.

In the past decade, certified electronic health records (EHRs) have been instrumental in transforming medical records from paper to digital formats. 

What obstacles are currently preventing providers from sharing patient data with each other or patients from sharing health information from their personal devices with their providers? In this episode of our special series on interoperability, hear from Tomaž Gornik, founder and CEO of Better.

Tomaž and Epstein Becker Green attorneys Karen Mandelbaum and Nivedita Patel talk about openEHR and emerging data solutions and pathways for U.S. businesses.

Health workers are not OK, and that poses a threat to anyone who may need health services. That’s the central finding of the latest report from the office of U.S. Surgeon General Vivek Murthy, “Addressing Health Worker Burnout.” This special episode of KHN’s “What the Health?” podcast is a conversation about the report between Murthy and KHN chief Washington correspondent Julie Rovner, which was recorded at the annual research meeting of AcademyHealth in June.

For Blue plans, 2021 reflected trends in membership, the effects of cost management and a redeployment of expenses. Blues experienced a modest decline in costs, the first since 2015. Also, for continuous plans, this was the third year in a row of declines in the rate of growth. Total costs per member per month (PMPM) declined to a median decline of 0.4% from 5.2% in the prior year. The growth in in Account and Membership Administration (representing over 45% of all expenses) fell to 1.7% from 2.7% in 2020.

This analysis is based on the twenty-fifth annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by year end, more than 950 health plan years. This 24th analysis of Blue Plans is based on a peer group of sixteen Blue Cross Blue Shield Plans who collectively serve approximately 49.1 million people, not including Host, specialty, and other products. We believe this universe to be quite robust. Participants in this year’s study serve about 71% of all Blue comprehensive membership, excluding those served by publicly-traded firms.

Staffing challenges and cost inflation are seriously impacting health care construction as well as other sectors of the U.S. construction economy.

On this episode of our Owner’s Outlook series, hear from special guest Mike Noli, founder of the NoliWhite Group, and one of the health care industry’s leading providers of construction management and equipment planning services.

Mike and Epstein Becker Green construction attorney Chris Dunn break down which projects are at greatest risk and how to successfully manage these projects amid the current market pressures.

Listen to the first episode in the series: “Owner’s Outlook: Vaccine Mandate for Construction Workers at Health Care Facilities.”

The wait is nearly over for parents of kids under 5 as a key advisory committee to the FDA recommends authorizing a covid-19 vaccine for the youngest children. Meanwhile, Congress is struggling to fill in the details of its gun control compromise, and, as the Supreme Court prepares to throw the question of abortion legality back to the states, the number of abortions has been rising. Shefali Luthra of The 19th, Sarah Karlin-Smith of the Pink Sheet, and Sandhya Raman of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too.

The U.S. House passed a package of bills seeking to keep some guns out of the hands of children and teenagers, but its fate in the Senate remains a big question mark. Meanwhile, the Federal Trade Commission takes on drug and hospital prices. Alice Miranda Ollstein of Politico, Anna Edney of Bloomberg News, and Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Cori Uccello of the American Academy of Actuaries about the most recent report from Medicare’s trustees board.

Stemming gun violence is back on the legislative agenda following three mass shootings in less than a month, but it’s hard to predict success when so many previous efforts have failed. Meanwhile, lawmakers must soon decide if they will extend current premium subsidies for those buying health insurance under the Affordable Care Act, and the Biden administration acts, belatedly, on Medicare premiums. Margot Sanger-Katz of the New York Times, Sandhya Raman of CQ Roll Call, and Rachel Cohrs of Stat News join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews KHN’s Michelle Andrews, who reported and wrote the latest KHN-NPR “Bill of the Month” episode about a too-common problem: denial of no-cost preventive care for a colonoscopy under the Affordable Care Act.

The nationwide shortage of baby formula, which has been simmering for months, finally burst into public consciousness as more parents become less able to find food for their babies, prompting a belated federal response. Meanwhile, covid-19 cases rise but prevention activities don’t, and abortion-rights backers ready their legal arsenal for a post-Roe world. Alice Miranda Ollstein of Politico, Tami Luhby of CNN, and Rachel Cohrs of Stat join KHN’s Julie Rovner to discuss these issues and more. Plus, for extra credit, the panelists suggest their favorite health policy stories of the week they think you should read, too.

Accountable Care Organizations participating in the Medicare Shared Program have already progressed through the spectrum of value based care arrangements, with many achieving measurable levels of success. This session addresses the potential to leverage that success further by transitioning to Medicare Advantage participation, including examination of a case study on enabling providers through a multiprogram IPA and ACO infrastructure forward/

During the session Medicare FFS ACO and Medicare Advantage program structures will be overviewed, compared and contrasted. The opportunities available with a collaborative value-based care approach under Medicare Advantage will be examined, with respect to how a standard approach to VBC can achieve success.

The National Hospital Acquired Conditions and Readmissions Summit is the leading forum on current CMS policy implications and reduction strategies for Hospital Acquired Conditions and Readmissions, including the latest in patient safety initiatives and technology-enabled solutions for transitions of care and patient engagement. The Summit will highlight successful hospital strategies and tools, but equally important will feature some of the important new partnerships and collaborations.

Day Two Agenda: Wednesday, May 11, 2022
“Hospital Acquired Conditions during COVID-19 hospitalization in a high-risk national population”
Florian B Mayr Assistant Professor of Critical Care Medicine University of Pittsburgh

“Three-Year Impact Of Stratification In The Medicare Hospital Readmissions Reduction Program”
Karen Joynt Maddox, MD, MPH, Co-Director, Center for Health Economics and Policy, Institute for Public Health, Washington University in St. Louis

“Factors Associated With Disparities in Hospital Readmission Rates Among Dual Eligibles”
Demetri Goutos, MBA, Research Associate, Center for Outcomes Research and Evaluation, Yale/Yale New Haven Hospital Center

The National Hospital Acquired Conditions and Readmissions Summit is the leading forum on current CMS policy implications and reduction strategies for Hospital Acquired Conditions and Readmissions, including the latest in patient safety initiatives and technology-enabled solutions for transitions of care and patient engagement. The Summit will highlight successful hospital strategies and tools, but equally important will feature some of the important new partnerships and collaborations.

Day One Agenda: Tuesday, May 10, 2022
“CMS National quality strategy, patient safety and overall quality metrics”
Michelle Schreiber, MD, Deputy Director for Quality & Value, CMS, Clinical Standards and Quality

“Outlook from DC: What’s on the Horizon for Medicare Quality Programs”
Sheila Madhani, Vice President, McDermott+Consulting

“Patient engagement and Care in the home: Addressing utilization from the patient perspective”
Caroline Blaum, MD, MS, Senior Research Scientist, NCQA

The unprecedented early leak of a Supreme Court draft opinion that would overturn the landmark abortion-rights ruling Roe v. Wade has heated the national abortion debate to boiling. Meanwhile, the FDA, after years of consideration, moves to ban menthol flavors in cigarettes and cigars. Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, Shefali Luthra of the 19th, and Jessie Hellmann of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Plus, Rovner interviews KHN’s Paula Andalo, who wrote the latest KHN-NPR “Bill of the Month” episode about a family whose medical debt drove them to seek care south of the border.

What has contributed to the biotechnology industry’s explosive growth over the last several years? In this episode, special guests Don and Lisa Drakeman, two former CEOs of biotech companies, reflect on what it takes to succeed, the regulatory challenges they have faced, and how current events are shaping the future of the industry.

Joining our special guests are Epstein Becker Green attorneys Robert Wanerman and Rachel Weisblatt, who address how biotech leaders, entrepreneurs, and investors can best navigate the complex legal issues that arise along the path from product development to thriving business.

Congress is in recess, so the slower-than-average news week gives us a chance to catch up on underreported topics, like Medicare’s coverage decision for the controversial Alzheimer’s disease drug Aduhelm and ominous new statistics on drug overdose deaths and sexually transmitted diseases. Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and the Johns Hopkins Bloomberg School of Public Health, and Alice Miranda Ollstein of Politico join KHN’s Julie Rovner to discuss these issues and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too.

This MCOL podcast features a discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial performance of value based care organizations for the fourth quarter 2021.

The ACO REACH Model Team hosted a health equity webinar on Tuesday, April 5, 2022  The ACO REACH Model team highlighted Health Equity provisions added to the ACO REACH Model.

In his proposed budget, President Joe Biden called for a boost in health spending that includes billions of dollars to prepare for a future pandemic. But that doesn’t include money he says is needed immediately for testing and treating covid-19. Also this week, federal regulators authorized a second booster shot for people 50 and older yet gave little guidance to consumers about who needs the shot and when. Amy Goldstein of The Washington Post, Jennifer Haberkorn of the Los Angeles Times, and Rachana Pradhan of KHN join KHN’s Mary Agnes Carey to discuss these issues and more. Plus, Julie Rovner interviews KHN’s Julie Appleby, who reported and wrote the latest KHN-NPR “Bill of the Month” episode about a very expensive air ambulance ride.

On February 24th, CMMI announced revisions to the Medicare FFS Global and Professional Direct Contracting (GPDC) model, which will now be re-branded as the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. As part of this revision, there will be an application window for this program spanning March 7th through April 22nd.

This session will discuss this new program’s requirements and financial components, including how this program compares to the existing GPDC model as well as MSSP. Attendees will develop a deeper understanding of the ACO REACH model, and the pros and cons of joining or staying in the program vs exploring other options.

Please join us as speakers from WakeMed Key Community Care; UC San Diego Health; and MCG Health discuss how providers are leveraging MCG Health solutions for care coordination to develop high-quality care programs in the HealthcareWebSummit event co-sponsored by MCG Health: Value-Based Care and Care Coordination.

• Customer success stories in care coordination and value-based care
• Challenges to delivering value-based care that can be addressed by MCG solutions (today and in the future)
• How MCG solutions for care coordination and value-based care may support the goals of your organization

This webinar focused on the new financial policies featured in the ACO REACH webinar, providing financial methodology for the ACO REACH Model that will be transitioned from the Global and Professional Direct Contracting (GPDC) Model.

Although its fate was in doubt more than a few times, the Affordable Care Act turned 12 this week. Year 13 could be pivotal in determining how many Americans receive ACA health insurance, and at what price. Meanwhile, three leading credit bureaus agreed to stop using most medical debt to measure U.S. consumers’ creditworthiness. Anna Edney of Bloomberg News, Rachel Cohrs of Stat, and KHN’s Mary Agnes Carey join KHN’s Julie Rovner to discuss these issues and more.

The White House makes a move as a new wave of covid threatens. President Joe Biden brings in Dr. Ashish Jha to take over the executive branch effort. Meanwhile, it remains unclear if and when Congress can come up with the funds to continue much of the federal anti-covid effort. Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, Sandhya Raman of CQ Roll Call, and Alice Miranda Ollstein of Politico join KHN’s Julie Rovner to discuss these issues and more.

Prevailing attitudes about the future suggest that the health care industry is either approaching a new equilibrium or reverting to the pre-pandemic mean—but Advisory Board believes that the future is still unwritten, for the moment. While most health plans were generally stable throughout the pandemic and used excess strategically to make principled (rather than reactive) investments, leaders in other sectors are now finding themselves with their own unique—but time-limited—opportunities to shape that future.

This presentation will explore what health plans need to know about key structural shifts of the peri-pandemic period that may play out in different directions, depending on the actions taken by stakeholders across the industry in the near future. These include new price transparency requirements, value-based payment, physician alignment, virtual care, home-based care, and health equity.

The interoperability and information-blocking rules have imposed new regulations and requirements on health information exchanges (HIEs). How are HIEs responding to these new regulations in a space they have been in for decades? In this episode of our special series on interoperability, hear from Dan Paoletti, CEO of the Ohio Health Information Partnership.

Dan and Epstein Becker Green attorneys Allen Killworth and Nivedita Patel discuss the role of HIEs in the interoperability landscape and the impact of the information-blocking rules on HIEs.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the fourth quarter 2021.

One of the long-term goals of the interoperability and information-blocking rules is to give health care providers a much more comprehensive view of a patient’s entire continuum of care.

In this episode, Andrea Darby, the Vice President of IT Integration – Applications for OhioHealth, offers a provider’s perspective on their role in a health care ecosystem that is striving to achieve much-needed interoperability.

Epstein Becker Green attorneys Jenny Nelson Carney and Nivedita Patel also discuss how providers are tackling the compliance challenges associated with the interoperability and information-blocking rules.

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Trine Tsouderos, and Strategy& Principal, Igor Belokrinitsky, in discussion with PwC's Global Pharmaceutical and Life Sciences Cyber Leader, Nalneesh Gaur and PwC's Cybersecurity Principal, Robbie Higgins, on cybersecurity issues and privacy laws that pharmaceuticals and life sciences companies are dealing with in China. This episode includes insights and implications of: 

• China Cybersecurity Law
• Multi-layer Protection Scheme 2.0
• Data Security Law
• Personal Information Protection Law

In anticipation of the Supreme Court rolling back abortion rights this year, both Democrats and Republicans are arguing among themselves over how best to proceed to either protect or restrict the procedure. Meanwhile, millions of Americans are at risk of losing their health insurance when the federal government declares an end to the current “public health emergency.” Alice Miranda Ollstein of Politico, Shefali Luthra of The 19th, and Rachana Pradhan of KHN join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews KHN’s Jay Hancock, who wrote the latest KHN-NPR “Bill of the Month” episode about a couple whose insurance company deemed their twins’ stay in intensive care not an emergency.

Tune into this episode of PwC's Next in Health to hear Strategy& Principal, Igor Belokrinitsky, in discussion with PwC Strategy& Director, Rohit Nayak, PwC Strategy& Senior Manager, Sri Murthy Guru and PwC Strategy& Senior Associate, Cailin Hong, on what physicians are seeking from payers, health systems and management services organizations (MSOs), to help improve the practice of medicine. This episode includes:

• Emerging business models and solutions that can enhance the physician experience
• The role of payers and providers in driving physician enablement within the health ecosystem
• Actions health organizations should consider to help support and encourage their physicians

As the pandemic wanes, for now, the ever-rising cost of health care is again taking center stage. Meanwhile, a year into the Biden administration, the FDA finally has a Senate-confirmed commissioner, Dr. Robert Califf. Tami Luhby of CNN, Sarah Karlin-Smith of the Pink Sheet, and Rachel Cohrs of Stat join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Hannah Wesolowski of the National Alliance on Mental Illness, about how the pandemic has worsened the nation’s mental health crisis and what can be done about it.

Tune into this episode of PwC's Next in Health to hear Strategy& Principal, Igor Belokrinitsky and PwC Health Industries Vice Chair, Jenny Colapietro, in discussion with US Pharmaceutical & Life Sciences Deals Leader, Glenn Hunzinger and US Health Services Deals Leader, Nick Donkar, on current deal trends impacting the health sector. This episode includes:

• Significant mergers and acquisitions of 2021
• Future deal drivers for 2022 and the potential impact on current trends
• Deal growth activity in healthcare and pharma & life sciences subsectors

View a brief presentation on survey results conducted in conjunction with the 2022 Future Care Web Summit, which includes comparisons to previous year results. Find out what healthcare topic will have the greatest impact in 2022, and who will be the healthcare economic winners and losers this year.

Congress is set to start its once-every-five-years review of the law that authorizes user fees to finance the hiring of personnel to speed the FDA review of drugs. The periodic renewals of “PDUFA” also give lawmakers a chance to make other changes to the agency at the hub of the pandemic. Meanwhile, the FDA could also find itself at the center of the abortion debate and a controversial new medication to treat Alzheimer’s disease. Anna Edney of Bloomberg News, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more.

Tune into this episode of PwC's Next in Health to hear Strategy& Principal, Igor Belokrinitsky, in discussion with PwC Director, Sierra Hawthorne, PwC Strategy& Managing Director, Josette Beran, and The PwC Katzenbach Center Managing Director, Reid Carpenter, on the current state of the health industry and three trends to watch for in 2022, including:

• Investing in our workforce
• Building trust
• Creating financial sustainability

Tune into this episode of PwC's Next in Health to hear Strategy& Principal, Igor Belokrinitsky and PwC Health Industries Vice Chair, Jenny Colapietro, in discussion with the Founder & CEO of Concert Health, Spencer Hutchins, on the evidence-based health care model that will help tighten the gaps in our behavioral and mental health services. This episode includes:

• How Concert Health’s collaborative care model addresses issues around healthcare access and integration
• The importance of integration and partnerships with providers and payors in addressing behavioral health
• Leveraging data and analytics to drive growth and innovation in behavioral health services
• Key considerations to reduce racial disparities and prevent burnout in behavioral health care

Health and Human Services Secretary Xavier Becerra is drawing criticism for his hands-off handling of the covid crisis even though the heads of the Centers for Disease Control and Prevention, National Institutes of Health, and FDA report to him. Meanwhile, the Department of Labor looks to enforce mental health “parity laws” that have failed to achieve their goals. Margot Sanger-Katz of The New York Times, Alice Miranda Ollstein of Politico, and Rachel Cohrs of Stat join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews KHN’s Noam N. Levey, who reported and wrote the latest KHN-NPR “Bill of the Month” episode about a large emergency room bill for a small amount of medical care.

The 21st Century Cures Act kicked off a major paradigm shift in the approach to accessing and sharing patient data. How will the health care industry adapt to this new way of thinking? In the first episode of our special series on interoperability, Steve Yaskin, the CEO and Co-Founder of Health Gorilla, and Epstein Becker Green’s Nivedita Patel discuss why interoperability is so important for patients and all stakeholders within the health care ecosystem.

Steve and Nivedita also provide a recap of how various regulations and government actions have led to the market demand for innovative solutions to meet the interoperability requirements.

What are the key healthcare business issues and trends for 2022, and how can you best position for them? Attend the Twentieth Annual Future Care Web Summit, which addresses these topics and more.

Noted national healthcare expert speaker Mark Lutes, the Chair of Epstein Becker Green, will address these three pivotal regulatory and policy questions: Where are primary care incentivization and delivery models going? Will digital health innovations find payment success? What will CMS and payor response be to genetic and other breakthrough therapies ?

National thought leader Paul Keckley takes us on a journey through key selected trends impacting such topics as healthcare private equity, inflation and pricing, the value-based agenda and more Paul Keckley is an intense observer of that change, diving deep into the trends, tipping points, intended and unintended consequences to bring clients and opinion leaders the unvarnished truth.

Chris Sukenik, Principal, BDC Advisors will highlight key market dynamics that will reshape the healthcare landscape in 2022 and beyond for payers and providers. Chris is a proven consulting leader and trusted advisor to senior healthcare executives with a focus on provider and payer healthcare markets.

Temporary subsidies helped boost enrollment under the Affordable Care Act to a record 14.5 million, according to the Department of Health and Human Services. But unless Democrats in Congress extend those subsidies, many of those new enrollees will be in for a rude surprise just ahead of midterm elections. Meanwhile, the need to replace retiring Supreme Court Justice Stephen Breyer further crowds an already tight legislative schedule. Joanne Kenen of Politico and the Johns Hopkins Bloomberg School of Public Health, Sarah Karlin-Smith of the Pink Sheet, and Anna Edney of Bloomberg News join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Diana Greene Foster, author of “The Turnaway Study: Ten Years, a Thousand Women, and the Consequences of Having — Or Being Denied — An Abortion.”

Jan. 22 marks the 49th — and very likely last — anniversary of the Supreme Court’s landmark abortion decision, Roe v. Wade. The court’s conservative supermajority seems poised to overturn later this year the ruling that legalized abortion nationwide. Also this week, the Biden administration turns 1, with much of its domestic and health agenda yet unrealized. Alice Miranda Ollstein of Politico, Shefali Luthra of the 19th, and Kimberly Leonard of Insider join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Marjorie Dannenfelser, president of the Susan B. Anthony List, about what a post-Roe world might look like.

Learning Objectives address in this session:
To recognize and recall the potential impact of major foreseeable trends in US healthcare in 2022
To be able to explain at least one action to mitigate risk and one action to seize opportunities for the participating organization

Anticipated Market Dynamics to be discussed:
A shift in the way digital health is delivered toward decentralization
The increasing role of AI to create insights and improvements to diagnostic capabilities and care pathways
The exponential rise in value-based objectives applied to more modalities in healthcare – Clinical, Operational and Financial

2022 Healthcare Trends  Addressed by Topic:
Provider consolidation
Private branded insurance products
Delayed / deferred care
Physician burden and migration
Managed Medicare

The Biden administration has released a series of rules and guidance to implement the No Surprises Act, which went into effect on January 1. All providers and facilities must now provide a good faith estimate to uninsured and self-pay patients scheduling appointments for services or upon request.

On this episode of Diagnosing Health Care, attorneys Helaine Fingold, Robert Hearn, and Alexis Boaz discuss the good faith estimate, what it entails, who needs to provide it, and updates regarding enforcement.

Additionally, you’ll hear about what “substantially in excess” means and how the provider-patient dispute process works.

Medicare officials tentatively plan to restrict the use of a controversial Alzheimer’s drug to only those patients participating in clinical trials, while the Department of Health and Human Services looks into lowering the monthly Medicare Part B premium. Meanwhile, covid confusion still reigns, as the Biden administration moves, belatedly, to make more masks and tests available. Joanne Kenen of Politico and the Johns Hopkins Bloomberg School of Public Health, Sarah Karlin-Smith of the Pink Sheet and Rachel Cohrs of Stat join KHN’s Julie Rovner to discuss these issues and more.

2022 will offer a complex, challenge-filled healthcare landscape, that can’t be navigated with a roadmap viewable on a device screen without a whole lot of scrolling involved. Watch a three and one half minute video highlighting sixteen key healthcare business trends for 2022, as detailed in mcolblog

It’s 2022 and the covid-19 pandemic is still with us, as are congressional efforts to pass President Joe Biden’s big health and social spending bill. But other issues seem certain to take center stage on this year’s health agenda, including abortion, the state of the health care workforce, and prescription drug prices. Tami Luhby of CNN, Alice Miranda Ollstein of Politico and Mary Ellen McIntire of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews KHN’s Victoria Knight, who reported the latest KHN-NPR “Bill of the Month” episode.

Sen. Joe Manchin (D-W.Va.) dealt a blow to congressional efforts to pass President Joe Biden’s domestic agenda bill, forcing Democrats to regroup starting in 2022. Meanwhile, the omicron covid variant spreads rapidly in the U.S., threatening the stability of the nation’s health care system. Joanne Kenen of Politico and the Johns Hopkins School of Public Health, Rachel Cohrs of Stat and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more, plus a look back at the year in health policy. Also this week, Rovner interviews Ceci Connolly, president and CEO of the Alliance of Community Health Plans.

Even before the omicron variant of covid starts to spread widely in the U.S., hospitals are filling up with post-holiday delta cases. Meanwhile, the Supreme Court signals — loudly — that 2022 will be the year it rolls back abortion rights in a big way. Margot Sanger-Katz of The New York Times, Alice Miranda Ollstein of Politico and Mary Ellen McIntire of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more.

Tune into this episode of PwC's Next in Health to hear Strategy& Principal, Igor Belokrinitsky and PwC's Health Industries Vice Chair, Jenny Colapietro, in discussion with PwC Principal, Omar Chane, and PwC Managing Director, Amy Hunckler, on the evolution of the vaccines market and mRNA technology, including:

• The impact of new entrants on the vaccine industry
• Manufacturers' role in improving the customer experience
• How mRNA and its various applications will continue to shape the pharmaceutical and life sciences industry

In this session, Milliman experts provide relevant, timely and useful information about the state of the MSSP ACO market. Given that MSSPs represent such a large portion of the Medicare FFS landscape, it is worthwhile to look at the available data for how ACOs have performed and evolved over time. We can then use this data to better understand what MSSP features may be associated with financial success. It is just as important to see what factors are not correlated with success or failure in the program.

In order to provide insights on these drivers, Milliman analyzed CY 2020 experience for MSSP ACOs as reported in CMS 2020 Shared Savings Program Public Use Files, as well as 2015-2019 PUFs, to identify and examine key MSSP trends and patterns in shared savings/loss rates, participation, and other key metrics.

Financial results for 2020 may have been materially impacted by the pandemic as well as CMS’s modifications to MSSP rules and regulations. Due to the potential for skewed results, as well as to highlight potentially longer-term observations, prior year savings outcomes were analyzed as well.

Tune into this episode of PwC's Next in Health to hear Strategy& Principal, Igor Belokrinitsky and PwC's Health Industries Vice Chair, Jenny Colapietro, in discussion with PwC's Pharmaceutical and Life Sciences Research and Development Principals, Anup Kharode and Brian Slizgi, on the evolution of the clinical trial delivery model, including:

• Impact of COVID-19 on clinical trials and research
• Emerging trends and disruptors
• Implications for clinical research organizations (CROs) and the broader pharmaceutical industry
• The future of decentralized clinical trials

The No Surprises Act (NSA) will go into effect on January 1, 2022. Since our last episode on the topic, the federal government has issued additional interim final rules and guidance to implement the NSA, including the second interim final rule. In addition to describing how the NSA interacts with the plan external review procedures, the second interim final rule describes the independent dispute resolution (IDR) process and how the IDR’s determination is made.

On this episode of Diagnosing Health Care, attorneys Helaine Fingold, Lesley Yeung, and Alexis Boaz dive into how these changes impact entities subject to the NSA’s balance billing prohibitions.

The fight over covid vaccines continues to intensify, with Republicans on Capitol Hill pushing — with some success — to cancel President Joe Biden’s “test regularly or vaccinate” requirement for private employers. Meanwhile, abortion is not the only health issue before the Supreme Court this term. Joanne Kenen of Politico and the Johns Hopkins Bloomberg School of Public Health, Sarah Karlin-Smith of the Pink Sheet and Rachel Cohrs of Stat News join KHN’s Julie Rovner to discuss these issues and more.

In healthcare, "gaps in care" refers to the gaps that exist between best practices and actual patient care. Closing these gaps is important to deliver value-based care and quality of care. Additionally, care gaps, when not properly managed, can be both harmful and costly. Reporting of open care gaps and closing care gaps is a core component of value-based care between payers and providers.

Health Level Seven International (HL7), the not-for-profit, ANSI-accredited standards developing organization, introduced Fast Healthcare Interoperability Resources (FHIR), to address interoperability challenges as "a new standard for exchanging healthcare information electronically. The HL7 FHIR standard is well-suited to form the basis of real-time API data exchange between applications, devices, and systems. The HL7 Da Vinci Project was born out of the need to accelerate FHIR adoption" to support and integrate value-based care and payment model data exchange.

Join this webinar to learn about leveraging claims and clinical history to inform potential care gaps that can be closed to improve HEDIS/STAR ratings and non-HEDIS measures.

Tune into this episode of PwC's Next in Health to hear Strategy& Principal, Igor Belokrinitsky and PwC's Health Industries Vice Chair, Jenny Colapietro, in discussion with PwC Director, James Lin, on price transparency regulations, including:

• Key implications and considerations for payers, providers and pharma and life sciences
• Impacts to consumer behavior and market pricing
• How to improve the relationship between price and quality transparency.

A Supreme Court majority appears ready to overturn nearly 50 years of abortion rights, at least judging by the latest round of oral arguments before the justices. And a new covid variant, omicron, gains attention as it spreads around the world. Alice Miranda Ollstein of Politico, Sarah Karlin-Smith of the Pink Sheet and Shefali Luthra of The 19th join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Blake Farmer of Nashville Public Radio about the latest KHN-NPR “Bill of the Month” episode

This MCOL podcast features a discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial performance of value based care organizations for the third quarter 2021.

Tune into this episode of PwC's Next in Health to hear Strategy& Principal, Igor Belokrinitsky and PwC's Health Industries Vice Chair, Jenny Colapietro, in discussion with PwC’s Consulting Solutions Director, Aparna Kumar, on how the next generation is transforming philanthropy to drive organizational success and social change, including:

• The current philanthropic funding landscape
• Benefits of strategic partnerships
• The role of technology in shaping the future of philanthropy
• Bridging the relationship between philanthropy and ESG

President Joe Biden’s social spending budget is on its way to the U.S. Senate, where Democratic leaders are (optimistically) hoping to complete work by the end of the year. Meanwhile, covid is surging again in parts of the country, along with the political divides it continues to cause. Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and the Johns Hopkins School of Public Health, and Mary Agnes Carey of KHN join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner previews next week’s Supreme Court abortion oral arguments with Florida State University law professor Mary Ziegler.

We’re beginning to see how mergers and acquisitions in the hospital industry are being impacted by President Biden’s executive order promoting competition in the American economy. The Federal Trade Commission recently announced policy changes, and the Department of Justice has been asked to consider policy changes, that boards of directors and C-suite officers must take into account when weighing transactions.

On this episode of Diagnosing Health Care, special guest Dr. Subramaniam (Subbu) Ramanarayanan, Managing Director at NERA Economic Consulting, and Epstein Becker Green attorneys John Steren, Patricia Wagner, and Dan Fahey discuss what leaders need to know about the government’s heightened antitrust scrutiny in the hospital market.

Federal health officials appear poised to extend a recommendation for covid boosters to all adults, following moves by some governors and mayors to broaden the eligible booster pool as caseloads rise. Meanwhile, the Food and Drug Administration finally has a nominee to head the agency: former FDA chief Robert Califf. And Medicare premiums for consumers will likely rise substantially in 2022, partly due to the approval of a controversial drug to treat Alzheimer’s disease. Tami Luhby of CNN, Sarah Karlin-Smith of the Pink Sheet and Rachel Cohrs of Stat join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Dan Weissmann, host of the “An Arm and a Leg” podcast.

In this session, Milliman experts present their findings that the drivers of recent success are quite different and, in some cases, the opposite of what they were in 2015. With Pathways to Success, CMS endeavored to reshape the MSSP by adjusting incentives, encouraging greater accountability in ACOs, and offering options specific to each ACO’s ability to take on risk. Their analysis gives early indication that these changes are rewarding ACOs for attained efficiency levels, possibly enhancing the attractiveness of the program. Furthermore, the authors also see evidence of at least some correlation between tracks with downside risk and higher gross savings, supporting CMS’s case for accountability as a policy priority, though voluntary track selection may also be playing a role. Lastly, the authors see some indication that ACOs strongly emphasizing primary care are having greater success than their peers.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the third quarter 2021.

Tune into this episode of PwC's Next in Health to hear Strategy& Principal, Igor Belokrinitsky and PwC's Health Industries Vice Chair, Jenny Colapietro, in discussion with PwC Principal, Kevin McLellan, on the latest medical device trends and innovations, including:

• Shifting consumer and patient engagement
• Implications of connected devices and data on care experience
• Differentiated growth opportunities for medical technology to unlock value and reimagine tradition care model

Tune into this episode of PwC's Next in Health to hear Strategy& Principal, Igor Belokrinitsky and PwC's Health Industries Vice Chair, Jenny Colapietro, in discussion with PwC Principal, Paul Leinwand, PwC Director, Inshita Wij and PwC Senior Manager, Lauren Christian, on recent consumer healthcare survey findings, including:

• What consumers are seeking from their healthcare experience and how health systems can respond
• Must-haves for improving consumer experience and loyalty
• The demand for virtual care persists
• Future considerations for health organizations to increase consumer engagement

As 2021 nears a close, acute care hospitals and health systems are facing a host of financial, regulatory, and legislative challenges. In this special episode of Diagnosing Health Care, Rick Pollack, President and CEO of the American Hospital Association, and Epstein Becker Green’s Ted Kennedy, Jr., discuss the ways in which the industry is working with the Biden administration and Congress to shape policy around critical issues, such as surprise billing, coverage expansion, value-based care, and telehealth.

Rick and Ted look at how these policy issues relate to broader mark.

Congress is making slow progress toward completing its ambitious social spending bill, although its Thanksgiving deadline looks optimistic. Meanwhile, a new survey finds the average cost of an employer-provided family plan has risen to more than $22,000. That’s about the cost of a new Toyota Corolla. Alice Miranda Ollstein of Politico, Anna Edney of Bloomberg News and Rebecca Adams of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Rebecca Love, a nurse academic and entrepreneur, about the impending crisis in nursing.

Epstein Becker Green’s Helaine Fingold and Bob Hearn help stakeholders sort through the No Surprises Act with guidance on compliance and discussion of the issues, implications, and resulting opportunities, in the HealthcareWebSummit event: Making Sense of the No Surprises Act and Interim Final Rules.

In this session, Epstein Becker Green’s Helaine Fingold and Bob Hearn help to make sense of the Act, examine the business opportunities and solutions that exist despite the high-stakes legal, policy, and regulatory issues that the health care industry faces, and discuss specific and “operationalized” guidance to providers, facilities, and health plans on complying with the Act, including its challenging interaction with state balance billing laws. Their insights are based on experience in this arena and are rededicated to deciphering the complex interaction between state law and the new federal law.

Democratic negotiators on Capitol Hill appear to be nearing a compromise on President Joe Biden’s social spending agenda, spurred partly by Democratic losses on Election Day in Virginia. Meanwhile, the Supreme Court hints it might allow abortion providers to sue Texas over its restrictive new ban. But the relief, if it comes, could be short-lived if the court uses a second case, challenging a law in Mississippi, to weaken or overturn Roe v. Wade. Alice Miranda Ollstein of Politico, Margot Sanger-Katz of The New York Times and Mary Ellen McIntire of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews KHN’s Rae Ellen Bichell, who reported and wrote the latest KHN-NPR “Bill of the Month” feature about an emergency bill for a nonemergency birth.

President Joe Biden unveiled a compromise “Build Back Better” framework shortly before taking off for key meetings in Europe, but it’s unclear whether the framework can win the votes of all Democrats in the House and Senate, and it leaves out some of the party’s health priorities, notably significant provisions to lower prescription drug prices. Meanwhile, younger children may soon be eligible for covid vaccines. Joanne Kenen of Politico and Johns Hopkins, Sarah Karlin-Smith of the Pink Sheet and Rachana Pradhan of KHN join KHN’s Julie Rovner to discuss these issues and more.

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Trine Tsouderos, and Strategy& Principal, Igor Belokrinitsky, on the long-respected history of bloodletting, including:

• Barber surgeons and early medicine
• The practice and evolution of bloodletting
• The influence of ancient principles on modern medicine

The COVID-19 pandemic spurred record growth in the dietary supplement industry in 2020. With this heightened consumer interest and many new entrants to the market, important questions have emerged about the adequacy of the current regulatory framework for dietary supplements. Are current controls adequately protecting consumers from supplement products that are unsafe? What is the right level of regulation and enforcement for these products?

In this episode of Diagnosing Health Care, Epstein Becker Green attorneys Delia Deschaine, Jack Wenik, and Bonnie Odom discuss recent trends that are shaping business decisions and compliance in the dietary supplement industry.

Negotiations on the health parts of President Joe Biden’s domestic agenda are getting serious but have yet to produce a deal every Democrat can support. Meanwhile, the Food and Drug Administration remains without a nominated leader but manages to take the first steps toward approving over-the-counter hearing aids. Joanne Kenen of Politico and Johns Hopkins, Tami Luhby of CNN and Rachel Cohrs of Stat join KHN’s Julie Rovner to discuss these issues and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too.

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Trine Tsouderos, and Strategy& Principal, Igor Belokrinitsky, in discussion with PwC’s Partner, Derek Gaasch, on how health insurance companies can optimize their member engagement, to help them achieve better health, including:

• The consumerization of health
• The importance of advocacy for members and health insurers
• Proactive efforts to increase members’ health and wellness engagement
• Technology’s impact on member advocacy

Like almost everything else associated with the covid-19 pandemic, partisans are taking sides over whether vaccines should be mandated. Meanwhile, Democrats on Capitol Hill are still struggling to find compromise in their effort to expand health insurance and other social programs. Alice Miranda Ollstein of Politico, Jen Haberkorn of the Los Angeles Times and Mary Ellen McIntire of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews best-selling author Beth Macy about her book “Dopesick,” and the new Hulu miniseries based on it.

View three selected MCOL Daily Factoids for Fall 2021, including:

• September 15, 2021 Hypertension in Women, Globally
• September 29, 2021: Top 10 Languages Used in Patient/Healthcare Provider Encounters
• September 9, 2021, Imnpact of Patient Online Reviews for Providers

The polarizing abortion issue threatens to tie up Congress, the Supreme Court and the states for the coming year. Meanwhile, Congress kicks the can down the road to December on settling its spending priorities. Joanne Kenen of Politico and the Johns Hopkins School of Public Health, Yasmeen Abutaleb of The Washington Post and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews KHN’s Aneri Pattani, who delivered the latest KHN-NPR “Bill of the Month” episode about a covid test that cost as much as a luxury car.

Negotiations continue on Capitol Hill over President Joe Biden’s health agenda — along with a long list of other items. With Republicans on the sidelines, liberal Democrats delayed a House vote on a Senate-passed infrastructure bill to extract moderates’ support for a social-spending bill that includes expansions of benefits for Medicare, Medicaid and the Affordable Care Act. Meanwhile, the Biden administration’s new rules to prevent “surprise” medical bills pleases some health stakeholders and angers others. Alice Miranda Ollstein of Politico, Tami Luhby of CNN and Kimberly Leonard of Insider join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews Anna Flagg of the Marshall Project about how a century-old report on medical education contributed to racial inequities that persist today.

On December 27, 2020, President Trump signed into law the No Surprises Act as part of the $2.3 billion Consolidated Appropriations Act. Recently, the Biden administration issued its first interim final rule in order to implement this act, which will go into effect on January 1, 2022. While the goal is to protect patients from surprise billing, the law will also impose significant compliance burdens on plans, providers, and facilities.

Epstein Becker Green attorneys Helaine Fingold, Bob Hearn, and Alexis Boaz discuss the key areas health care companies need to keep in mind as they prepare to comply with the No Surprises Act.

Congress is back in session with a short time to finish a long to-do list, including keeping the government operating and paying its bills. Hanging in the balance is President Joe Biden’s entire domestic agenda, including major changes proposed for Medicare, Medicaid and the Affordable Care Act. Meanwhile, the new Texas abortion law that bans the procedure early in pregnancy is prompting action in Washington. Joanne Kenen of Politico, Mary Ellen McIntire of CQ Roll Call and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews former FDA Commissioner Scott Gottlieb about his new book on the covid-19 pandemic.

As part of the 21st Century Cures Act, the interoperability rule seeks to drive patient access to personal and medical data, and support the ability to share that data, allowing patients more power to coordinate their own healthcare. The rule bolsters the existing trend toward a more patient-focused model, empowering patients to participate more effectively in their own medical care and improve public health services. 

Payer organizations need to able to gather and share data around member costs and coverage, clinical interactions and other data points. All of these efforts aim to prevent information blocking and improve the flow of easy member access to or transfer of data. As payers plan for the future, they should look beyond current system data and consider use cases that may become possible with enriched data sets.

Watch this webinar to learn about the 21st Century Cures Act interoperability and what it means for data exchange for payers. As payers stand up their “Patient Access” APIs, there is an opportunity to look beyond compliance and embrace this new data standard to improve outcomes for their members.

Democrats have hit a snag in their effort to compile a $3.5 trillion social-spending bill this fall — moderates are resisting support for Medicare drug price negotiation provisions that would pay for many of the measure’s health benefit improvements. Meanwhile, the new abortion restrictions in Texas have moved the divisive issue back to the political front burner. Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat and Shefali Luthra of The 19th join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interview’s KHN’s Phil Galewitz about the latest KHN-NPR “Bill of the Month” installment, about two similar jaw surgeries with very different price tags.

Between 2019 and 2020, administrative cost growth for Medicare-focused plans accelerated from 5.2% to 5.6%, shown in Figure 1. Account and Membership Administration expenses lagged total cost growth, increasing by 1.8% and dropping sharply from last year’s rate of 9.3%. Thirteen plans participated in this year’s Medicare benchmarking study, collectively serving 12.2 million people. 

This analysis is based on the eighteenth annual edition of our performance benchmarks for Medicare-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of 929 health plan years. This 18th analysis of Medicare plans is based on a peer group of 13 plans who collectively serve 12.2 million people. Of the thirteen plans, seven were repeat participants from a year ago. The average plan participating in the Medicare Sherlock Benchmarks this year served 1.2 million people and the median membership was 941,000. The geographic reach extended from coast to coast.

The covid pandemic has spotlighted the often-unseen role of public health in Americans’ daily lives. And the picture has not all been pretty. What is public health and why is it so important — and controversial? Dr. Ashish Jha, dean of the Brown University School of Public Health, explains the basics. Then, Joanne Kenen of Politico and Lauren Weber of KHN join KHN’s Julie Rovner to discuss what could happen next.

As payers look to uncover every possible recovery opportunity, identifying the proper liable party for payment of health care services is essential. Join this webinar to learn how to maximize the ROI of your subrogation strategy by understanding the key building blocks for success: 

• Breaking down the components of subrogation success

• Understanding both core and ancillary benefits of doing subrogation right

• Appreciating the differences between internal and outsourced subrogation efforts

• How to maximize the ROI of your subrogation program

Speakers: Debra Whaley, Senior Executive Subrogation Analyst, Trustmark Companies; Ryan L. Woody, Partner, Matthiesen, Wickert & Lehrer; Mara Gericke, Director of Subrogation Recovery Operations, Conduent; Moderator: Clive Riddle, President, MCOL

Subrogation is a critical element in ensuring payment integrity. Challenges for improving health plan subrogation recoveries include a multitude of factors such as: complexities in regulatory compliance; a relative “under-the-radar” level of c-suite awareness of subrogation performance issues in some organizations; the difficulty in capturing data identifying claims as subrogation-appropriate; the increased trend rate in accidental injuries and death; and Post-ACA expansion of coverage increasing the volume of potential claims to consider, particularly with the age 19-26 population that experiences a higher rate of accidental injuries.

Yet opportunities exist to meet these subrogation challenges. Advances in analytics provide enhanced capabilities in addressing high volumes of data and identification of potential subrogation claims.

Optimizing the success of health plan subrogation efforts requires a rich understanding of state and ERISA regulations and the skill to recognize the best path to claim resolution.  In this webinar our experts will share their insights on the rules governing healthcare subrogation and their experiences in maximizing results in the current subrogation environment.

Additional Tags: Claims, TPA, Third Party Administrator, Payment Integrity, Slef-Insurance, Self-Funding, Benefits Administration

The FDA’s formal approval of the first vaccine to prevent covid-19 may or may not prompt doubters to go out and get shots, but it has clearly prompted employers to make vaccination a work requirement. Meanwhile, moderates and liberals in the U.S. House put aside their differences long enough to keep a giant social-spending bill on track, at least for now. Joanne Kenen of Politico, Tami Luhby of CNN and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Plus, for “extra credit,” the panelists suggest their favorite health policy stories of the week they think you should read, too.

• Enrollment, Utilization and Financial Data by Plan and by Category
• Trends in Enrollment Changes and Utilization/Financial Ratios
• Highlights of Recent Market Activity

MCOL has compiled key current and historical California Health Plan enrollment, utilization and financial data by plan and by selected categories, and has identified trends in changes in enrollment as well as in utilization and financial ratios. Significant recent market activity has also been highlighted for selected plans. This analysis provides the opportunity to consider the pandemic impact so far on these health plan indicators, and what are the trends and market activities driving the data. MCOL President Clive Riddle provides an interesting tour of the numbers and trends behind the current state of California health plans.

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Trine Tsouderos, and Strategy& Principal, Igor Belokrinitsky, in discussion with PwC’s Consulting Solutions Director, Aparna Kumar, on how the U.S. can overcome the shortage of healthcare workers, including:

• Physician workforce projections released in The Association of American Medical Colleges’ (AAMC) annual report
• The pandemic’s impact on the physician shortages
• Decreasing regulatory barriers for internationally educated physicians could ease the burden of physician shortages
• Short-term strategies to address physician workforce shortages

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the second quarter 2021.

As the delta variant continues to spread around the U.S., the Biden administration is taking steps to authorize covid vaccine boosters, require nursing home workers to be vaccinated and protect school officials who want to require masks despite state laws banning those mandates. Meanwhile, the U.S. House is returning from its summer break early to start work on its giant budget bill, which includes a long list of health policy changes. Alice Miranda Ollstein of Politico, Margot Sanger-Katz of The New York Times and Kimberly Leonard of Business Insider join KHN’s Julie Rovner to discuss these issues and more.

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Trine Tsouderos, and Strategy& Principal, Igor Belokrinitsky, in discussion with Carrum Health’s CEO, Sachin Jain and SVP of Provider Partnerships, Christoph Dankert, on healthcare marketplace and delivery transformation, including:

• The role of value based care and price transparency in addressing current state issues such as physician incentive misalignment
• The impact of shifting power, behavior and quality dynamics between providers, payers, employers and consumers
• The role of bundles, and the influence of data and technology, in driving meaningful prices, quality of care and the overall healthcare experience

The U.S. Senate worked well into its scheduled August recess to pass a bipartisan infrastructure bill and a budget blueprint that outlines a much larger bill — covering key health priorities — to be written this fall. Meanwhile, the latest surge of covid is making both employers and schools rethink their opening plans. Joanne Kenen of Politico, Mary Ellen McIntire of CQ Roll Call and Yasmeen Abutaleb of The Washington Post join KHN’s Julie Rovner to discuss these issues and more. Also, for “extra credit,” the panelists suggest their favorite health policy stories of the week they think you should read, too.

The pandemic has shifted how and where Americans gain access to care, a shift large enough to influence multiple aspects of price and utilization and, thus, medical cost trend. PwC tells us that the aftereffects of the pandemic and the health system’s response to changes and failures observed during the pandemic are expected to drive up spending (inflators) in 2022. At the same time, some positive changes in consumer behavior and provider operating models that occurred during the pandemic are expected to drive down spending (deflators) in 2022.

The impact of the COVID-19 pandemic on healthcare costs has become clearer. For the first time during the 16-year history of the Milliman Medical Index, healthcare costs decreased during the past year (between 2019 and 2020). Eliminated care more than offset the cost of COVID-19 testing and treatments in 2020. But in 2021, Milliman projects healthcare costs to grow again, with the cost of healthcare for a hypothetical family of four insured through an employer PPO standing at $28,256.

This session provides detailed discussion of medical cost trend calculations, projections, components and implications addressed in this year’s release of the PwC Behind the Numbers, and Milliman Medical Index Reports, with time provided for audience Q&A.

Additional Tags: cost, utilization, premium, self-insurance, self-funding, TPA

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Trine Tsouderos, and Strategy& Principal, Igor Belokrinitsky, in discussion with US Pharmaceutical & Life Sciences Deals Leader, Glenn Hunzinger and US Health Services Deals Leader, Nick Donkar, on the current deals activity impacting the health and pharma and life sciences sectors, including: 

• Tailwinds that are driving sector deals activity and growth
• Headwinds that pose challenges for deals activity
• Factors that can influence merger and acquisition success
• Deals landscape outlook 

Covid is back with a vengeance, with some people clamoring for booster shots while others harden their resistance to getting vaccinated at all. Meanwhile, the Food and Drug Administration is pushing hard on drugmaker Pfizer’s request to upgrade the emergency authorization for its vaccine and give it final approval. Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Also, for “extra credit,” the panelists suggest their favorite health policy stories of the week they think you should read, too.

Although the COVID-19 pandemic exposed cybersecurity vulnerabilities across sectors, it has particularly challenged the resilience of information systems for health care and life sciences companies. Because ransomware attacks have the potential to cripple access to important data, expose patient health records, and shut down machinery and life-saving equipment, it’s no surprise that health care executives continue to lose sleep thinking about potential ransomware or other similar malicious attacks.

Epstein Becker Green attorneys Alaap B. Shah and Jessika Tuazon are joined by Andrew Morrison, principal at Deloitte & Touche LLP and Cyber Risk Services Strategy, Defense & Response solution leader for Deloitte Risk & Financial Advisory. Together, they discuss the impact of ransomware attacks on the health care and life sciences industries, and considerations for companies to strengthen their cybersecurity posture.

View four selected MCOL Daily Factoids appearing in Summer 2021, including:

• June 30: MD Specialties With Highest Annual Compensation
• July 1: MA Members Reporting "Very Good" / "Better" Health
• July 13: Plan Behavioral Health Contract Payments by Type
• July 27: Hospital Compliance with Price Transparency Rule

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Trine Tsouderos, and Strategy& Principal, Igor Belokrinitsky, in discussion with Pharmaceutical Quality Partner, Jan Paul Zonnenberg, on the importance of drug quality in the health ecosystem, including:

• The history and current state of pharmaceutical quality in the U.S.
• Patient trust and quality in the drug development ecosystem
• What forces are accelerating quality improvements?
• The role of culture in improving drug quality

The summer that promised to let Americans resume a relatively normal life is turning into another summer of anxiety and face masks, as the delta variant drives covid caseloads up in all 50 states. Meanwhile, the Americans with Disabilities Act turns 35, and the Missouri Supreme Court orders the state to expand Medicaid after all. Mary Ellen McIntire of CQ Roll Call, Anna Edney of Bloomberg News and Rachana Pradhan of KHN join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews KHN’s Samantha Young, who reported and wrote the latest KHN-NPR “Bill of the Month” episode about an Olympic-level athlete with an Olympic-size medical bill.

With covid cases on the upswing again around the country, partisan division remains over how to address the pandemic. Meanwhile, the Biden administration proposes bigger penalties for hospitals that fail to make their prices public as required. Stephanie Armour of The Wall Street Journal, Alice Miranda Ollstein of Politico and Tami Luhby of CNN join KHN’s Julie Rovner to discuss these issues and more. Also, for “extra credit,” the panelists suggest their favorite stories of the week they think you should read, too.

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Trine Tsouderos, and Strategy& Principal, Igor Belokrinitsky, discuss how consumers are accessing their healthcare post pandemic, including:

• Challenges and implications of differing perspectives among provider executives and consumers on virtual health
• Considerations for delivering a personalized virtual health experience
• New entrants' role in shaping the health system
• Importance and influence of consumer preferences in optimizing the care delivery experience

This analysis is based on the nineteenth annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by year end, approximately 929 health plan years.

Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to most Independent / Provider – Sponsored plans possessing the ability to compile high-quality, segmented financial and operational data.

We surveyed the participants to populate the Sherlock Benchmarks and this summary.This 19th analysis of IPS plans is based on a peer group of 19 Independent / Provider – Sponsored plans who collectively serve approximately 9.6 million people, not including Managed Long Term Services and Supports and other products.

Tune into this episode of PwC's Next in Health to hear PwC US Healthcare Technology Consulting Leader Will Perry, in discussion with Microsoft’s Chief Medical Officer, Dr. David Rhew, on how technology is fundamentally changing how healthcare is designed and delivered, including:

• What role does Microsoft play in the health ecosystem?
• The importance of digital channels and engagement
• Consumer digital health journey
• Predictive analytics and the future of healthcare

Democrats in Congress reached a tentative agreement to press ahead on a partisan bill that would dramatically expand health benefits for people on Medicare, those who buy their own insurance and individuals who have been shut out of coverage in states that didn’t expand Medicaid. Meanwhile, controversy continues to rage over whether vaccinated Americans will need a booster to protect against covid-19 variants, and who will pay for a new drug to treat Alzheimer’s disease. Rachel Cohrs of Stat and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews KHN’s Rae Ellen Bichell, who reported and wrote the latest KHN-NPR “Bill of the Month” episode about a mother and daughter who fought an enormous emergency room bill.

Health and Human Services Secretary Xavier Becerra is the special guest for this bonus episode of KHN’s “What the Health?” podcast. He and host Julie Rovner discuss a breadth of topics the secretary oversees, including covid-19, prescription drug prices, Medicare, Medicaid and the Affordable Care Act.

The Biden administration is moving to undo many of the changes the Trump administration made to the enrollment process for the Affordable Care Act to encourage more people to sign up for health insurance. Meanwhile, Congress is opening investigations into the controversial approval by the Food and Drug Administration of an expensive drug that might (or might not) slow the progression of Alzheimer’s disease. Joanne Kenen of Politico, Kimberly Leonard of Insider and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews Marshall Allen of ProPublica about his new book, “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win.”

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Trine Tsouderos, and Strategy& Principal, Igor Belokrinitsky, discuss medical cost trend for 2021 and expectations for 2022, including:

• The impact of COVID-19
• Projections for the coming year
• The effects of deferred care and intervention
• The need for investments in forecasting and predictive modeling

As payer telehealth policies evolve from short-term approaches in response to the pandemic, to longer-term approaches designed to recognize the opportunities for post-pandemic virtual-care; stakeholders need to be up-to-speed on the current state of telehealth reimbursement and contracting, as well as preparing for the future. In this disruptive environment, stakeholders also need to explore leveraging future opportunities such as remote patient monitoring, as well as understanding the return on investment that can be realized from increasing focus on virtual care.

This session begins with understanding current telehealth billing and coding and revenue cycle considerations, and will then explore opportunities to be successful in value-based and likely future performance-based virtual care arrangements.

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Trine Tsouderos, and Strategy& Principal, Igor Belokrinitsky, in discussion with Health Industries Principal, Abbas Mooraj, on how cloud enables healthcare organizations to harness data and analytics, including:

• Current cloud-based investments for providers
• Future of the healthcare system’s cloud journey
• Enterprise cloud computing’s return on investment
• Leveraging cloud technologies to adopt a more patient-centric healthcare system

Expense growth in 2020 for Blue Cross Blue Shield Plans was sharply lower in 2020 compared with 2019. Total costs per member per month (PMPM) growth declined to a median of 5.2% from 6.6% in the prior year, the slowest growth since 2016. The decline in Account and Membership Administration (representing over 45% of all expenses) was even more dramatic, falling to growth of 2.7% from 6.0% in 2019.

These results are excerpted from the Blue Cross Blue Shield edition of the 2021 Sherlock Benchmarks The Sherlock Benchmarks for Blue Cross Blue Shield Plans provide a window to health plan adaptation to this event and to how the Plans built for the future on this foundation. This 23rd analysis of Blue Plans is based on a peer group of fourteen Blue Cross Blue Shield Plans who collectively serve approximately 41.5 million people, not including Host, specialty, and other products. We believe this universe to be quite robust. Participants in this year’s study serve about 61% of all Blue comprehensive membership, excluding those served by publicly-traded firms.

Collectively in 2020, the health plan operations of these Plans earned annual premiums plus fees of nearly $130 billion and nearly $230 billion in premium equivalents. The median Plan participating in the Sherlock Benchmarks this year served 2.1 million people. The Plans were geographically disbursed, serving 22 states. Thirteen of this year’s fourteen participants also participated last year.

Democrats in Congress and the states are devising strategies to expand health coverage — through the Affordable Care Act, Medicare, Medicaid and a “public option.” But progress remains halting, at best. Meanwhile, lawmakers in Washington may have to agree on how to control prescription drug prices if they wish to finance their coverage initiatives. Alice Miranda Ollstein of Politico, Tami Luhby of CNN and Shefali Luthra of The 19th join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews Michelle Andrews, who reported and wrote last month’s KHN-NPR “Bill of the Month” episode about a very expensive sleep study.

In a surprisingly strong 7-2 decision, the Supreme Court turned back the latest constitutional challenge to the Affordable Care Act, likely heralding the end of GOP efforts to strike the law in its entirety through court action. Meanwhile, Democratic lawmakers are looking for ways to expand health benefits. Joanne Kenen of Politico, Mary Ellen McIntire of CQ Roll Call and Rachel Cohrs of Stat join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews Andy Slavitt, who recently stepped down from the Biden administration’s covid response team, about his new book on the pandemic.

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Trine Tsouderos, in discussion with PwC’s Health Services Principal, Claudia Douglass, on the future of telehealth in a post COVID-19 world, including:

• The current state of telehealth
• Different types of telehealth services
• Connected diagnostic devices and technical infrastructure requirements
• Designing a more consumer-centric telehealth experience

Welcome to another MCOL Podcast edition. Rong Yi discusses Chinese Healthcare and more with MCOL's Clive Riddle. Dr. Rong Yi is the principal responsible for Milliman’s Greater China Healthcare Analytics Practice. She joined Milliman in 2009. She will also be discussing Chinese Healthcare and more in future posts at http://www.mcolblog.com/

A presentation of Medicaid Managed Care Organization Enrollment data and trends for 2021

The Departments of Labor, Health and Human Services, and the Treasury jointly released a set of frequently asked questions (“FAQs”) related to recent changes made to the Mental Health Parity and Addiction Equity Act effective as of February 10, 2021, and enacted by the Consolidated Appropriations Act at the end of 2020. Accordingly, health plans and insurers must ensure that they understand, and are prepared to provide regulators with documentation of their compliance with, parity requirements on at least a small group of specific non-quantitative treatment limits.

Special guest Henry Harbin, MD, Health Care Consultant and former CEO of Magellan Health Services, and Epstein Becker Green attorneys Kevin Malone, David Shillcutt, and Tim Murphy discuss how stakeholders can gain key insights into the federal enforcement approach on parity from the new set of FAQs, including where the government might get the most return on investment for enforcement.

The federal approval of a controversial drug to treat Alzheimer’s disease has reignited the debate over drug prices and the way the Food and Drug Administration makes decisions. Meanwhile, President Joe Biden seeks to gain goodwill overseas as he announces the U.S. will provide 500 million doses of covid vaccine to international health efforts. Sarah Karlin-Smith of the Pink Sheet, Margot Sanger-Katz of The New York Times and Joanne Kenen of Politico join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews Chiquita Brooks-LaSure, the new administrator of the Centers for Medicare & Medicaid Services. And to mark the podcast’s 200th episode, the panelists discuss what has surprised them most and least over the past four years.

Federal and state cannabis regulation and enforcement appear to be moving in different directions. While the Food and Drug Administration (“FDA”) has broadened its net to target businesses making claims that their products can treat specific conditions, a growing number of states have passed bills that, among other things, legalize adult-use cannabis. Epstein Becker Green attorneys Delia Deschaine, Nathaniel Glasser, and Megan Robertson discuss how developments in 2021 impact the cannabis industry and why all players, including employers, health care providers and retailers, and businesses operating in the cannabis space, need to pay close attention to the different nuances between federal and state laws.

Republicans, Democrats and the public at large agree that prices for prescription drugs are too high. But no one seems to know how to fix it. Vanderbilt University drug price researcher Stacie Dusetzina explains the basics of why drugs cost so much and why it’s hard to do something about it. Joanne Kenen of Politico, Sarah Karlin-Smith of the Pink Sheet and Anna Edney of Bloomberg News join KHN’s Julie Rovner to discuss the prospects for policy changes.

View four selected MCOL Daily Factoids from May 2021, and published in June 2021 including:

May 5, 2021 World's 10 Best Hospitals 2021
May 13, 2021 Survey: What led you to try telehealth?
May 20, 2021 Survey on State of Medicare Beneficiaries
May 27, 2021 Adult Behavioral Health Indicators During Pandemic

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Benjamin Isgur and Trine Tsouderos cover a round-up of the latest COVID-19 headlines and trends, including:

• Preventing the next pandemic with infectious disease forecasting
• Global vaccine passports
• Vaccine lotteries and incentives within the United States
• COVID-19 variants, including B.1.1.7
• U.S. government subsidized health coverage

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Benjamin Isgur and Trine Tsouderos, in discussion with PwC’s HIA Operations Strategy Principal, Namit Mehta and PwC's Cyber Security Principal, Robbie Higgins, on how organizations can build resiliency and plan for future potential supply chain disruptions, including:

• Importance of scenario planning in building resiliency
• Organizational interventions to consider and/or prioritize to secure the supply chain
• Steps for organizations to take to begin scenario planning
• Future technologies and their impact on the future health system

Lawmakers are working on fleshing out the concept of a “public option,” a government-run or heavily regulated insurance plan that would compete with private insurance. But the details are complicated, both substantively and politically. Meanwhile, bioethicists are debating whether the U.S. should be vaccinating low-risk adolescents against covid-19 while high-risk adults in other countries are still waiting. Margot Sanger-Katz of The New York Times, Alice Miranda Ollstein of Politico and Rachana Pradhan of KHN join KHN’s Julie Rovner to discuss these issues and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too.

Join this webinar to learn about the No Surprises Act and what it means for provider data accuracy. As payers are grappling with payments and billing process changes, they might be missing the new rules about provider data accuracy that go into effect in January 2022. 

• New directory accuracy requirements
• What we might expect after January 1, 2022
• How this bill creates risk for payers and the best strategy to mitigate it

Providers move, stop accepting patients and leave insurance networks – causing provider directory inaccuracies. 30% of provider data changes every year and studies found over 45% of provider directory locations had at least one error. Health Plans need to bring their provider data into clearer focus – with greater accuracy - to comply with the new Federal No Surprises Act requiring constant continuous provider directory verification.

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Benjamin Isgur and Trine Tsouderos, discuss the risks employers should be aware of, if they decide to adopt a vaccine mandate in the workplace, including:

• Whether employers can require employees to be vaccinated?
• The influence that federal, state and local laws may have on employer mandates
• Different types of employer incentives to encourage employee vaccinations
• The history and growing controversy surrounding vaccine passports

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Benjamin Isgur and Trine Tsouderos, provide an update on the continued challenges we are experiencing due to COVID-19, including: 

• COVID-19 reaches Mount Everest
• The current job outlook for healthcare providers in the U.S.
• Will the proposed TRIPS Agreement waiver, aid in equitable distribution of the COVID-19 vaccines in low-income countries?
• How can we encourage people to get vaccinated?

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the first quarter 2021.

The newly conservative Supreme Court will hear a case that could overturn the nationwide right to abortion and cause political upheaval. Meanwhile, the Centers for Disease Control and Prevention’s abrupt announcement that vaccinated people can take off their masks in most places has caused upheaval of its own. Alice Miranda Ollstein of Politico, Sarah Karlin-Smith of the Pink Sheet and Mary Ellen McIntire of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too.

The vaccine passport has been a major topic of discussion as businesses and governments consider how to balance privacy and safety through the rollout of the COVID-19 vaccine. Epstein Becker Green attorneys Patricia Wagner, Alaap Shah, and Jessika Tuazon discuss the privacy and security concerns companies must weigh as they consider developing or implementing vaccine passports, such as the collection and use of an individual's personal health information. As state governments and the private sector take the lead on developing vaccine passport initiatives, it is imperative that businesses implement better privacy and security practices to mitigate or manage risk.

Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Benjamin Isgur and Trine Tsouderos in discussion with PwC’s Strategy& Partner, Will Nolen, on why quality improvement in healthcare is important, including:

• The differing definitions of healthcare quality among stakeholders and consumers across the ecosystem
• The association between healthcare quality and costs
• The importance of designing more consumer centric quality offerings through technology and innovation
• The significance of archetypes in the quality of healthcare

Tune into this episode of PwC's Next in Health to hear Health Research Institute leader, Benjamin Isgur, and Health Research Institute Regulatory Center leader, Trine Tsouderos in discussion with PwC’s Deals Strategy & Pharma and Life Sciences Principal, Claire Love, on what role private equity firms play, in the rapid growth market of gene and cell therapies, including:

• What are the growth drivers for private equity firms?
• What technologies and innovations can be leveraged to increase supply chain efficiency?
• Opportunities and risks private equity firms should consider
• Improving collaboration between the pharmaceutical industry and private equity investors

Democratic leaders in Congress have vowed to pass legislation to address high prescription drug prices this year, but some moderates in their own party appear to be balking. Meanwhile, younger teens are now eligible for a covid-19 vaccine and the Biden administration reinstated anti-discrimination policy for LGBTQ people in health care. Joanne Kenen of Politico, Sarah Karlin-Smith of the Pink Sheet and Rachel Cohrs of Stat join KHN’s Julie Rovner to discuss these issues and more.

View four selected MCOL Daily Factoids from April 2021, and published in May 2021 including:

April 6, 2021: Change in Rx Out of Pocket Costs During Past Year
April 13, 2021: COVID-19 Impact: Healthcare Worker Mental Health
April 20, 2021: Average Charges for Retail Clinic Procedures
April 27, 2021: Survey on Seeking Healthcare During the Pandemic

The Biden administration is bucking the drug industry and backing a waiver of covid-19 vaccine patent protections to help the rest of the world vaccinate its populations. Here at home, the Food and Drug Administration wants to ban menthol flavorings for cigarettes, setting off a fight with the tobacco industry. Alice Miranda Ollstein of Politico, Tami Luhby of CNN and Kimberly Leonard of Business Insider join KHN’s Julie Rovner to discuss these issues and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too.

Since the start of the COVID-19 pandemic, many jurisdictions have enacted protections from COVID-19-related liability claims through legislation and executive orders.  These liability shields, however, may give health care businesses a false sense of security and offer little protection when it comes to employment claims. Epstein Becker Green attorneys Denise Merna Dadika, Gregory Keating, and Elena Quattrone discuss the unintended liability consequences health care employers must consider as they transition more employees back to in-person work and the ways to mitigate increasing whistleblower and retaliation risks.

The Diagnosing Health Care podcast series examines the business opportunities and solutions that exist despite the high-stakes legal, policy, and regulatory issues that the health care industry faces.

Differences in Social Determinants of Health contribute to the stark and persistent chronic disease disparities in the United States among racial, ethnic, and socioeconomic groups, systematically limiting opportunities for members of some groups to be healthy. Interventions targeting SDoH have tremendous potential to narrow disparities across many chronic diseases by removing systemic and unfair barriers to practicing healthy behaviors.

The health and economic crisis stemming from the pandemic has magnified the systemic barriers to health and how they are particularly worse for marginalized groups. Though past and current efforts have focused on addressing health outcomes – racial and geographic health disparities – today’s social climate demands that stakeholders acknowledge how systemic racism and economic inequality are drivers of health inequities, which, in turn, perpetuate disparities.

How can health plans, health systems and other healthcare stakeholders engage to improve health equity through targeted SDoH initiatives? The panel of speakers in this session provide case examples on providing optimal care through the lens of SDoH for black women residing in medically underserved communities. Through tech-enabled and community-based service providers involving transportation, virtual care, and prenatal and postpartum care, these collective uses of service combined with culturally competent providers and technology could have a resounding effect to improve outcomes and reduce global maternal mortality.

t’s 100 days into Joe Biden’s presidency and a surprisingly large number of health policies have been announced. But health is notably absent from the administration’s $1.8 trillion spending plan for American families, making it unclear how much more will get done this year. Meanwhile, the Centers for Disease Control and Prevention loosens its mask-wearing recommendations for those who have been vaccinated, but the new rules are confusing. Joanne Kenen of Politico, Mary Ellen McIntire of CQ Roll Call and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Plus, Rovner interviews KHN’s Julie Appleby, who reported the latest KHN-NPR “Bill of the Month” episode.

The Biden administration has started to speed efforts to reverse health policies forged under Donald Trump. Most recently, the administration overturned a ban on fetal tissue research and canceled a last-minute extension of a Medicaid waiver for Texas. That latter move may delay the Senate confirmation of President Joe Biden’s nominee to head the Medicare and Medicaid programs, as Sen. John Cornyn (R-Texas) seeks to fight back. Anna Edney of Bloomberg News, Rachel Cohrs of Stat and Alice Miranda Ollstein of Politico join KHN’s Julie Rovner to discuss these issues and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too.

Podcast panelists discuss a range of health policy developments, from the latest in the covid vaccination effort to the HHS budget, among other things.

CMS hosted a virtual office hour in which presenters provided a review of the Calendar Year 2022 payment design and payment rates related to the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model. This session also offered attendees an opportunity to ask follow-up questions.

View four selected MCOL Daily Factoids from March 2021 including:

March 1, 2021: Change in Physician Visits During Pandemic
March 11, 2021: Healthcare Workers Refusing COVID Vaccinations
March 18, 2021: Healthcare Executives Prioritizing Automation
March 23, 2021: Health System 2021 Staffing Trends 

The Centers for Medicare & Medicaid Services ("CMS") and the Office of Inspector General ("OIG") of the Department of Health and Human Services have at last published their long-awaited companion final rules advancing value-based care. The rules present significant changes to the regulatory framework of the federal physician self-referral law (commonly referred to as the “Stark Law”) and to the federal health care program’s Anti-Kickback Statute, or “AKS.” Epstein Becker Green attorneys Anjali Downs, Jennifer Michael, Lesley Yeung, and Paulina Grabczak give an overview of the final rules and point out key issues health care companies should carefully consider as they take advantage of these value-based care safe harbors and exceptions.

President Joe Biden’s infrastructure proposal includes items not traditionally considered “infrastructure,” including a $400 billion expansion of home and community-based services for seniors and people with disabilities, and a $50 billion effort to replace water pipes lined with lead. Meanwhile, the politics of covid-19 are turning to how or whether Americans will need to prove they’ve been vaccinated. Joanne Kenen of Politico, Tami Luhby of CNN and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Plus, Rovner interviews KFF’s Mollyann Brodie about the KFF COVID-19 Vaccine Monitor.

The ink is barely dry on the recent covid relief bill, but Democrats in Congress and President Joe Biden are wasting no time gearing up for their next big legislative package. Meanwhile, predictions of more states expanding Medicaid have proved premature. Alice Miranda Ollstein of Politico, Rachel Cohrs of Stat and Kimberly Leonard of Business Insider join KHN’s Julie Rovner to discuss these issues and more. Plus, Rovner interviews KHN’s Lauren Weber, who reported the latest KHN-NPR “Bill of the Month” episode.

The $1.9 trillion coronavirus relief package, the American Rescue Plan, includes money for rural hospitals, billions of dollars for COVID-19 testing and contact tracing, and extra subsidies to help people buy health coverage through an Affordable Care Act ("ACA") plan. Epstein Becker Green attorneys Mark Lutes, Philo Hall, and Tim Murphy discuss the health-specific portions of the legislation, including increased funding for federal oversight activities, changes to public insurance programs, and what these changes might mean for stakeholders.

The Diagnosing Health Care podcast series examines the business opportunities and solutions that exist despite the high-stakes legal, policy, and regulatory issues that the health care industry faces.

After a bruising confirmation process, Xavier Becerra was sworn in as secretary of Health and Human Services this week. The Senate also confirmed the nominations of former U.S. Surgeon General Vivek Murthy to return to the post he held in the Obama administration, and former Pennsylvania health secretary Rachel Levine as assistant secretary for health. Levine is the first openly transgender person to receive Senate confirmation. Meanwhile, questions continue to swirl around the AstraZeneca covid vaccine, which some public health experts worry will create more hesitancy toward other vaccines.

The Biden administration has invoked the Defense Production Act ("DPA") to speed up the production of vaccines and increase the domestic production of COVID-19 tests, personal protective equipment (or “PPE”), and other essential supplies. Epstein Becker Green attorneys Neil Di Spirito, Constance Wilkinson, and Bonnie Odom discuss the administration's reliance on the DPA as it continues to operationalize its pandemic response, and the challenges these actions are likely to present for medical product suppliers.

The covid relief bill signed by President Joe Biden includes a long list of new health benefits for consumers. But many eligible people may have difficulty taking advantage of them because of the interaction with the income tax system and a lack of expert guidance. Meanwhile, Democrats are debating internally about what should come next on the health agenda. Joanne Kenen of Politico, Mary Ellen McIntire of CQ Roll Call and Rachana Pradhan of KHN join KHN’s Julie Rovner to discuss these issues and more.

Beyond the billions of dollars aimed squarely at the pandemic, the covid relief bill cleared by Congress this week includes significant changes to health policy. Among them are the first major expansions to the Affordable Care Act since its enactment 11 years ago and changes that could expand coverage for the Medicaid program. Tami Luhby of CNN, Alice Miranda Ollstein of Politico and Rachel Cohrs of Stat join KHN’s Julie Rovner to discuss these issues and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too.

The FDA authorized the emergency use of a one-shot vaccine made by Johnson & Johnson, which could help accelerate the pace of vaccinations to prevent covid-19. But after a dramatic decline, case numbers are again rising, and several states are rolling back public health mitigation efforts. Mary Ellen McIntire of CQ Roll Call, Joanne Kenen of Politico and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews KHN’s Jordan Rau about the latest KHN-NPR “Bill of the Month” episode.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the fourth quarter 2020.

View four selected MCOL Daily Factoids from February 2021 including:

• February 2, 2021: Highest In-Network Claim Denial Rates - ACA Plans
• February 4, 2021: Hospital Margins & Volumes 2020 vs 2019
• February 18, 2021: Consumer Experience With Telehealth Visits - Deloitte
• February 25, 2021: % Adult Health Insurance Coverage

This session explores the current and future impact of COVID-19 on Alternative Payment Models for providers, examining the current state of APMs, the key effects of COVID-19 on the dynamics involved in provider payments, the impact of COVID-19 on the main types of APMs and the implications for providers considering current or potential risk-based contracting arrangements. 

Tune into another episode of Avalere Health Essential Voice. In this segment, we are joined by experienced dietitians to discuss the rise of telehealth in providing nutrition care during the pandemic, as well as barriers and future opportunities in virtual care.

This Diagnosing Health Care episode focuses on the legal history of the current immunization delivery system for vaccines in the United States. The system is complex and requires the coordination of many players, from manufacturers and distributors in the supply chain to health care facilities that provide administration, down to public health centers that track the doses. Special guest Richard Hughes IV, Vice President of Public Policy at Moderna, and Epstein Becker Green attorneys Victoria Vaskov Sheridan and Jessika Tuazon discuss the factors impacting an individual’s decision to get vaccinated and the ways that policies and practices at the federal, state, local, and tribal levels can support equity, transparency, accountability, availability, and access to COVID-19 vaccines.

More than a month into the Biden administration, California Attorney General Xavier Becerra, the nominee to run the Department of Health and Human Services, finally got his confirmation hearings in the Senate, along with nominees for surgeon general and assistant secretary for health. Meanwhile, the Supreme Court announced it would hear a case challenging the Trump administration’s regulation that effectively evicted Planned Parenthood from the federal family planning program. Margot Sanger-Katz of The New York Times, Tami Luhby of CNN and Alice Miranda Ollstein of Politico join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews HuffPost’s Jonathan Cohn, whose new book, “The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage,” is out this week.

Telehealth has achieved a new normal of acceptance and prevalence. Virtual care applications of all kinds have become mainstream tools. Many organizations admit that they made as much as five years of progress on telehealth within just a few weeks in 2020.

This webinar will look at where telehealth is at the beginning of 2021 in terms of long-awaited digital transformation and detail the essential steps that our industry needs to take to use these digital solutions to their fullest potential.

• Finding the new normal for telehealth utilization
• How new money and emerging partnerships are changing the telehealth landscape
• Leveraging data to make progress on telehealth reimbursement and quality

Tune into another episode of Avalere’s Journal Club Review podcast series on Avalere Health Essential Voice. In this segment, our experts discuss the findings, themes, and relevant application of a study comparing taste-focused and health-focused food labels and how they affect consumption.

Keeping a campaign promise, President Joe Biden has reopened enrollment for health coverage under the Affordable Care Act on healthcare.gov — and states that run their own health insurance marketplaces followed suit. At the same time, the Biden administration is moving to revoke the Trump administration’s permission for states to impose work requirements for some adults on the Medicaid health insurance program. Alice Miranda Ollstein of Politico, Kimberly Leonard of Business Insider and Rachel Cohrs of Stat join KHN’s Julie Rovner to discuss these issues and more. Also, Rovner interviews medical student Inam Sakinah, president of the new group Future Doctors in Politics.

Even while the Senate is busy with Donald Trump’s impeachment trial, the House has gotten down to work on a covid relief bill using the budget reconciliation process. Meanwhile, the watchword for covid this week among the public is confusion — over masks, vaccines and just about everything else science-related. Joanne Kenen of Politico, Paige Winfield Cunningham of The Washington Post and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Also this week, the panelists recommend their favorite “health policy valentines” along with their favorite health policy stories they think you should read, too.

The 117th Congressional health care agenda, including COVID-19 related action, will require 60 votes in the Senate or passage through budget reconciliation. Attorneys Mark Lutes, Philo Hall, and Timothy Murphy discuss the prospects for additional coronavirus relief and what that would mean for stakeholders, as well as the possibility for coverage expansion through changes to the Affordable Care Act or Medicaid.

Can schools safely reopen before all teachers and staffers are vaccinated against covid? And what’s the best way to communicate that science — and scientific recommendations — change and evolve? Also, get ready for a redo of open enrollment for Affordable Care Act coverage, this time with help and outreach to find those eligible. Margot Sanger-Katz of The New York Times, Alice Miranda Ollstein of Politico and Anna Edney of Bloomberg News join KHN’s Julie Rovner to discuss these issues and more.

This Diagnosing Health Care episode dives into the growth of physician practices accepting risk-based payments from health plans and examines why these practices are attractive to investors. Special guest Jason Madden, Managing Director at Accordion, and Epstein Becker Green attorneys Joshua Freemire, Jason Christ, and Tim Murphy, discuss the health regulatory considerations investors must assess when evaluating investment opportunities with physician practices accepting risk-based payments.

President Joe Biden signed a pair of health-related executive orders this week that would, among other things, reopen enrollment under the Affordable Care Act and start to reverse former President Donald Trump’s anti-abortion policies. Meanwhile, Congress remains bogged down with taking up the next round of covid-19 relief. Joanne Kenen of Politico, Mary Ellen McIntire of CQ Roll Call and Shefali Luthra of The 19th join KHN’s Julie Rovner to discuss these issues and more. Plus, for “extra credit,” the panelists recommend their favorite health policy stories of the week they think you should read, too.

What does the remainder of the pandemic, and what does a Post-COVID-19 world hold for healthcare? What are the key healthcare business issues and trends for 2021, and what is the policy outlook under a Biden Administration that will impact you and your organization, and how can you best position for them? Attend the Nineteenth Annual Future Care Web Summit, which addresses these topics and more.

The 90-minute webinar agenda includes:

• Top Health Industry Issues of 2021 and Policy Outlook - Crystal Yednak, Senior Manager, PwC Health Research Institute; and Ingrid Stiver, Senior Manager, PwC Health Research Institute
• State of the health plan in 2021 - Natalie Trebes, Director, Advisory Board   
• The Strategic Pricing Imperative - Chris Sukenik, Principal, BDC Advisors

Diagnosing Health Care Podcast - Episode 15: The Biden Administration's first 100 days in office will bring forth executive orders, regulations, and new legislation with noteworthy health care policy implications that health care organizations must watch. Member of the Firm Ted Kennedy, Senior Counsel Philo Hall, and attorney Paulina Grabczak discuss the Biden Administration's priorities, including their COVID-19 response plan, and examine which "midnight rules" put in place by the Trump Administration could be intercepted or retained.

The Diagnosing Health Care podcast series examines the business opportunities and solutions that exist despite the high-stakes legal, policy, and regulatory issues that the health care industry faces.

President Joe Biden is wasting no time getting to work. On his first day in office, Biden signed a series of executive orders addressing the covid pandemic, promising more to come. But even with Democrats taking the barest majority in the Senate, the new president’s ambitious proposals on covid and other health issues could be in for a rough ride. Alice Miranda Ollstein of Politico, Tami Luhby of CNN and Sarah Karlin-Smith of the Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Plus, for “extra credit,” the panelists recommend their favorite health policy stories of the week they think you should read too.

Diagnosing Health Care Podcast - Episode 14: 

This Diagnosing Health Care episode examines the fraud and abuse enforcement landscape in the telehealth space and considers ways telehealth providers can mitigate their enforcement risks as they move into the new year. Hear how the uptick in enforcement warrants close consideration by telehealth providers, especially those that are new to the space and have not yet built their compliance infrastructures.

The Diagnosing Health Care podcast series examines the business opportunities and solutions that exist despite the high-stakes legal, policy, and regulatory issues that the health care industry faces.

Several large business groups, including health industry organizations, are cutting off contributions to Republicans who voted against the certification of Joe Biden’s election even after riots shut down the Capitol on Jan. 6. Meanwhile, the outgoing Trump administration not only approved a Medicaid block grant for Tennessee, but also made it difficult for the incoming Biden administration to undo. Joanne Kenen of Politico, Margot Sanger-Katz of The New York Times and Kimberly Leonard of Business Insider join KHN’s Julie Rovner to discuss these issues and more. Plus, Rovner interviews KHN’s Victoria Knight about the latest KHN-NPR “Bill of the Month” episode.

Milliman Critical Point Podcast Episode 28: The COVID-19 pandemic has spurred—and aggravated—a range of mental health and substance use issues in the United States, and Milliman’s Stoddard Davenport discusses recent statistics on the topic and what the road ahead may look like for mental health in America.

Democratic victories in two runoff elections in Georgia will give Democrats control of the Senate starting Jan. 20, which means they will be in charge of both houses of Congress and the White House for the first time since 2010. Meanwhile, covid continues to run rampant while vaccine distribution lags. Alice Miranda Ollstein of Politico, Anna Edney of Bloomberg News and Mary Ellen McIntire of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too.

Tune into another episode of Avalere Health Essential Voice. In this segment, we are joined by experts from nutrition service organizations to discuss the impact of medically tailored meals (MTM) on health outcomes and healthcare costs, and future opportunities to expand their reach through health insurance plans.

Congress seems on the verge of finishing a long-delayed COVID-19 relief bill, which will reportedly include neither of the things each party wanted most — for Republicans, liability protections; for Democrats, funding for states and localities. That bill is likely to be tied to a package to fund the federal government for the rest of the fiscal year and, possibly, include a fix for “surprise” medical bills that patients receive when they inadvertently receive care outside their insurance network. Alice Miranda Ollstein of Politico, Rebecca Adams of CQ Roll Call and Mary Agnes Carey of KHN join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner talks to Elizabeth Mitchell, president and CEO of the Pacific Business Group on Health, about the future of employer-provided health insurance.

another episode of Avalere’s Journal Club Review podcast series on Avalere Health Essential Voice. In this segment, our experts discuss the findings, limitations, and implications of a recent study that examined disparities in the health development of young children with respect to race/ethnicity and income.

What is the outlook for Medicare Advantage Supplemental Benefits and Social Determinants of Health Initiatives under the Biden administration in 2021 and beyond? This session examines the Biden health policy agenda; the prognosis for Medicare Advantage Supplemental Benefits and Social Determinant of Health Initiatives during the coming year; developments in the SDOH arms race and what CMS policy can be anticipated during 2021 in this arena.

John Gorman, a nationally recognized health policy expert in areas including Medicare, Medicaid, ACA and SDOH, provides his significant insights for the coming year. John is Founder and Chairman of Nightingale Partners, a Qualified Opportunity Zone Fund and advisory firm connecting capital to payers and care providers to the medically underserved. Nightingale endeavors to improve the quality of care and reduce unnecessary health care expenditures for impactable, high-utilizers through advanced technology, locally-curated social services providers, and innovative financing to address Social Determinants of Health (SDOH). 

Even as the Food and Drug Administration nears emergency authorization for the first vaccine to protect against COVID-19, Congress remains at loggerheads over a COVID relief bill that could also provide the funding to fully distribute the vaccines. Meanwhile, President-elect Joe Biden announced the first members of his health team. Joanne Kenen of Politico, Kimberly Leonard of Business Insider and Mary Ellen McIntire of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Michael Mackert of the University of Texas-Austin, an expert on communicating public health information.

The Geographic Direct Contracting Model (also known as the “Model” or “Geo”) is a new payment and care delivery model being tested by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. The Model will test whether a geographic-based approach to care delivery and value-based care can improve health and reduce costs for Medicare beneficiaries across an entire geographic region. Leveraging best practices and lessons learned from prior Innovation Center models, Geo will enable Direct Contracting Entities (DCEs) to build integrated relationships with healthcare providers and community organizations in a region to better coordinate care and address the clinical and social needs of Medicare beneficiaries.

Epstein Becker Green Diagnosing Health Care Podcast - Episode 13: Contact tracing will continue to play a big role in fighting the COVID-19 pandemic, especially in understanding the impact of vaccines. Attorneys Michelle Capezza, Karen Mandelbaum, and Jessika Tuazon look at the privacy issues health care companies and employers across industries should consider when implementing contact tracing technologies.

View four selected MCOL Daily Factoids from November 2020 including:

• Physicians on Healthcare Demand in 2021
• Reduced Utilization: March/April 2020 vs 2019
• COVID-19 Impact on Physician Practices
• Employers and Virtual Visits

The official transition to a Joe Biden administration has finally begun, and he is expected to announce his health care team soon, including a new secretary of Health and Human Services. Meanwhile, as the COVID-19 pandemic worsens in the U.S., officials are preparing for the effort to get Americans vaccinated as soon as vaccines are approved by the FDA. Alice Miranda Ollstein of Politico, Margot Sanger-Katz of The New York Times and Paige Winfield Cunningham of The Washington Post join KHN’s Julie Rovner to discuss these issues and more. Also this week, Rovner interviews KHN’s Julie Appleby, who wrote the latest KHN-NPR “Bill of the Month” installment.

The COVID-19 pandemic will have a significant impact in all segments of healthcare for a prolonged period. As such, health plans have critical financial decisions to make in the upcoming months with limited data available and wide uncertainty on how the COVID-19 pandemic will transition toward the end of 2020 and into 2021. 

This session explores how COVID-19 may impact a health plan’s medical loss ratio (MLR) requirements in general and provides specific considerations for the Commercial, Medicare Advantage and Medicaid markets at the end of 2020 and into the future.

The following MCOL Infographics from November 2020 are featured:

• Childhood Vaccination Trends, 2019-2020
• Commercial Health Plan Premium Spending Distribution, 2016-2018
• Using Data in the Fight Against Breast Cancer

Tune into the second segment of the Avalere Health Essential Voice podcast series focused on social determinants of health (SDOH) data. In this segment, Avalere experts discuss how life sciences organizations are beginning to recognize the importance and impact of this data, particularly in real-world evidence value demonstration work.

President-elect Joe Biden is still being blocked from launching his official transition while President Donald Trump contests the outcome of the election. That could be particularly dangerous for public health as COVID-19 spreads around the country at an alarming rate.

Meanwhile, a second vaccine to prevent COVID — the one made by Moderna — is showing excellent results of its early trials. And unlike the one made by Pfizer, Moderna’s vaccine does not need to be kept ultra-cold, which could ease distribution.

There is news on prescription drug prices, as well. Amazon announced plans to get into the drug delivery market, and the Trump administration was set to announce a new rule that could base some U.S. drug prices on the price-controlled prices of other industrialized countries.

This week’s panelists are Julie Rovner of Kaiser Health News, Margot Sanger-Katz of The New York Times, Alice Miranda Ollstein of Politico and Sarah Karlin-Smith of the Pink Sheet.

Four MCOL factoids on mental health before and during the pandemic: 

• Impact of Coronavirus on Mental Health
• U.S. Adult Mental Health Treatment in 2019
• Seeking Mental Health Care During the Pandemic
• Millennials Behavioral Health Conditions

The fifth episode in the Avalere Health Essential Voice podcast series focused on social determinants of health (SDOH): In Part 1 of this segment, experts from Avalere’s Health Economics and Advanced Analytics practice discuss the importance of SDOH data, how health plans are increasingly utilizing that data, and the ongoing limitations to data access.

Since the mid-1980s, whenever there’s been a public health crisis, America — and six U.S. presidents — have turned to Dr. Anthony Fauci. As director of the National Institute of Allergy and Infectious Diseases (one of the National Institutes of Health), Fauci has helped guide the U.S. and the world through the HIV/AIDS epidemic, as well as various flu epidemics and outbreaks of SARS, Ebola and Zika.

On this special episode of KHN’s “What the Health?” podcast, Fauci sits down for an interview with KHN Editor-in-Chief Elisabeth Rosenthal, a fellow physician. They explore the thorny political landscape and discuss how regular Americans should prepare to get through the coming months — as the pandemic surges and we wait for vaccines to become available.

Oral arguments in California v. Texas offer a glimpse at how the Supreme Court might rule in deciding the fate of the Affordable Care Act (“ACA”). In this Epstein Becker Green Diagnosing Health Care Podcast - Episode 12, Attorneys Stuart Gerson and Tim Murphy also look at what Justice Amy Coney Barrett’s recent appointment means for the ACA and other health law decisions in the upcoming term.

The Diagnosing Health Care podcast series examines the business opportunities and solutions that exist despite the high-stakes legal, policy, and regulatory issues that the health care industry faces.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the third quarter 2020

Former Vice President Joe Biden is now the president-elect nearly everywhere but inside the Trump administration, where the president refuses to concede and has ordered officials not to begin a formal transition. That is a particular problem for health care as the COVID-19 pandemic surges. Meanwhile, there’s good news on the vaccine front, but it’s unlikely one will arrive by winter. And the ACA was back before the Supreme Court — again. Joanne Kenen of Politico, Stephanie Armour of The Wall Street Journal and Shefali Luthra of the 19th News join KHN’s Julie Rovner to discuss these issues and more. Plus, for extra credit, the panelists recommend their favorite health stories of the week they think you should read, too.

Dr. McDonald shared updates on CDC’s COVID-19 response, including the latest scientific information and what everyone should know about protecting themselves and others. In addition, CAPT Hammond and Dr. Kimmons discussed CDC COVID-19 guidance for building operations (HVAC, etc.) and healthy design guidelines for the long-term building design.

View four selected MCOL Daily Factoids from October 2020 including:

• US Adults Planning to Get Vaccinated Against Flu This Season
• US Adults Receiving Mental Health Treatment in 2019
• Millennials with Behavioral Health Conditions
• Medicare Advantage Supplemental Benefits in 2021

Former Vice President Joe Biden remains on the cusp of being declared the winner of the presidential election, and which party will control the Senate next year remains in question. The outcomes of both the presidential and Senate elections will have dramatic effects on the health agenda. Meanwhile, should President Donald Trump eke out a win, his administration is still pushing some sweeping health changes. Joanne Kenen of Politico, Kimberly Leonard of Business Insider and Mary Ellen McIntire of CQ Roll Call join KHN’s Julie Rovner to discuss these issues and more. Plus, Rovner has the winner of the KHN Halloween Haiku contest.

The following MCOL Infographics from October 2020 are featured:

• US Healthcare Spending Attributable to Modifiable Risk Factors
• States With Lowest Uninsurance Rates
• Top Ten Platforms Consumers Use to Choose a Healthcare Provider
• Estimated Economic Impact of COVID-19 in the US

We believe health systems must scale to achieve a level of market indispensability characterized by an integrated provider network able to invest in data analytics, bear risk, and offer patient-friendly physical and virtual care settings. But scale doesn’t guarantee relevance. Bigger doesn’t always result in better. Only those health systems that grow while advancing performance by strategically pursuing vertical integration into asset-light delivery mechanisms, exploring new business/product expansion opportunities into nontraditional healthcare services, and ensuring a deliberate and structured approach to scale will be positioned for clinical, strategic, financial, and operational success.

Part of ECG’s series of strategic perspectives on the changing dynamics of the US healthcare system, this webinar explores the relationship between size and performance, benefits of horizontal and vertical integration, and opportunities for health systems to reposition themselves for future success.

During this webinar, participants will learn:

• The Rule of Three and how it can inform health system strategy.
• Opportunities to broaden a health system’s perspective of its potential service offerings to allow for management of an even greater portion of a community’s health and well-being.
• Benefits from transitioning a health system to a more asset-light investment philosophy and options to do so.
• Guiding principles to support enhanced system performance.

White House chief of staff Mark Meadows said this week that “we’re not going to control the pandemic,” effectively conceding that the administration has pivoted from prevention to treatment. But COVID-19 cases are rising rapidly in most of the nation, and the issue is playing large in the presidential campaign. President Donald Trump is complaining about the constant news reports about the virus, prompting former President Barack Obama to say Trump is “jealous of COVID’s media coverage.”

Meanwhile, as the case challenging the constitutionality of the Affordable Care Act heads to the Supreme Court on Nov. 10, open enrollment for individual health insurance under the law begins Sunday.This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Tami Luhby of CNN and Anna Edney of Bloomberg News. Also this week, Rovner interviews KHN’s Anna Almendrala, who reported the latest NPR-KHN “Bill of the Month” installment, about a patient who did everything right and got a big bill anyway.

In this presentation, revenue cycle experts Brian Harris and Jess Stover will guide attendees through the steps every agency should take to optimize billing and collections workflows. Beginning with best practices and KPI tracking, we’ll examine how department structure and communication strategies are used to eliminate inefficiencies and create strong financial outcomes. Next we’ll take a look at how full or partial outsourcing can enhance productivity and add predictability to your agency’s cashflow. Finally, we’ll consider the anticipated regulatory changes ahead and discuss how agencies can best prepare their billing department for an uncertain future.

For more information on how BlackTree can help your agency achieve its operational goals, please visit www.BlackTreeHealthcare.com. 

The COVID-19 Vaccination Implementation Planning Update for Rural Stakeholders was presented by CDC subject matter expert, Dr. Amanda Cohn. Dr. Cohn is Chief Medical Officer for the National Center for Immunization and Respiratory Diseases as well as Chief Medical Officer for the Vaccine Task Force of the CDC COVID-19 Response. This session, presented specifically for rural stakeholders, was moderated by Dr. Diane Hall. PowerPoint slides for this video are available at https://www.cdc.gov/coronavirus/2019-ncov/downloads/vaccine-considerations-rural-health.pptx

On this Diagnosing Health Care episode, “On the Ballot 2020: Health Care Policy Outlook,” dive into the prospects of coverage expansion following the 2020 elections and also examine three major health care policy reform issues that have bipartisan support and could see traction regardless of who wins on November 3. The episode features Members of the Firm Ted Kennedy, Jr., and Lynn Shapiro Snyder as well as Senior Counsel Philo Hall, and is hosted by attorney Tim Murphy.

Tune into our fourth episode in the Avalere Health Essential Voice podcast series focused on social determinants of health (SDOH). In this segment, our experts discuss what health plans should know about SDOH data, specifically, the different types of data, what to do with them, and how to use them to fairly assess the impact of social risks on health outcomes.

This week’s panelists are Julie Rovner of Kaiser Health News, Margot Sanger-Katz of The New York Times, Paige Winfield Cunningham of The Washington Post and Alice Miranda Ollstein of Politico.

Among the takeaways from this week’s podcast: Opinions seem to be slowly shifting on opening schools around the country; California, which had a strong resurgence of the virus during the summer, is seeing signs of success in fighting back; A proposal by some researchers to move the country toward a “herd immunity” plan, in which officials would expect the virus to spread among the general population while also trying to protect the most vulnerable — such as people living in nursing homes — is gaining support among some of Trump’s advisers; Federal researchers this week announced that nearly 300,000 excess deaths have been recorded this year and much of it is attributed to COVID-19 or the lack of other health care; With the Senate poised to confirm Amy Coney Barrett, who opposes abortion, to the Supreme Court within days, the fate of the landmark Roe v. Wade decision is in question. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too.

CMS rule requiring all hospitals to publish detailed information regarding the pricing of their services effective January 1, 2021, has been finalized. Despite strong pushback from the industry, this initiative appears to be moving forward on schedule. What’s more, the industry is unprepared—an HFMA survey found that only 12% of executives believe their organizations are ready to comply with the new requirements. This is important for regulatory compliance reasons, but also because it has implications for how consumers shop for healthcare services and how providers should position themselves in their markets. In this session, ECG’s team of experts explain the rule’s requirements and health systems can best respond.

Learning Objectives

• What the CMS transparency rules are and how they will (or will not) improve transparency
• Near-term tactics for compliance
• Longer-term impact on consumer behavior and reimbursement rates
• Creative pricing strategies and patient-friendly, value-driven payment models

This analysis is based on the eighteenth annual edition of our performance benchmarks for Medicaid-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of 894 health plan years over 23 years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform.

So, within that constraint, it is open to all Medicaid-focused plans possessing the ability to compile high-quality, segmented financial and operational data. This analysis of Medicaid plans is based on a peer group of ten plans who collectively served 8.4 million people in comprehensive products. Eight of this year’s participants participated in the prior year.

Barring something unexpected, Democrats in the Senate appear to lack the votes to block the confirmation of Judge Amy Coney Barrett to the Supreme Court. So, instead they used the high-profile confirmation hearings to hammer on Republicans for again putting the Affordable Care Act in peril. Mary Ellen McIntire of CQ Roll Call, Shefali Luthra of The 19th and Sarah Karlin-Smith of Pink Sheet join KHN’s Julie Rovner to discuss these issues and more. Plus, Rovner interviews Dr. Ashish Jha, dean of the Brown University School of Public Health, about public health challenges in dealing with COVID-19.

On this Diagnosing Health Care episode, “Key Considerations for Reshoring U.S. Drug Manufacturing,” dive into the key business, policy, and legal considerations for reshoring active pharmaceutical ingredient (or “API”) and finished drug product manufacturing to the United States. The episode features Members of the Firm Delia Deschaine and Neil Di Spirito and is hosted by attorney Bonnie Scott.

Tour the timeline of the regulatory and market evolution of managed care plans from 1917 to the present during this brief presentation from MCOL.

This week’s panelists are Julie Rovner of Kaiser Health News, Alice Miranda Ollstein of Politico, Kimberly Leonard of Business Insider and Erin Mershon of Stat News.This week, Rovner also interviews Amy Howe, co-founder of SCOTUSblog and host of the “SCOTUStalk” podcast. Howe explains what the Supreme Court might do with the latest case challenging the constitutionality of the Affordable Care Act. 

Redundancy, duplication, and waste are pervasive in today’s healthcare delivery system, driving up both operating and capital costs. To achieve economic sustainability and market essentiality, health systems must integrate and rationalize to enhance clinical care, optimize operations, and lower costs, ultimately focusing on the improvement of every aspect of patient care operations.

Part of ECG’s series of strategic perspectives on the changing dynamics of the US healthcare system, this webinar explores four imperatives for healthcare organizations looking to advance their integration and rationalization efforts:

• Capitalize on technology innovation for business tasks.
• Eliminate unwarranted clinical variation.
• Design a platform for delivering and coordinating care across the continuum.
• Implement a capital asset plan that supports integration and rationalization.

Health plans need to focus on their population health management initiatives. Combining social determinants of health (SDOH) data with existing care management programs can bolster the effectiveness of those programs and help improve health outcomes. Rich Morino, Senior Director, Solutions Consultants, LexisNexis Risk Solutions discusses using Social Determinants of Health (SDOH) data to turbo-charge population health management initiatives in a post-pandemic world, in the HealthcareWebSummit event co-sponsored by LexisNexis Risk Solutions.

Leaning objectives include:

• Identify which members should have their care prioritized post pandemic
• Understand why select members are at risk for poor health outcomes
• Examine risks that can be mitigated by interventions or community/social services

This week’s panelists are Julie Rovner of Kaiser Health News, Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and Rebecca Adams of CQ Roll Call. Rovner also interviews KHN’s Laura Ungar, who wrote the latest installment of KHN-NPR’s “Bill of the Month. Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too.

This Diagnosing Health Care episode is part of a special series, “The Future of Health Care: Health Care Delivery and Consolidation Trends in 2020 and Beyond.” Attorney Gary Herschman speaks with Darren Black, Managing Director, Summit Partners, about how health care delivery will change in the years to come and how these changes will impact acquisition and development strategies and future consolidation trends moving forward.

On this Diagnosing Health Care episode, “Product Launching in the Era of COVID-19,” look at the adjustments to business operations and compliance programs that pharmaceutical and medical device companies need to consider as they launch new products during the ongoing COVID-19 pandemic. 

The episode offers holistic perspectives from across Epstein Becker Green’s offices and features Members of the Firm Julie Lampley and Lauren Sullivan, Strategic Advisor for EBG Advisors Machelle Dunavant Shields, and host Jessika Tuazon. 

This Diagnosing Health Care episode is part of a special series, “The Future of Health Care: Health Care Delivery and Consolidation Trends in 2020 and Beyond.” Attorney Gary Herschman speaks with Carsten Beith, Managing Director, Cain Brothers, about how health care delivery will change in the years to come and how these changes will impact acquisition and development strategies and future consolidation trends moving forward.

ECG’s oncology experts share industry best practices from across the country to support the successful ramp-up of cancer program operations. This session provides practical guidance based on lessons learned from leading institutions, addressing how to position operations to meet the anticipated surge in patient volumes while also continuing to ensure the safety of patients and staff at the center. In this session, we

• Discuss how to optimize performance in a COVID-19 environment.
• Explore strategies to transition patients and staff to alternative settings, as needed.

The CMS CMMI Direct Contracting Model Options team hosted a webinar on September 18, 2020. During this webinar, presenters provided a review of the financial methodology for the Direct Contracting Model Options.

This Diagnosing Health Care episode is part of a special series, “The Future of Health Care: Health Care Delivery and Consolidation Trends in 2020 and Beyond.” Attorney Gary Herschman speaks with Barry Ostrowsky, President & CEO, RWJBarnabas Health, about how health care delivery will change in the years to come and how these changes will impact acquisition and development strategies and future consolidation trends moving forward.

Health systems and provider organizations are experiencing significant financial pressure, exacerbated by the COVID-19 pandemic, while historical market forces continue to create serious challenges. Despite reform efforts that have seen mixed results, the march toward value-based care will go on. The path forward will be arduous, as we believe the current system is too costly, complex, and fragmented to remain viable.

ECG’s We Believe series offers strategic perspectives on the changing dynamics of the US healthcare system. In this webinar, ECG principal Andy Bachrodt discusses the tenuous state and future of the US healthcare provider economic model and what executives must do to guide their organizations toward a sustainable position of financial health.

Key learning objectives for this webinar include the following:

• Review and understand the foundational challenges in the US healthcare delivery and funding model.
• Define ECG’s perspective on the evolution of value-based care and industry readiness for the move to a true population health model.
• Discuss the strategies that support the four key imperatives health systems must address:
  • Own the consumer relationship.
  • Redesign the delivery network for high performance.
  • Optimize operations and cost structure.
  • Optimize revenue structure.
• Share lessons learned from participant organizations and their path forward

Changes to the 2021 Medicare Physician Fee Schedule (MPFS) will have far-reaching implications for provider arrangements nationally. CMS will implement the RVU changes and corresponding conversion factor reimbursement adjustment on January 1, 2021. The E&M code WRVU changes alone will impact provider productivity by upwards of 30% and disrupt medical group budgets across the country, unless adjustments are made. ECG’s experts share five ways to avert losses from these compensation models.

This session will provide the audience with:

• An understanding of the final and proposed changes for the 2021 MPFS.
• Clarity regarding the financial, operational, and contracting implications of the changes.
• A successful playbook for addressing the issues at your organization

Critical Point podcasts, brought to you by Milliman: In this episode of Critical Point, we're going to be talking about the rise of telehealth in the wake of the COVID-19 pandemic, and what that could mean for the future of healthcare in the United States. 

The COVID-19 crisis has had a dramatically negative impact on the financial performance of physician practices. Independent practices are ill-suited to address these challenges, and many will not survive the next year. As a result, hospital-physician alignment is likely to accelerate, and executives will need to assess the antitrust considerations of the various alignment options available. In this webinar, ECG and Davis Wright Tremaine experts:

• Examine COVID-19’s impact on physician productivity, including recent month-by-month activity trends.
• Outline various partnership models that health systems and independent physicians may find attractive in this challenging environment.
• Review recent, relevant antitrust cases and explore the key factors leading to antitrust investigations.

ECG consultants Len Henzke and Stuart McClure will be joined by antitrust experts Doug Litvack and David Maas from Davis Wright Tremaine in facilitating this webinar.

In this webinar, BlackTree Clinical Consulting Manager Maureen Kelleher offers a step-by-step guide for establishing a new palliative care program and positioning for long-term success. Covering everything from creating your business plan and staffing requirements to reimbursements and marketing for growth, this comprehensive presentation will provide the tools required for building a successful palliative care program.

For more information on how BlackTree can help your agency achieve its operational goals, please visit www.BlackTreeHealthcare.com. 

Tune into our third episode in the Avalere Health Essential Voice podcast series focused on social determinants of health (SDOH). In this segment, our expert from Avalere’s Center for Healthcare Transformation is joined by officials from the Washington State Department of Health to discuss public health programs focused on maternal and child health, and how these programs relate to healthcare access and health outcomes.

On this Diagnosing Health Care episode, “Holding Pattern: Cannabis Industry Waits for FDA Regulatory Rulemaking,” get a status update on the Food and Drug Administration’s plan for regulating cannabis and cannabis-derived products and what actions the agency has taken recently to make progress. The episode features Delia Deschaine and is hosted by Megan Robertson, both attorneys in Epstein Becker Green’s Washington, DC, office. 

The COVID-19 pandemic has turned the health care industry upside down and accelerated many of the ideas for the future that some thought would take decades to take hold. This session assists attendees in addressing the question: will these changes persist, or will hospitals go back to how they’ve always done business? The speed to decision and execution in this recovery phase is critical. Hospitals cannot go back to their old business models. It most likely is not viable given where health care is heading. As the industry begins to recover from the pandemic, hospital executives should consider how they can maintain their momentum toward operating as a hospital of the future and position their organizations to thrive. 

Discussion includes:

• Implications of how COVID-19 has accelerated future hospital transformation
• The three emerging themes on how hospitals are transforming
• Consideration for what parts of hospital COVID-19 responses should remain part of their new normal
• Steps for those entering the recovery phase of the pandemic toward how to ensure their organizations will thrive

This session will discuss home health industry trends and financial impacts of PDGM primary diagnoses and PDGM comorbidity groups including identifying financial impact of each primary diagnosis group, misconceptions about capturing PDGM comorbidity groups, accurately capturing comorbidity groups, and distinguishing comorbid diagnoses that warrant physician query.

For more information on how BlackTree can help your agency achieve its operational goals, please visit www.BlackTreeHealthcare.com. 

The Community Health Access and Rural Transformation (CHART) Model team hosted an overview webinar on Tuesday, August 18, 2020 from 1:00 - 2:00 PM EDT. Attendees had the opportunity to hear an overview of the CHART Model, including its objectives, eligible participants and their roles, payment options, and timeline. Following the session, attendees were provided an opportunity to participate in a live Q&A session.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the second quarter 2020

Tune into our second episode in the Avalere Health Essential Voice podcast series focused on social determinants of health (SDOH). In this segment, Avalere experts from the Center for Healthcare Transformation and Market Access practices discuss the strategies for SDOH solutions, specifically in the manufacturer space.

Inovcares Podcast: Pandemic of Inequalities with Dr. Laura Herrera Scott, MD, MPH, VP Medicaid Clinical Operations at Anthem. Dr. Scott has held several prominent leadership positions in the Baltimore area. As a trained family medicine physician, Dr. Scott has extensive public health experience and has led innovative programs specifically designed to improve health outcomes while saving costs. Most recently, Dr. Scott served as the Medical Director of Population Health and Community Health Programs at Johns Hopkins HealthCare, LLC. In addition to her years of work and volunteer experience, Dr. Scott also reached the rank of Major, Medical Corps after having served for 10 years in the United States Army Reserve.

The iron triangle of health care depicts how the three competing priorities of health care delivery – cost, quality, and access – are often interdependent to a fault. Improving any one almost always requires a trade-off with another. Clinical AI offers the promise of improving this equation so that it does not end in a zero-sum game. Attendees to this presentation will learn how a range of data and analytic assets are being combined at the national and account levels to more accurately assess risks and the vulnerability of key populations.

Health Plans continue to be subject to advanced persistent threats from organized hacking groups, and payers need to adopt and update in-depth strategies and comprehensive incident response plans to thwart or mitigate these attacks. These protective countermeasures should be part of the organization’s formalized information security program designed to anticipate, prevent, detect and respond to future similar attacks targeting any organization. 

Attendees to this presentation will learn about current cybersecurity trends impacting health plans, best practices to consider for health plan risk management response preparedness, and the importance of increasing Board and C-Suite visibility and awareness of these issues and responsibilities.

Tune into our first episode of the Avalere Health Essential Voice: Social Determinants of Health (SDOH) series. In this segment, Avalere experts from the Center for Healthcare Transformation and the Health Plans and Providers practice set the stage for how stakeholders are defining SDOH and the impacts of SDOH on health outcomes, specifically when addressing social risks and needs.

COVID-19 has overwhelmed hospitals, their emergency rooms, intensive care units and created a huge demand for respirators, personal protective equipment and other resources. However, hospital management and staff can be better prepared for this pandemic or any other extraordinary circumstance that comes their way. Through DNV GL Healthcare’s NIAHO hospital accreditation program, which integrates the ISO 9001 quality management system, providers can create a calm, systematic and highly effective response plan that not only mitigates risks but also ensures that patients receive the best and highest-quality care possible without overwhelming hospital operations and their frontline and management staff.

During this presentation, attendees will:

• Learn how one urban safety net hospital used ISO 9001 and NIAHO to create an effective COVID-19 response
• Learn how to craft their own effective pandemic response using ISO 9001 and NIAHO
• Understand how ISO 9001 and NIAHO can create a clear roadmap to an effective COVID-19 response
• Discuss how the accrediting organization they use to qualify for Medicare and Medicaid participation is absolutely crucial

Recent public health and economic crises have highlighted long-standing AMC (Academic Medical Center)  challenges. They have also inspired and emboldened leaders to work together to tackle politically sensitive and highly complex initiatives that have been debated for many years. In this session, ECG experts:

• Discuss how COVID-19 has exacerbated existing pain points across AMC mission areas.
• Highlight key diagnostics to rapidly identify opportunities to improve performance.
• Prioritize initiatives and define accountabilities.
• Underscore how AMC component entities can work together to achieve shared objectives.

Discover how Medicare Advantage initiatives are affecting providers and what can be done to overcome the operational challenges they pose. BlackTree Consulting Director Brian Harris and Consulting Manager Samantha Soulas in partnership with Beth Ann Morren of Elara Caring, will present the strategies needed to manage Medicare Advantage contracts and achieve profitability.

For more information on how BlackTree can help your agency achieve its operational goals, please visit www.BlackTreeHealthcare.com. 

InovCares Podcast: Building healthy habits and lifestyle you want can be daunting. So today we decided to bring two food experts to educate and inspire us to consider food as medicine by developing a healthy relationship with food. Shaun Chavis is the founder of LVNGbook, and Tambra Raye is founder of WANDA: Women Advancing Nutrition Dietetics & Agriculture.

This analysis is based on the twenty-third annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by year end, approximately 895 health plan years. Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to most Independent / Provider - Sponsored plans possessing the ability to compile high-quality, segmented financial and operational data.

We surveyed the participants to populate the Sherlock Benchmarks and this summary. This 18th analysis of Independent / Provider - Sponsored plans is based on a peer group of thirteen plans who collectively serve 8.4 million people. Their median and mean membership is 554,000 and 640,000, respectively.

An ASC with great physician partners, top-notch clinical staff, and substantial surgical volume can still struggle if its payer agreements are poorly negotiated. During this 30-minute webinar, contracting expert Matt Kilton from ECG Management Consultants and billing expert Angela Mattioda from Surgical Notes share their guidance on getting the most out of your payer contracts. They discuss examples and lessons learned from their combined 30 years in the ASC contracting and billing world.

This is a selected session from the Virtual Summit on Health System Recovery from the COVID-19 Pandemic, held June 22-25, 2020. The Nation’s Health System Leaders Engage in a Real-Time Dialogue on Pandemic Recovery and the Future of Health Care in America with over 80 speakers. Six month access to streaming content from the entire Virtual Summit is available for $125 at: https://healthsystemcovidrecovery.com/media-sales/

This session examines the intersection of Value-Based Care and Social Determinants of Health for Payers, Providers and Community-Based Organizations, and will address:

• Factors that Drive Operating Models of Payers, Providers and CBOs
• Payment Models: Reimbursement versus Grants or Contracts
• Measuring Outcomes, Reporting Requirements, and Data Infrastructure in Health and Social Sectors
• Pain Points Encountered at the Negotiating Table
• Successful Models: Common Components & Threads, and a Closer Look at the San Diego Model

GeekWire HealthTech Podcast: The last time we caught up with Pillsy co-founders Jeff LeBrun and Chuks Onwuneme, three years ago, they were focused on their flagship product, a smart pill bottle that sounds an alarm if people forget to take their pills. 

But that was just one example of the broader trend of remote patient monitoring — technology that helps medical professionals keep tabs on the status of patients at home, day in and day out, not just during periodic visits to the doctor’s office. Even before COVID-19 led to a boom in telehealth, LeBrun says, the need for better remote patient monitoring was becoming clear to Medicare officials, due to an aging population and a limited supply of health care workers. The company, now operating under the name optimize.health, raised a $3.5 million bridge investment from Bonfire Ventures and other investors earlier this year to help expand into this larger market. 

In this episode we're talking about artificial intelligence and its potential to transform healthcare, including processes and patient outcomes. One area where we're beginning to see AI put to use is in lung cancer screening using CT scans. Lung cancer is the number-one cancer killer in the US, so methods to improve the screening process hold a lot of promise, but AI technology in this area is also not without its challenges. Joining us is one of the foremost experts on the topic. Jim Mulshine is a thoracic medical oncologist who spent 25 years at the National Cancer Institute in Bethesda, Maryland. He's now at Rush University Medical Center. Also joining us is Bruce Pyenson here at Milliman who has worked closely with Jim studying this topic. 

Milliman’s Melody Craff, Francesca Hammerstrom, Adam Wallace and Edward Jhu present practical guidance to help organizations analyze the impact of COVID-19 on healthcare cost and utilization trends

This webinar, and Milliman’s accompanying white paper “Frameworks and considerations for COVID-19 related analyses,” present practical guidance to help organizations analyze the impact of COVID-19 on healthcare cost and utilization trends. The intent is to provide initial supportive resources for healthcare organizations, as they navigate dramatic changes in the healthcare landscape.

The COVID-19 pandemic has put tremendous stress on the US healthcare system. In this 60-minute webinar learn how both LexisNexis Risk Solutions and Blue Health Intelligence are contributing innovative solutions that healthcare leaders can use to better predict and prevent public health risk.

Topics Include

• Data for Good: Using data to identify vulnerable populations and care resource gaps
• Leveraging SDOH data, along with provider and claims intelligence to help healthcare organizations sharpen their focus
• Getting ahead of covid-19 using advanced analytics and reporting
• Combining a range of data and analytic assets to more accurately assess risks and key population vulnerabilities

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the first quarter 2020.

A physician group should conduct extensive “reverse due diligence” before entering into a private equity (PE) partnership.

Important things to consider include:

• the PE firm’s financial ability to close the transaction with the physician group;
• the physicians’ comfort level with the PE firm’s experience, integrity, culture, vision, and fit as a partner for the group;
• and the PE partner’s specific experience and track record investing in physician services – in terms of both working well with physicians and achieving substantial value enhancement.

You should speak directly with multiple physicians who have partnered with the investor in the past to assess all of these factors.

Physician groups can keep their practice competitive–and on the “cutting edge”—by partnering with a private equity (PE) platform. The health care marketplace is evolving, and it takes substantial investment in infrastructure, such as IT, to stay ahead and continue be successful and profitable.

A PE investor provides capital to acquire important strategic initiatives, like cutting-edge medical equipment and technologies, advanced electronic medical record capabilities, data analytics, new offices, and new and/or expanded ancillary services. The PE investor’s existing corporate infrastructure may immediately provide some of these benefits.

A private equity (PE) transaction can give a physicians group more room to focus on clinical care as they relinquish much of the administrative and practice management duties. A PE partnership allows physicians access to the PE platform’s seasoned and sophisticated management team and capital.

The team can provide managed-care contracting expertise, advanced electronic medical record capabilities, excellent billing and collection teams, financial management, HR executives, compliance staff, and more. Not only will significant cost savings be enjoyed, but operations will be improved and expanded.       

On the flipside, PE investors don’t want to tell physicians how to practice medicine. In fact, in many states, interference of that kind is illegal. PE investors will keep their focus on improving the business aspects of the practice.    

National Center for Immunization and Respiratory Diseases (NCIRD) - CDC provides recommendations on how parents and caregivers can help support children and teens during COVID-19 pandemic.

A private equity (PE) transaction can help physicians “hedge” the uncertain future of private medical practices in an ever-changing and regulated industry. Uncertainty in the industry includes changing reimbursement models, the prospect of “Medicare for All,” increasing regulation/compliance, and the need for advanced IT and other infrastructure investments.

With a PE investment, some of this risk is mitigated because PE brings in an experienced and sophisticated management and “C-suite” team and the ability to be part of a large platform with hundreds of other physicians in the same specialty, experience in value-based care, and significant economies of scale for expensive EMR and other infrastructure. But not all uncertainty can be eliminated. For example, when the PE partner eventually “exits” its investment who will the new buyer be? How will it impact the practice? However, stability can be its own hedge. Any new buyer will likely be wary of changing a well-run and managed enterprise without the continued support of its physicians.

Provides a thorough examination of the legal, regulatory and corporate structural implications, issues, and challenges for healthcare organizations that are exploring and evaluating offering telehealth services.

In this current environment, healthcare organizations not already providing telehealth services are faced with critical decisions regarding developing such capabilities for the populations they serve. However, there are myriad legal and regulatory complexities in doing so, particularly at the state level.

Topics include:

• Key legal and regulatory telehealth issues
• Corporate formation and corporate practice of medicine considerations
• Implications of applicable telehealth modalities to deploy
• Potential regulatory developments in the current environment

Part of the VA PTSD Consultation Program: Lecture Series. The April 2020 webiar: How Mental Health Providers Can Care for Themselves and Support Colleagues During the COVID-19 Virus Outbreak includes discussion of Factors in Recovery From Adversity and Stress and Stress First Aid. 

Partnering with a private equity (PE) investor can help physicians monetize the value of their practice. Why treat your practice differently than other assets in your retirement portfolio?

A PE transaction will provide an up-front cash payment and/or rollover equity in the PE platform. Up-front cash, usually 70-80% of the “real value” of your practice, is calculated on a multiple of the practice’s free cash flow or earnings before interest, taxes, depreciation, and amortization (or “EBITDA”).  The remaining balance of purchase price (20%-30%) is usually paid in the form of rollover equity.

Rollover equity converts to additional cash payments upon a secondary sale to another investor down the road. Further, many PE transactions are structured so that if a physician retires, becomes disabled, or dies, his/her rollover equity is purchased at its then fair market value.

The Centers for Medicare & Medicaid Services hosted a webinar on Thursday, April 2, 2020 to discuss the Value Based Insurance Design (VBID), Part D Payment Modernization, and Part D Senior Savings models. Attendees received an overview of the models and the CY 2021 application process, and had an opportunity for questions and answers with the Model teams. 

Heather Trafton and Catherine Turbett discuss how Accountable Care Organizations (ACOs) can attain success under challenging risk-based payment models in this special 45-minute HealthcareWebSummit event.

Topics Include:

• Developing strategies that address fundamentals of financial performance in value-based contracts
• Five key accountable care analytics strategies
• MSSP and Next Generation ACO performance results for Arcadia customers
• Arcadia ACOs’ experience and lessons learned

Piedmont Healthcare is a large hospital system in the Atlanta area, four of their hospitals are DNV GL Healthcare certified stroke centers – a designation they have held for the last 5 years. Since the date of certification and with each annual survey, the hospitals have experienced substantial growth through improved delivery of safe and top-notch quality stroke care. Discussion centers on the process of achieving a DNV GL Stroke Program Certification and how certification has positively impacted the Piedmont Healthcare System.

Service line excellence and growth don’t occur organically. They are the result of purposeful planning, and these plans must dovetail with the vision, strategic direction, and strengths of the health system. The transition to value calls for health systems to rethink and redesign care delivery across services lines. But they cannot do it without the support of physicians in those service lines. Comanagement and gainsharing are complementary financial arrangements that facilitate hospital/physician alignment through enhancements in service line performance.

Learning Objectives

• Best practices in gainsharing and comanagement arrangements
• Program development approach
• Funds flow and compensation
• Valuation considerations
• Relevant legal agreements

Nightingale Partners’ John Gorman explores Nightingale’s approach and how Opportunity Zone Funds can partner with Medicare Advantage and Medicaid plans to invest in Social Determinants of Health initiatives.

Service line excellence and growth don’t occur organically. They are the result of purposeful planning, and these plans must dovetail with the vision, strategic direction, and strengths of the health system. The transition to value calls for health systems to rethink and redesign care delivery across services lines. But they cannot do it without the support of physicians in those service lines. Comanagement and gainsharing are complementary financial arrangements that facilitate hospital/physician alignment through enhancements in service line performance.

Learning Objectives

• Best practices in gainsharing and comanagement arrangements
• Program development approach
• Funds flow and compensation
• Valuation considerations
• Relevant legal agreements

While net professional collections across all physicians have remained virtually flat, clinical compensation among teaching physicians has steadily increased. Despite these increases, academic medical centers (AMCs) have not been able to keep up with compensation increases for community hospital providers and face significant recruiting challenges as a result. Additionally, academic organizations encounter serious financial sustainability concerns as they continue to find their resources stretched to subsidize their teaching and research mission. In this webinar, ECG experts will discuss the driving forces behind these trends and offer strategic and tactical approaches to help academic organizations cope.

At the end of this presentation, participants will be able to:

• Describe the physician compensation expense pressures and recruitment challenges faced by AMCs.
• Identify compensation approaches that balance market tensions against financial sustainability.
• List important considerations in incentivizing faculty for their contributions to patient care as well as their teaching and research activities.
• Distinguish best practices to acknowledge value in clinical compensation.
• Recognize opportunities to support market-level compensation for structurally underfunded departments.
• Explain compensation differences between faculty physicians and nonfaculty community physicians in the academic setting

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the fourth quarter 2019.

Terri L. Welter and David A. Wofford address the implications of the CMS Price Transparency Rules and the resulting need for creative pricing strategies and patient-friendly value-driven payment models, in this special 45-minute HealthcareWebSummit event.

Topics Include:

• How the CMS transparency rules will (or will not) improve transparency
• Anticipated impact on consumer behavior and reimbursement rates
• The need for creative pricing strategies
• Embracing patient-friendly, value-driven payment models

In 2018, the median loss per physician among hospital-based specialties was more than $200,000. In this part of our webinar series, we will explore how these rising costs, both per physician and in aggregate, have spurred fundamental changes to coverage models and compensation structures as organizations attempt to create cost efficiencies without sacrificing quality and outcomes. Beyond this, we will examine how the influence of advanced home health and telemedicine will increasingly impact coverage-based models.

In this webinar, we will:

» Understand the driving forces behind the rising loss per FTE.

» Discuss how systems are dealing with these losses.

» Explore how advanced practitioners and telemedicine are influencing coverage models.

» Identify how compensation incentives have changed.

» Learn how clinical expectations and the definition of an FTE have changed over time, as well as the impact of this change.

People expect a frictionless experience, especially in health care. Yet, despite spending millions of dollars on experience improvements, plans still lag behind because they aren't investing in things that matter the most for member satisfaction and costly care use.

In our 2019 health care experience survey, we asked over 3,000 individuals about the frictions they experienced while getting care to see which ones impacted costly care use or retention.

This presentation will provide case studies and key insights into where in the customer journey plans should invest to improve satisfaction and lower medical spend.

Private equity (PE) investment in physician groups has steadily grown over the last several years, with 219 physician group deals being announced or closed last year.  This trend leaves some groups wondering, is PE for us? There are five critical factors that physician groups should consider:

1. “Monetizing” the value of your ownership in your practice
2. Hedging future risk in light of increasing uncertainty in the health care industry
3. Increasing efficiencies in practice management to allow the physicians to focus on clinical care
4. Having access to capital to invest in better infrastructure and growth
5. Assessing the experience, financial track record, and culture of the PE partner

Stephanie W. Kanwit examines the provisions, complexities, challenges, implications and outcomes of the CMS Hospital Price Transparency Final Rule.

Topics Include:

• The provisions set forth in the CMS Hospital Transparency Final Rule
• The complexities surrounding the scope of the Final Rule
• The challenge of making a hospital’s negotiated rates “consumer friendly”
• Illustrative examples in the application of risk adjustment
• Practical implications and outcomes for hospitals, consumers, and regulators

Many organizations are expanding the APP footprint within their care teams to improve patient access, replace an aging physician workforce, and meet other strategic and business objectives. In doing so, organizations are focusing on operations and compensation for APPs to maximize their investment. In this session, ECG experts explore the limitations and drivers of operations and incentive alignment for APP performance.

The Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar on Thursday, January 30, 2020 to provide information and answer questions about the hospice benefit component recently added to the Value Based Insurance Design (VBID) Model. The Centers for Medicare & Medicaid Services announced in January 2019 that beginning in calendar year 2021, the VBID Model will test including the Medicare hospice benefit in Medicare Advantage.

Topics included an overview; a deep dive into the quality, network, and payment policies being tested as part of the hospice benefit component of the Model for CY 2021; and the application process. During the webinar, CMS shared next steps and engagement opportunities as well as a live question and answer (Q&A) session.

$3 billion recovered under the False Claims Act (“FCA”). That’s what the US Department of Justice (“DOJ”) reported collecting in FY2019. The health care and life sciences industries accounted for $2.6 billion of the total recoveries. That’s 87% of all FCA judgments and settlements. $678 million of the health care recoveries came from DOJ initiated enforcement actions. $1.9 billion of the health care recoveries were generated by cases brought by whistleblowers who filed qui tam actions. Qui tam actions remain a principal driver of FCA enforcement in the health care space.

Enforcement targeted pharmaceutical and medical device companies, managed care entities, hospitals, pharmacies, hospice organizations, laboratories, and physicians. The recoveries also reflect DOJ’s intent to hold individuals, not only corporations, accountable in FCA cases.

What does the coming year and new decade hold for healthcare? What are the key healthcare business issues and trends for 2020 that will impact you and your organization, and how can you best position for them? Attend this web summit event and get 2020 vision for your healthcare organization. The Eighteenth Annual Future Care Web Summit addresses key future trends and also focuses on several important cutting-edge healthcare business topics, including:

• Forces of Change: The Future of Healthcare into 2040
• The Legal, Regulatory and Policy Landscape for 2020
• Social Determinants of Health Program & Policy Developments for 2020
• On-Demand Sessions: Transformation Through Digitally Enabled Care, MSSP Pathways to Success

The Direct Contracting Model Options team hosted a webinar on January 22, 2020 to provide additional information on the Direct Contracting model's payment methodology following the Payment Part 1 Webinar on January 15th. The team presented on additional aspects of the financial model not covered during the Payment Part 1 Webinar, such as its risk adjustment, benchmark methodologies, and quality measures. The forum also provided an opportunity for potential applicants to ask the team questions regarding these topics and other topics related to the model application.

Employees value choice when it comes to health benefits. When employers facilitate these choices, the method for setting employee premium contributions can create selection bias toward certain options. Selection bias happens when a sicker and more costly population tends to choose one option over another. In order to reduce the selection bias, employers should adjust each option for morbidity. Risk adjustment is used to adjust applicable costs of two or more cohorts of people so all cohorts can be compared as if each had the same morbidity.

Topics Include:

• The concepts of selection bias and risk adjustment
• The implications and justification for applying risk adjustment
• The methodologies involved in setting employer contribution rates and application of risk adjustment
• Illustrative examples in the application of risk adjustment

Additional Tags: Slef-Insurance, Self-Funding, TPA, Actuarial

The Direct Contracting Model Options team hosted a webinar on January 15, 2020 to provide an overview of the Direct Contracting Model's payment methodology. During the session, the Direct Contracting model team presented key aspects of the Direct Contracting financial model, such as its risk-sharing options and risk mitigation strategies, as well as its capitation and other advanced payment alternatives. The forum also provided an opportunity for potential applicants to ask the team questions regarding these topics and other topics related to the model application.

The Value Based Care Primer Video is a five minute video covering the basic concepts behind value based care

Health care organizations are under increasing pressure to reduce costs, perform successfully under value-based care models, and manage constant industry change and regulatory pressures. Central to effectively managing these pressures is the ability to leverage data to understand and impact quality of care, patient outcomes and the financial health of your organization.

This webinar will explore strategies that health plans and provider organizations can leverage to improve data quality, starting with patient encounter data. Join Optum Advisory Services to learn about how health care organizations are successfully identifying and resolving encounter data quality issues and impacting financial sustainability, including case studies from recently completed projects for Medicare Advantage and Medicaid and insights from payers on their efforts to improve encounter data quality.

As we head into 2020, stakeholder research tells us that:

• High-deductible health plans are waning
• High-performing networks are in
• Highly personalized benefits offerings are a must

To stay ahead of these and other healthcare benefits trends and demands, there is a greater need for near real-time, population-specific health benefits analytics.

Although hospitals are always striving to improve patient safety, they have come under new pressures in recent years to better their performance. Since the Centers for Medicare & Medicaid Services (CMS) began penalizing hospitals for unnecessary readmissions and weighing patient satisfaction scores, it has become imperative for inpatient providers to look at patient safety not as a compartmentalized function, but as a holistic mission involving all facets of hospital management.

As the nation's fastest-growing healthcare accrediting organization, DNV GL Healthcare emphasizes continuous quality improvement. It is always assisting its more than 500 hospital clients in improving patient safety and outcomes. One of the ways to accomplish that is to integrate risk management with patient safety. That may mean weighing the unreimbursed costs of properly sterilizing duodenoscopes versus avoiding infections that may cost more down the line to treat in terms of both money and goodwill. Successfully navigating such decisions can not only make the hospital setting safer, but will also improve the bottom line.

A recent study published in JAMA found that only 15.6% of physicians reported screening for all five social determinant of health factors: food insecurity, housing instability, utility needs, transportation needs, and interpersonal violence.

During this webinar, Alliance for Better Health will talk about how it is working with health systems and payers in alternative payment arrangements, and providing their providers with SDoH data, allowing them to connect patients with community-based organizations to improve care and reduce costs. Topics Include:

• Case Study of Alliance for Better Health Social Determinants of Health (SDoH) Initiatives
• Overview of SDoH Challenges with infrastructure and technology for providers to make referrals to community-based organizations
• How Alliance for Better Health is working with New York health systems and payers in alternative payment arrangements
• How Alliance for Better Health  furnishes providers with SDoH data, allowing them to connect patients with community-based organizations to improve health and reduce

In this webinar, ECG’s team of experts review the findings of ECG’s 13th annual Pediatric Subspecialty Physician Compensation Survey. The session includes our analysis of important pediatric physician and advanced practice provider performance trends from the 2019 survey and how these trends impact children’s hospitals. Included in this webinar is a discussion of market trends related to value-based care and implications for compensation planning as well as overall organization strategies.

Session Objectives

• Share the findings of the 2019 Pediatric Subspecialty Physician Compensation Survey.
• Highlight physician and APP compensation and production trends, including trends in value-based compensation, benefits, work standards, and recruiting.

The ambulatory surgery center (ASC) landscape continues to rapidly evolve, driven by market and legislative forces, patients, payers, and providers. Health systems and hospitals are under pressure from all sides to reduce costs, while changes in government regulations and commercial payer practices reward providers for migrating high‑acuity surgery to the ASC setting. This migration poses a financial threat to health systems, given the significance of surgical revenue. These combined factors motivate the need for ASCs and hospitals to develop and implement a comprehensive ASC strategy.

In this webinar, Naya Kehayes, Principal, and Sean Hartzell, Associate Principal, will discuss the current state of the ASC market, how migration is affecting hospitals’ strategic options, and how hospitals can engage in proactive strategies to survive and thrive in the changing surgical environment.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the third quarter 2019.

In this webinar, ECG’s team of experts will review the findings of our 20th annual Physician Compensation Survey. The session will include our analysis of important physician and advanced practice provider performance trends from the 2019 survey, as well as how these trends impact hospitals, health systems, medical groups, and universities/schools of medicine. Included in this webinar will be a discussion of market trends related to value-based care, as well as implications specific to compensation planning and organizational strategies overall.

Session Objectives

• Share the findings of the 2019 Physician Compensation Survey.
• Highlight physician and APP compensation and production trends, including trends in value-based compensation, benefits, work standards, and recruiting.

• Framework for new Medicare Advantage supplemental benefit flexibility
• What MA plans are doing in 2020
• How to best to seize these new opportunities
• Exploring target populations and an array of potential supplemental benefits
• Challenges and accountability associated with new supplemental benefit flexibility
• How Special Needs Plans play an important role

This is a selected session from Twentieth Annual Pharmaceutical and Medical Device Compliance Congress held November 6 - 8, 2019 in Washington, DC with over 120 speakers, and sponsored by Pharmaceutical Compliance Forum. The Pharmaceutical and Medical Device Compliance Congress is the oldest and largest gathering of pharma and device compliance professionals and in-house counsel who come together annually to discuss best practices in legal and regulatory compliance. A Flash Drive Archive or Six Month Online Streaming Access of the entire Congress is available for $195 at:  https://2019.pharmacongress.com/multimedia-sales/

• Avalere research findings on payer and life science OBCs
• Perceived challenges with OBCs
• OBC considerations for new/existing products, and therapeutic areas of focus
• OBC cost savings expectations timelines
• Potential usage of ancillary services under OBCs
• Methods to measure value and financial incentives

This analysis is based on the seventeenth annual edition of our performance benchmarks for Medicaid-focused health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of more than 858 health plan years.

Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to all Medicaid-focused plans possessing the ability to compile high-quality, segmented financial and operational data. This analysis of Medicaid plans is based on a peer group of twelve plans who collectively serve 10.3 million people in comprehensive products. Seven of this year’s participants participated in the prior year.

National Center for Injury Prevention and Control: Studies show flu and whooping cough vaccines are very safe for pregnant women and developing babies.

This analysis is based on the twenty-second annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) and we project will represent the cumulative experience of over 855 health plan years by September.

Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to most Independent / Provider - Sponsored plans possessing the ability to compile high-quality, segmented financial and operational data. We surveyed the participants to populate the Sherlock Benchmarks and this summary.

This 17th analysis of Independent / Provider - Sponsored plans is based on a peer group of nineteen plans who collectively serve 10.2 million people. Their median and mean membership is 470,000 and 534,000, respectively.

Insights and aspects of security management and the security vulnerability analysis (SVA) as this is applied under the National Integrated Accreditation for Healthcare (NIAHO) requirements and NFPA 99.

Milliman shares a historical view of the Employer Stop Loss (ESL) market, including portfolio characteristics, underwriting measures, pricing measures, historical results, and product terms offered. Milliman will also address the considerations and implications for health plans evaluating ESL market opportunities.

• The employer stop-loss market opportunity for health plans
• A  historical view of the employer stop-loss market
• Employer stop-loss market characteristics, measures, results and products
• Considerations and implications for health plans evaluating employer stop-loss market opportunities

Additional tags: Self-Insurance, Self-Funding, Reinsurance, TPA

Insights drawn from years of experience in administering Reference Based Pricing (RBP) plans to talk about it's challenges and benefits, as well as key strategies for successfully implementing and administering RBP plans. The session will include case studies of 2 employer groups that switched from a traditional PPO structure to an RBP plan.

Additional Tags: Self-Funding, Self-Insurance, TPA, contracting

Several of the organizations who collaborated on the Guiding Principles for the Ethical Use of Social Determinants of Health provide an overview of the guiding principles, bring clarity to what the industry views as the appropriate use of SDOH, and offer examples of how SDOH can and should be leveraged to help patients achieve optimal health outcomes and wellness.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the second quarter 2019.

National Center for Injury Prevention and Control: The video describes the increased use of naloxone that can help end the opioid overdose epidemic

This is a selected session from the Seventh National Physician Advisor and Utilization Review Boot Camp held July 29 - 31, 2019 in Washington, DC with almost 20 speakers. The conference, in partnership with Day Egusquiza and AR Systems, Inc., addressed Medicare Advantage: Building Blocks of Contracting, Provider Sponsored MA Plans, and the Ongoing Denial Challenges, plus the pre-conference: "The Basics: Medicare 101, P2P 101, CDI 101 and Denials/Appeals 101." A Flash Drive Archive or Six Month Online Streaming Access of the entire conference is available for $195 at:  https://racsummit.com/multimedia-sales/

This analysis is based on the twenty-second annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) and we project will represent the cumulative experience of over 855 health plan years by September.

Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to most Independent / Provider - Sponsored plans possessing the ability to compile high-quality, segmented financial and operational data. We surveyed the participants to populate the Sherlock Benchmarks and this summary.

This 17th analysis of Independent / Provider - Sponsored plans is based on a peer group of nineteen plans who collectively serve 10.2 million people. Their median and mean membership is 470,000 and 534,000, respectively.

How hospitals can change the accreditation process from an ordeal to a learning experience capable of transforming their institution and improving quality of care, identification of potential tools and strategies for identifying and addressing quality of care issues, and how NIAHO and ISO 9001 are tools of empowerment for hospital managers.

Examine a framework for integrating social determinant of health data into population health analytics, consider application of time-dependent survival modeling in a study to predict survival of patients in hospice, and explore a case study that addresses how much data is enough to build an accurate deep learning model.

This is a selected session from the Tenth National Accountable Care Organization (ACO) Summit, collocated with MACRA Summit IV and Bundled Payment Summit IX, held June 17 - 19, 2019 In Washington, DC with over 90 speakers. The ACO Summit is considered the leading forum on Accountable Care Organizations (ACOs) and related delivery system and payment reform. A Flash Drive Archive or Six Month Online Streaming Access of the collocated Summits is available for $195 at: https://www.acosummit.com/media-sales/
 

This analysis is based on the twenty-second annual edition of our performance benchmarks for health plans. The Sherlock Benchmarks (Sherlock Expense Evaluation Report or SEER) represent the cumulative experience of, we expect by year end, over 855 health plan years.

Each peer group in the Sherlock Benchmarks is established to be relatively uniform. So, within that constraint, it is open to most Blue Cross Blue Shield plans possessing the ability to compile high-quality, segmented financial and operational data. We surveyed the participants to populate the Sherlock Benchmarks and this summary

This 21st analysis of Blue Plans is based on a peer group of fourteen Blue Cross Blue Shield Plans who collectively serve 36.7 million people, excluding Host, specialty and other products. We believe this universe to be quite robust. Participants in this year’s study serve 52% of all Blue membership, excluding those served by publicly-traded firms. Collectively in 2018, the health plan operations of these Plans earned annual premiums plus fees of $106.7 billion

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the first quarter 2019.

A discussion on ways for health plans to reduce the risk of a data breach, the necessary steps to validate and verify member information, and ingredients for a strong multi-factor authentication strategy.

To learn what MCOs and MA plans are doing to address social needs among their enrollees, the Deloitte Center for Government Insights and the Deloitte Center for Health Solutions interviewed executives and leaders from 14 MCO and MA plans across the country. This project builds upon a previous study by the Deloitte Center for Health Solutions that surveyed a nationally representative sample of hospitals and health systems to learn about their current and future SDoH investments.

Exploration of how new digital services and products can make care affordable and effective for Medicaid and underserved populations - as a laboratory for innovation that will ultimately shape care for everyone.

Confidence in an organization's sterile processing departments and processes can be accomplished and the risk of infection from improperly processed instruments can be reduced, if not eliminated if protocols are followed in a way that is a good fit for a hospital’s management structure and corporate culture.

What will the health plan of tomorrow look like? How will traditional health plans transform, and what choices do leaders need to make now to survive the forthcoming disruption? To begin answering these questions, the Deloitte Center for Health Solutions conducted crowd-sourcing research with 28 health care, policy, and technology experts. Over four days, these experts presented and discussed use cases for the next innovation cycle with a focus on four key areas: customer centricity; innovation; collaboration; and operational excellence.

Milliman shares several data mining tactics that they have seen successful ACOs adopt to effectively guide strategies to reduce medically unnecessary services and in turn reduce the ACO’s total population costs.

This is a selected session from the Nineteenth Population Health Colloquium, held March 18 - 20, 2019 in Philadelphia, PA with over 60 speakers. The Jefferson College of Population Health is the exclusive Academic Partner for the Colloquium. The Colloquium addresses practicing population health, the implications of socioeconomic disparities, transformation of care delivery to meet the specific needs of each community, advances in technology, data analytics and precision medicine, with national and regional thought leaders examining industry trends and sharing their expert insights, best practices and case studies.  A Flash Drive Archive or Six Month Online Streaming Access of the entire Colloquium is available for $195 at:  https://2019.populationhealthcolloquium.com/multimedia-sales/ 

Discussion of some of the many ways episode analytics can be used by Managed Medicaid plans to drive improved care quality and lower total costs of care, and insights into some of the clinical aspects of episodes of care which are unique to the Medicaid market.

With the MSSP final rule, CMS is offering greater shared savings potential to ACOs participating in the BASIC track and making the BASIC track available to a broader set of ACOs. The effect of these rule changes on specific ACOs will vary significantly depending on an ACO’s size, region, cost and quality performance, and structure. It is critical that ACOs fully consider all of the implications of these rules in order to identify both the risks and the opportunities specific to their organizations.

This MCOL podcast features a brief discussion by Doug Sherlock, Senior Health Care Analyst and President, Sherlock Company (www.sherlockco.com), featuring his insights into the quarterly financial reports of health plans, for the fourth quarter 2018.

This is a selected session from the Fourteenth National Value-Based Payment and Pay for Performance Summit, held February 25 - 27, 2019 in Los Angeles, CA with over 80 speakers. The Summit has been the Leading Forum on Pay for Performance, Transparency and Value-Driven Healthcare, co-sponsored by APG and IHA.  A Flash Drive Archive or Six Month Online Streaming Access of the entire Congress is available for $195 at:  https://pfpsummit.com/multimedia-sales/

Edifecs will illustrate how health plans participating in government-sponsored programs (such as Medicare Advantage) can take off the blindfold and improve risk-adjusted revenue accuracy and reduce associated costs with clinical data integration.

This session identifies CareMore Medicaid program innovation strategies, scope and components; reviews CareMore and AmeriGroup program outcomes and results in in Iowa and Tennessee; explores CareMore's approach to comprehensive, relationship-based primary care; and considers how CareMore has fostered collaborative behavioral health.

Explore key healthcare innovations and trends that will be highly impactful on healthcare stakeholder this year; gain a sense of the critical legal, regulatory and policy issues impacting healthcare in 2019; and ascertain the implications of the state of value based care in 2019.

Organizations have evolved to accept a growing number of value-based and global-risk contracts. Across the industry, building compensation models to incentivize physicians is challenging. Further, benchmarks to evaluate physician compensation under risk-based models are lacking, making it difficult to obtain a fair market value (FMV) opinion. A value-based model asks physicians to behave differently, so we should measure performance differently. Most medical groups are inexperienced with this type of arrangement, or they lack the right tools and benchmarks. Set aside your $/WRVU models and benchmark percentiles as this on demand webinar guides you through the journey from volume to value.

This recording’s learning objectives include:

• Understanding the development success factors for risk-based agreements.
• Differentiating the issues associated with FFS models from risk-based models.
• Delineating a framework for evaluating the commercial reasonableness of value-based models.

Animated Graphic: Hypertension, or high blood pressure (HBP), increases your risk for heart disease and stroke. HPB is “the silent killer.” 

Manatt Health reviews the role that Medicaid agencies and Medicaid managed care plans are playing in testing SDOH-related interventions and integrating them into their healthcare delivery system—creating a platform for “whole person” care that seamlessly addresses individual physical, behavioral and social needs.

This session provides a discussion of Blue Cross PCMH program scope and components, PCMH capability implementation, PCMH program results, and how the PCMH program fits into the Blue Cross Blue Shield of Michigan value-based reimbursement model.

CoxHealth, a six-hospital system in southwest Missouri, spent years trying to follow industry "best practices" to try and reduce its rate of readmissions, but to no avail. Instead, it created a successful readmission reduction program by closely analyzing its own discharge data, identifying high-risk patients and creating a focused, proactive readmissions reduction program in conjunction with local first responders. The result was a double-digit drop in readmission

This session examines novel payer analytic techniques ranging from retrospective data analysis to predictive modeling, that can help health plans and PBMs leverage their data to identify people at high risk for opioid misuse. The role of emerging technologies including virtual care, digital therapeutics, remote patient monitoring, AI and more are explored.

Explore the implications and impact of ACO experience in Medicare ACO performance, in the Avalere study considering the tenure of ACO services in performance, and as a predictor of success; examine the Dobson DaVanzo & Associates study that found MSSP ACOs generated gross savings of $1.84 billion for Medicare in 2013–2015, nearly double the $954 million estimated by CMS; and consider the opportunities and issues involved from CMS proposed regulations regarding telehealth and other non-face-to-face services.

This session addresses how to evaluate the impact of the fiscal year 2019 Inpatient PPS Final rule on your hospital, with respect to coding, payment calculations, reporting measures, legislative and regulatory issues and the longer range implications of price transparency.

This session provides tips for improving member portal experience and utilization; tools that can be added to the website for additional functionality; and ways financial functionality in the member portal can be used to improve the member experience and provider satisfaction.

Highmark's True Performance is a value-based reimbursement program for Primary Care Physicians (PCPs) focused on affordability and quality of health for Highmark members. The program evaluates PCPs' ability to deliver the right care at the right time and in the most appropriate setting, and rewards PCPs for their performance on quality and cost/utilization measures.

This session will provide insights based on the real experience of University of Maryland Medical Systems Health Plan and how UMMS is working collaboratively with hospitals in and out of their network. Also learn how UMMS is enabling those hospitals to look outside the walls of their facilities, by sharing data and the accompanying analysis.

In this session, McKinsey & Company, will share the potential for episode analytics and highlight some of the many ways health plans leverage this intelligence to improve the quality and efficiency of healthcare. Change Healthcare will then share examples of the episode of care data visualizations being using by health plans to identify opportunities across their businesses to improve costs and care quality.

While there are always uncertainties regarding the outcome of any proposed regulation, a deeper understanding of the Pathways to Success program and its implications is essential for stakeholders to best position themselves going forward. This session provides a summary and analysis of the proposed regulation’s key provisions and discusses how they might impact the MSSP.

Having successfully scaled its Enhanced Personal Health Care program, which rewards primary care providers who succeed in delivering patient-centered, value-based care, Anthem is expanding its work to base specialty care payments on quality and efficiency. Anthem’s approach includes multiple programs across both commercial and government-sponsored business, designed to reward specialists for coordination with primary care, as well as for consistently high-quality, efficient care.

An Avalere study found that Medicare Advantage has a higher proportion of patients with clinical and social risk factors shown to affect health outcomes and cost than FFS Medicare; and that despite a higher proportion of clinical and social risk factors, Medicare Advantage beneficiaries with chronic conditions experienced lower utilization of high-cost services, comparable average costs, and better outcomes.

New Deloitte Center for Health Solutions research explores five key findings from analyses of the financial performance of commercial health plans. Deloitte's study focuses on the fully insured commercial group and commercial individual books of business of US health plans. The study uses financial data reported by insurers to CMS according to statutory accounting principles.

The industry is buzzing with exciting words like Machine Learning, APIs, Blockchain and more. This session helps to understand the promise that these and other technologies hold as it relates to solving one of the industry’s greatest challenges: provider data management. Leveraged appropriately these technologies can help automate efforts, create transparency and reduce friction between health plans and providers.

This session explores application of risk adjustment and predictive modeling through brief case studies involving key topics; examines the potential of enhanced models to identify patients with rising risk; and considers the impact and implications of analyzing prescription data to determine future patient costs and serve as predicators regarding opioid abuse patients.

Bob Goodner, a survey team leader and physical environment specialist for DNV GL Healthcare, will share his insights and discuss the aspects of security management and the SVA as this is applied under the National Integrated Accreditation for Healthcare (NIAHO) requirements and NFPA 99. Synjyn Dodd, System Director of Safety, Security and Emergency Management, Emerus Holdings, and Kelly Proctor, Physical Environment Sector Leader, DNV GL Healthcare will also share their insights.

Topics discussed include:

• Reviewing security measures and protocols for hospitals
• Assessing risks for workplace violence
• Enhancing workplace safety
• Conducting a thorough security vulnerability analysis

The spectrum and prevalence of value-based payment arrangements continues to expand significantly. The financial impact of such initiatives can be in the millions of dollars for hospitals and can materially impact practitioners’ reimbursement. In this changing environment, financial models are essential to understand the impact of value-based arrangements.

Compared to the financial performance of US health plans overall, how have government programs fared over the past few years? New Deloitte Center for Health Solutions research explores six trends in Medicare Advantage and Medicaid managed care. This research focuses on information health plans are required to file with the National Association of Insurance Commissioners (NAIC).

Medicaid coverage continues to face challenges nationally amidst funding uncertainties, and program changes advanced by the Trump administration. At the same time, increased opportunities continue to be advanced for value based solutions in serving the Medicaid population.

This webinar focuses on trends in physician enterprise, including market factors influencing medical group financial performance and trends in benchmarking for integrated health systems. The speakers highlight findings from ECG’s 2017 Medical Group Cost and Infrastructure Survey, which identifies comprehensive operating costs and staffing benchmarks for large multispecialty system–employed and foundation-affiliated medical groups across a range of cost categories, staff functions, and operations. Metrics such as investment per physician and cost per RVU/visit are discussed.

The speakers also present case studies for how medical groups can compare themselves to appropriate market benchmarks in order to identify and prioritize performance improvement initiatives.

Specific learning objectives:

• Trends in ambulatory performance improvement
• Factors to consider when benchmarking medical group staffing and operations
• How medical groups can identify functions or areas for performance improvement within their physician organizations

CMS released Comprehensive Care for Joint Replacement (CJR) model results for Performance Year 1 (episodes with start dates between April 1st and September 30, 2016 and end dates on or before December 31st, 2016.) The CJR model is a mandatory bundled payment model in which 799 participating hospitals from 67 metropolitan statistical areas (MSAs) were originally required to participate. Each episode begins with a lower extremity joint replacement procedure, and completes after 90 days post-discharge. There was no downside risk for Performance Year 1, but future years will include downside risk. Going forward, a recent CMS final rule will allow hospital participation in 33 of the 67 MSAs to become voluntary, which will result in fewer participating hospitals in the program.

What are the key healthcare business issues for 2018 that will impact you and your organization, and how can you best position for them? The Sixteenth Annual Future Care Web Summit addresses key trends and also focuses on several important cutting-edge healthcare business topics.

Whole Health System Series: The Whole Health Approach to Clinical Care presented by the Department of Veteran Affairs.

As the prevalence of commercial value based contracts grows, so too does the variability of a provider's overall compensation. In value based contracting, providers are "measured" on certain performance metrics that will dictate ho much they are ultimately paid. In this environment, risk adjustment plays an integral role in determining the provider's "measurement" of financial performance.

Where are Quality Payment Programs established under MACRA headed in 2018? What is the role that Medicare Advantage and other Medicare and Medicaid managed care programs can play in future years of the QPP, and the criteria that such plans must meet to be considered an Advanced APM? What is the CMS perspective for Medicare Quality Payment Programs in 2018?

The Eighth Annual Accountable Care Web Summit features a 90 minute webinar with three prominent national Accountable Care speakers from Catalyst Health Network, the National Business Group on Health and Milliman that will share their spectrum of knowledge to help ACO stakeholders position themselves for 2018.

Additional Tags: contracting, provider network, self-insurance, self-funding, TPA

Based on the ECG whitepaper, this webinar examines market dynamics that are pushing ambulatory surgery to the forefront of the healthcare delivery. Presenters highlight the ways in which health systems are looking at Ambulatory Surgery Center development and joint ventures as an opportunity to partner with physicians and other organizations to effectively implement an ambulatory surgery strategy.

Whole Health System Series: Core Concepts - The Radical Redesign of Health Care

Medicaid can be overlooked in conversations about value-based strategy, but state initiatives can present major opportunities or challenges for health plans and health care providers. ​Many states have been experimenting with Medicaid alternative payment models (APMs) to try to control spending, improve care, and increase accountability within Medicaid and across the health care system. But have any of these models worked? And how might Medicaid initiatives align with the Medicare Quality Payment Program (QPP) established by the Medicare Access and CHIP Reauthorization Act (MACRA) to reinforce value-based care initiatives and drive system-wide change?

As technology, innovation, treatment options and care coordination all continue to advance, the impact and implications of organ and tissue transplant resource utilization becomes even more significant for healthcare stakeholders. Possessing and understanding current intelligence regarding transplant costs, utilization and demographics is critical in this regard.

Reference Pricing is an insurance benefit design that encourages enrollees to favor providers charging low prices for non-emergency “shoppable” surgical procedures, diagnostic tests, and pharmaceuticals. Reference pricing can motivate providers to compete based on price as well as quality, and to pursue cost-reducing innovations.

Additional Tags: Pharmaceutical, contracting, self-insurance, self-funding, TPA

Value-based pharmaceutical contracts, sometimes referred to as risk sharing agreements between pharmaceutical manufacturers and health plans or other purchasers are critical in today’s very complex and costly healthcare marketplace. These agreements allow placement of high-risk, high-cost and often times specialty pharmaceutical products onto purchaser formularies through basing payment on outcomes as opposed to volume metrics.

Additional Tags: PBM, Self-Insurance, Self-Funding, TPA

There has been a great deal of uncertainty in recent months surrounding the use of episode-based payment models at CMS. The voluntary Bundled Payments for Care Improvement (BPCI) models have been operational since 2012, and the mandatory Comprehensive Care for Joint Replacement (CJR) program was implemented in April of 2016 and has hundreds of participants nationally.

The wide spectrum of current stakeholder initiatives to achieve a triple or quadruple aim in healthcare objectives require that the needs and resources involved with chronically ill patients and their families be addressed and supported on the front lines by case managers and social workers.

With the publication of the MACRA final rule in the fall of 2016, CMS gave the healthcare industry a reprieve by allowing providers to use 2017 as a transition year. In June 2018, CMS released its 2018 proposed rule which extends this transition period, but with some important changes. Providers must adjust to avoid a negative payment adjustment and maximize their changes for enhanced earnings. This is particularly the case in complex environments involving multiple tax IDs and a mix of value-based reimbursement methodologies. This webinar is intended for audiences that are already well acquainted with the basic provisions of MACRA and are seeking concrete guidance on how best to respond.

On April 11, 2017, the Physician-Focused Payment Model Technical Advisory Committee (PTAC) considered and made recommendations to HHH regarding the first three application for approval as an Alternative Payment Model (APM) to come before the PTAC. The background and lessons learned by three applicants that day are shared during this interactive webinar: 

• Regarding Project Sonar - Lawrence Kosinski, MD, MBA, AGAF, FACG; Managing Partner, Illinois Gastroenterology Group; President, SonarMD, LLC ; Community Private Practice Councillor, AGA Governing Board; Elgin, IL
• Regarding COPD and Asthma Monitoring Project (CAMP) - Daniel P. Ikeda, MD, FCCP; PMA - Pulmonary Medicine Associates (Pulmonary Medicine, Infectious Disease and Critical Care Consultants Medical Group Inc.); Sacramento, CA 
• Regarding ACS-Brandeis Advanced APM - Frank Opelka, MD, FACS; Medical Director for Quality and Health Policy; American College of Surgeons; Washington, DC
• Moderator - Susan Dentzer; President and Chief Executive Officer, NEHI (The Network for Excellence in Health Innovation); Analyst on Health Policy, The NewsHour; Washington, DC
   

Advanced Strategies in Appropriately Reducing Readmissions in the Context of Bundled Payment Arrangements Case Studies in Cardiac (cardiology and cardiac surgery), Oncology and Orthopedics

Medicaid coverage faces uncertainties nationally as Congress and the Trump administration continue to pursue repeal and replacement of the Affordable Care Act. 

Population Health has gravitated to become a central component of the delivery of healthcare in the 21st century, and takes on particular importance given the evolution towards value based care. It is critical for leaders, clinicians and staff of healthcare organizations to have a vision going forward on how to best incorporate population health into their approach - sharing from insights, innovations, best practices, strategies and experiences from national leaders involved with population health.

With the first performance year for the new Merit-Based Incentive Payment System (MIPS) underway, eligible clinicians must strategize payment implications under the program.

Today’s health care executive is considering many strategies to drive value. How can bundled payments and post-acute care fit into an organization’s future plans? 

The Medicare Access and CHIP Reauthorization Act (MACRA) makes significant changes to the Medicare payment system by introducing a quality-based payment model. 

In this webinar, a framework and metrics for measuring SNF performance is discussed, followed by an exploration of SNF performance levels across the United States in order to provide a quantitative assessment of the opportunity to reduce spending for SNF services through steerage of patients to more cost-efficient SNFs.

Milliman reviews their RAPS to EDS transition study and discuss transition problems and how Medicare Advantage organizations should respond.

Sessions include: Key Healthcare Legal, Regulatory and Policy Issues for 2017; The Employer Role in Healthcare Transformation 2017; and Top Ten Trends for Healthcare Marketing 2017

A state of the art examination of the consumer driven landscape going forward from two national consumerism experts.

Detailed research findings relating to the impact and implications of narrow networks on health plans premiums with respect to the public marketplaces.

This video was created to raise awareness of CDC’s important global health work to protect Americans and save lives.

Results from Deloitte’s 2016 Survey of US Health Care Consumers and Deloitte's study on Realizing the potential of telehealth report on trends in telehealth and consumer interest; with a discussion of the regulatory landscape; and the potential barriers, opportunities, and enablers for telehealth in the coming years.

Sessions include: Five Common Pitfalls in Commercial ACO Shared Risk Arrangements; The Aledade ACO Perspective; and ACOs, Risk, and Paradigm Shifts

In this webinar, ECG’s team of experts will review findings of ECG’s 17th annual Physician Compensation Survey. The session will include our analysis of important physician and advanced practice clinician performance trends from the 2016 survey. A particular focus of this webinar will be on market trends related to value-based provider compensation planning and how those plans integrate with overall organization strategies. As healthcare reimbursement transitions from volume- to value-based, it is essential that physician compensation plans also evolve to ensure organizational success under changing financial incentives.

Discussion of a range of issues and considerations under the final rule implementing Medicare physician payment reforms included in the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”).

Discussion of the risk sharing pricing environment and payment methodologies, the process involved in building your managed care pricing strategy at a service line level as well as across an aligned provider network, and the impact of physician integration on different risk models and payer contracting strategy.

The speakers share their health system population health insights and experiences.

This session builds on the Health Plan Alliance's perspective of the shared experiences, opportunities and challenges faced today by provider sponsored health plans and their integrated delivery systems.

This presentation will review the findings and implications from the survey of executives from hospital/health systems, health plans, biopharmaceutical companies, and medical technology companies, regarding awareness, preparedness, and perceptions about MACRA.

This session will position stakeholders for 2017 and beyond by providing a deeper understanding of the current Medicare environment; an examination of the intricacies of the challenges facing Medicare Advantage plans and networks - especially provider sponsored and regional plans and networks

Explore the dynamics of how MACRA will impact all parts of the healthcare market; the key concepts surrounding how MACRA will impact provider reimbursement; and specific strategies for how both providers, health systems, and health plans can leverage MACRA to its fullest effect to further organizational goals and reimbursement.

A brief overview of the proposed rule, timing for the final rule, and implementation timelines will be discussed, and Implications of the MIPS scoring proposal will be addressed.

An overview of Bright Health's vision, insights, perspectives, experiences, strategies and initiatives as they face the challenges of a start up health plan setting its sights on national presence in this era of healthcare transformation.

A discussion of the state of rural ACOs and their lessons learned, drawing on Caravan Health experience.

A discussion regarding applying risk adjustment to value based payment models.

Sessions include: Five Health Care Trends that will Impact Your Population Health Strategy; Capturing Triple Aim Value Across the Care Continuum in Value-Based Programs ; and Telemedicine and the long-tail problem in healthcare.

A case study in the Delaware Valley ACO's evolving approach.

This session provides an overview of CPC+ program details and examines the new model's implications, strategies and issues for stakeholders.

This session explores the crucial role of diagnosis coding by focusing on the role of certain variables—including carrier size, market share, and market size—on the ACA risk adjustment formula.

This session examines the current bundled payments environment and what successful organizations are doing to position themselves in the new era of payment reform and value-based care.

PwC research and insights on the private exchange value proposition, and the evolution of private exchanges

How and why patient complexity is reshaping care delivery.

A case study of innovation in care for the Medicaid population hrough innovative technology and other initiatives combined with a highly efficient, patient-centered, team-based model of care.

Sessions include: Top Healthcare Trends and Issues for 2016; Key Healthcare Legal, Regulatory and Policy Issues for 2016; and Reference Pricing - Coming soon to a health plan near you?

An interesting review of African-American contributions to American medicine. HealthWatch with Terrance Afer-Anderson

The video describes what an Emergency Operations Center (EOC) is, how it fits within the framework of Incident Management Systems, how it functions and the benefits of establishing one and the importance of routine use in maintaining it.

Sessions include: The Evolution of Accountable Care in 2016 and Beyond; Preparing For Direct Employers Contracts: The Next Business Curve for ACOs; and Eight Essential Keys to Successful ACO Contracting.

In this webinar, ECG’s team of experts will review the findings of ECG’s 9th annual Pediatric Subspecialty Physician Compensation Survey. The session will include our analysis of important physician and advanced practice clinician performance trends from the 2015 survey. A particular focus of this webinar will be on market trends related to value-based provider compensation planning and how those plans integrate with overall organizational strategies. As healthcare reimbursement transitions from volume to value, it is essential that physician compensation plans also evolve to ensure organizational success under changing financial incentives.

ECG’s surveys focus on provider performance trends, including compensation, production, and benefits by specialty; compensation plan design and metrics; recruiting efforts and signing bonuses; CPT code physician profiling; and many other key performance metrics. The 2015 ECG surveys include data from 134 physician specialties and 15 advanced practice provider specialties from more than 110 physician organizations, representing more than 32,000 practitioners. Together, this data contributed to produce our most comprehensive reports to date.

A macro and micro examination of California's Health Insurance Exchange and Market.

A discussion on how Payors can avoid certain problems associated with narrow networks and give themselves a clear competitive advantage by designing high-performing health networks using three criteria.

A discussion of the UMass Memorial ACO case study that other Accountable Care Organizations can consider as they address their specific post acute care issues and approach.

This session examines balancing the constructive use of lifestyle and behavioral data and analytics to slow certain chronic illnesses in their tracks, while making sure that data is not misused.

An examinaation of the myriad of legal, regulatory and ethical considerations that must be addressed in order for healthcare stakeholders to properly leverage Big Data in healthcare, and adopt best practices in data mining.

Components and implications of reference pricing, current use of reference pricing in the U.S., and how reference pricing can be structured on a more widespread basis

Findings from the Deloitte Center for Health Solutions Survey of US Health Care Consumers, and sharing of perspectives, insights and potential stakeholder strategies regarding Public Health Exchanges and Consumer Engagement.

Presentations include: Analysis of Medicaid Managed Care Administrative Costs; The Colorado State Innovation Model, a Case Study; and Fostering Medicaid Accountable Care Organization Development in New Jersey

This presentation provides an outline of ECG Management Consultant's perspective on the significance of health plan consolidation on provider organizations, and the steps they are recommending that their clients take in preparation.

This session will explore demographic changes, readmissions reduction challenges, work force and caregiver issues and successful intervention approaches involved with SCAN Health Plan initiatives to reduce readmissions.

During this session, case examples will be provided detailing how technology has been employed at one health network to facilitate the development of patient-centered medical homes; and telehealth use cases in medical home settings, addressing different modes of telehealth transmission and platforms.

During this presentation, an overview will be given of the key features of the CCJR model. Examples of possible savings opportunities will be provided, and participants will learn how they can estimate the potential effect CCJR will have on their practice pattern and revenue cycle.

This session will address the relevant details of the Medicaid Managed Care Proposed Rule, as well as highlight key implications of the major provisions for stakeholders, and what overall level of revisions might be expected with issuance of the Final Rule.

This session will discuss in detail PwC research findings, expand on individual factors that will "deflate" and inflate components of the medical cost trend for 2016, and address strategic implications for health plans, providers, employers, consumers and other stakeholders.

This session addresses Treasury Department new guidelines for not-for-profit hospitals on how and when to offer financial assistance, and upcoming IRS changes in reporting requirements and scrutiny of both community benefits and patient financial assistance.

Atrius Health's ACO case experience, results, challenges, opportunities, insights, and perspectives as a platform for their Medicare population health strategy.

Discussion of a comprehensive Dual Eligibles study that provides insights into how clinical, sociodemographic and community resource characteristics impact health outcomes and Medicare Advantage (MA) plan Five-Star ratings.

A discussion of applying the principles of population health to improve the health of a large employee population and illustrate the value of a population health driven approach to practicing physicians.

Sessions will include: Population Health Management: Innovations in Risk Adjustment and Predictive Modeling; Risk Adjustment and Shared Savings Agreements; and Connecting Predictive Modeling and End-Users: the Last Mile Problem.

Ths session examines research on the current and historical number of ACOs and covered beneficiaries for Medicare and Commercial categories, geographical representation and access to coverage, along with other Accountable Care data and further insights.

A presentation on Capital BlueCross' Accountable Care approach - discussing their medical value strategy; an overview and history of Capital BlueCross’ value-based programs; detailing their Accountable Care Arrangements model; and sharing data regarding their program outcomes and results.

A discussion of the scope of the controlled substance abuse epidemic and a variety of methods to detect misuse and abuse; the Prime CS Score study, its implications, and opportunities for stakeholders to lightly manage or aggressively manage the problem.

Sessions include: Tools for Managing and Monitoring Population Health for Health Plans and Hospitals; Expanding Access to Diabetes Self-Management Education: The Economic Case; and Integrating Behavioral Health: Essential for Population Health.

Patient Engagement Systems' Benjamin Littenberg, MD, CMO and National Kidney Foundation's Joseph A. Vassalotti, MD, discuss Chronic Kidney Disease & the Primary Care Practitioner: Early Screening and Prevention for the At-Risk Patient. This presentation was an on-demand session as part of the 2015 Population Health Web Summit.

An in-depth look at forward-thinking diabetes management approaches some companies are taking, and ways other employers might integrate innovative elements into their own programs.

An examination of the GRACE Team Care Approach in Managing High-Risk Medicare Populations.

A discussion of the specifics of the provisions that participating ACOs under the Next Generation model will be subject to, as well as further-reaching implications for all ACO stakeholders with respect to the impact the new model will have on the Medicare ACO program as a whole, and the entire Accountable Care movement.

Research findings and lessons learned from a three-year evaluation of a pilot program conducted between 2009 and 2012 with more than 28,000 AARP Medicare Supplement Plan beneficiaries insured through UnitedHealthcare.

The Obama White House: Five years after the Affordable Care Act passed, 30 million young adults can no longer be denied coverage for a pre-existing condition, 105 million Americans no longer have a lifetime limit on their health coverage, and 76 million Americans are benefiting from preventive care coverage.

A presentation on CareSource's innovative persona approach that has transformed their care management for acuity based care coordination using cluster analysis to yield outputs of clinical personas.

A discussion of the National Rural Accountable Care Consortium's 2014 experience of their initial rural ACO, was well as their approach and initiatives going forward.

Results from the Private Exchange Evaluation Collaborative's survey, based on the responses of 446 employers, regarding private exchanges as a strategy for full-time active and retirees, and a national assessment that specifically captures the experience of early adopters of both private exchanges for active employees as well as retirees.

Three expert perspectives on the California Healthcare Environment in 2015.

Sessions include: Top Health Industry Issues for 2015; Key Healthcare Legal, Regulatory and Policy Issues for 2015; and ICD-10 as a Strategic Enabler in 2015.

A discussion of Humana's approach to value-based reimbursement, which involves analyzing practice readiness for participation in value-based reimbursement programs, and determining where appropriate practices might fit along the Accountable Care Continuum.

Follow along and find out what vaccines are recommended for adults.

Milliman insights on key health plan issues pre and post the Supreme Court King v. Burwell decision.

Three prominent Accountable Care speakers share their organizational experience, insights, strategic perspectives and operational knowledge, including presentations on the Providence-Swedish ACO experience with employer driven Accountable Care; Accountable Anesthesia Organizations; and ACO legal, regulatory, strategic and operational hurdles for physicians to navigate.

Betsy Imholz of Consumers Union and Michael O'Neil with Healthcare Bluebook discuss the future of price transparency.

In-depth session on Medicare Bundled Payment PAC Utilization Benchmarking.

Applicable enrollment trends and the outlook for public and private health insurance exchanges.

Lessons learned for ACOs in Maryland.

PwC research, insights and perspectives regarding the continued evolution towards private exchanges including defined contribution approaches.

In-depth session on ACA Plan Sponsor Roadmap regarding Current and Upcoming Compliance Challenges

Issues and considerations that stakeholders need to address regarding ACO consolidation and antitrust issues in the marketplace.

Sessions include: Transforming Medicaid - Lessons Learned; Innovations and the Future of Medicaid Managed Care Contracting; and Medicaid Accountable Care Organization Development and Initiatives.

In-depth session addressing Best Practices in Managing Advanced Illness through Population Health Management.

Three national experts will share their experience, insights and strategies and initiatives in reducing preventable readmissions, including: a discussion on the PACT program; engaging Emergency Departments and Urgent Care for care transitions; and the next phase of hospital readmission research.

An in-depth session on the strategies for success for employer sponsored population health programs.

Employer 2015 medical cost trends and implications for stakeholders

Oliver Wyman research of ACOs at this juncture provides keen insight into the state of Accountable Care at this tipping point. Their research examines the current and historical number of ACOs and covered beneficiaries for Medicare and Commercial categories, geographical representation and access to coverage, along with other Accountable Care data and insights.

Implications of DSH changes for hospitals by area, with details of the mechanics of the new DSH and Uncompensated Care payments, and issues specific to Medicare Advantage plans.

The changing world of reimbursement and the use of quality measurements in provider contracts.

Cigna's Collaborative Care Strategy and results from their collaborative Accountable Care initiatives.

Stakeholder considerations for large employers involving fully-insured group plans as well as private exchange evaluation.

Topics addressed include: (1) predictive analytics research into evaluation of provider efficiency in order to advance techniques for value based provider payments; (2) ways hospitals have used analytics for staffing optimization; and (3) predictive analytics applied to users of a health behavior change program in order to predict future engagement.

Topics include: partnering and creating a culture of health with local employers; ROI analysis and methodology; and decision areas in population health.

The best of consumer engagement innovation during the past 12 months, that organizations should embrace as they move forward; and strategies and insights for healthcare organizations managing their CX journey into the future.

SCAN's initiatives to improve outcomes through patient engagement for their Medicare plan population

Research findings, and implications for stakeholders seeking to improve patient medication adherence and reduce overall costs

Additional Tags: PBM, Self-insurance, self-funding, TPA

Learn about the requirements for a successful multi-stakeholder cooperative care model to reduce readmissions, including Collaboration and Clinical Outreach and Care; Business Sustainability; and Employee Communications and Outreach.

Topics discussed include: How new ACA enrollees are being absorbed by ACOs and other provider networks; How health plans are dealing with enrollment administrative issues; How California compares to the rest of the country; Changes to the safety net; and The challenges ahead.

Results, lessons learned, challenges and implications of WESTMED's and UnitedHealth Network's ongoing Accountable Care collaboration.

Innovative research findings, and implications for stakeholders in the new public and private health insurance exchange environment

Tenet's Accountable Care initiatives supported by Conifer Health Solutions, and the implications of these initiatives.

Insights and perspectives on the top health industry issues for 2014; results and stakeholder implications from the 2014 Segal Health Plan Cost Trend Survey; and a discussion of collaborations between health systems as the strategic impetus for the formation of clinically integrated networks.

Known regulatory and market changes impacting estimates, and techniques and approaches for adjusting morbidity assumptions in the absence of claims data, so that plans can take advantage of data sources to gain some perspective into future pricing

National Center for Immunization and Respiratory Diseases (NCIRD) - By vaccinating them according to CDC’s recommended schedule, parents can protect their babies from 14 serious diseases before they turn two years old.

Sessions include: The Journey to Physician Gain-Sharing Success; Legal Issues Arising Out of the Operation and Expansion of ACOs; and Actuarial Perspectives on ACO Provider Payment Rates.

Key research findings from two respective studies regarding healthcare social media activity.

Northeast Business Group on Health report based on a collaborative examination by 15 executives from large employers and health plans and highlighting approaches employers are taking to tackle the high cost and serious health issues stemming from obesity, and the keys to making programs more effective in the future.

PwC's HRI Health Exchange research and assessment of stakeholder positioning and recommended strategies going forward at the "opening bell" juncture for public Health Insurance Exchanges.

Discussion of the American Psychiatric Foundation's Partnership for Workplace Mental Health initiative regarding their free worksite education program that enables employers to raise awareness about depression and increase help-seeking behaviors.

Insights, perspectives and detailed research findings from ReviveHealth's Exchange Rates Survey, and the implications for stakeholders

The Kentucky Health Cooperative shares insights, perspectives and experiences on their organizational development, challenges, marketplace environment and key issues going forward.

Results and implications of SAI Global's Health Insurance Compliance Benchmark Study.

Sessions include: Avoid Readmissions through Collaboration - The ARC Initiative; Reducing Readmissions at UCLA: A Collaborative Approach; and Readmission Rates and the Robotic Operating Room Computerized Checklist.

Booz research and perspectives on the unfolding environment, employer segmentation, strategic considerations and stakeholder implications regarding payor participation in private exchanges.

Employer 2014 medical cost trends and implications for stakeholders.

Critical marketplace insights, perspectives and strategies for healthcare organizations to shift from a B2B to B2C model.

Sessions include: Predictive Modeling Opportunities, Issues and Implications from Richer Data Streams via EHR and Other Sources; Medication Adherence Interventions: using predictive modeling and risk stratification to target and improve program efficiency; Protons Don't Smoke - A unified theory for biologic science - in the context of big data in healthcare.

How WellSpan Health successfully transitioned a virtual SuperUtilizer Pilot to a dedicated Ambulatory Intensive Care Unit model, and perspectives on other SuperUtilizer programs and state initiatives.

Detailed provisions and stakeholder implications of CMS FFE guidance.

HealthPartners' strategies, initiatives, results and perspectives for success in the readmissions arena.

Key financial and operational considerations for providers to evaluate participation in exchanges.

Aetna initiatives, experiences and perspectivesto improve the coordination of care for Medicare Advantage members.

This session connects the dots between the issues of Medication Adherence, Readmissions Management and Predictive Analytics; providing insight into the correlation between medication adherence and readmissions; the application of predictive models for medication adherence; and the implications for improving outcomes, efficiencies and performance in a variety of care settings.

Detailed study results and an in-depth exploration of the Diabetes Health Plan case experience, performance and structure.

Essential Health Benefit and State Benchmark Plan requirements, guidelines and process, and findings from Milliman's analysis of state variability in benefits.

Descriptions of the currently uninsured population, where they may be getting coverage under different scenarios, their health status, the impact to Medicaid plans and the Exchanges, and how to design risk adjustment to reflect their unique characteristics.

Sessions include: The race to 2014 - health reform and the 30 million newly insured; Employer Health Benefit Trends for 2013; and 2013: The ACO Surprise

TeamSTEPPS is a teamwork system designed for health care professionals developed by Department of Defense's Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality

National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) - short piece: CDC works around the world 24/7 as our nation’s front line of defense from health threats. 

TeamSTEPPS is a teamwork system designed for health care professionals developed by Department of Defense's Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality.

Sessions include: Evolving Toward the Accountable Future: Aetna's Accountable Care Vision and Collaborations; Cigna National Collaborative Accountable Care Strategies and Initiatives; and How to avoid the mistakes of the 2010s - pitfalls of risk-based contracts, the importance of data and how to strategize to be a successful ACO

Expert discussion and analysis of the policy and regulatory implications of the 2012 elections, with time allotted for questions and answers.

Marketplace intelligence, insights and perspectives based on a Booz research including a study of more than 500 employers and 300 consumers regarding interest in private exchanges.

Detailed results from Healthcore's hallmark PCMH research findings and experiences.

Will Fox of Milliman overviews the concepts and issues involved with Transparent Cost Networks including provider pricing and contracting and consumer selection, and how the Networks could work. This presentation was made as part of the 2012 Consumerism Web Summit.

This session presents detailed findings and analysis of PwC's 2011 HIX report, Change the channel: Health insurance exchanges expand choice and competition. It outlines the key strategic considerations for insurers as they gear up for participation in health insurance exchanges, including the impact of various exchange models on their business. Each state has flexibility in how to design and operate an exchange, which could mean dozens of variations in exchange models across the country. The differences could make some exchanges profitable for some insurers but not for others, and insurers will need to decide which ones they will enter. Join PwC's Serena Foong and Shannon Smith as they discuss PwC's HIX report in depth, address strategic considerations for stakeholders, and tackle your specific HIX questions.

This lecture highlights the pivotal role of testing in HIV prevention and treatment, presented as part of CDC HIV/AIDS 30 Years: Commemoration Activities.

A discussion of the legal, regulatory, policy, fiscal and operational implications for ACOs, their sponsors and other stakeholders regarding the Medicare Shared Savings Program Proposed Rule:

A presentation on 2010 HSA (Health Savings Accounts) market statistics and trends, made during the 2011 consumerism Web Summit

This video explains the many factors that have contributed to the obesity epidemic, and showcases several community initiatives taking place to prevent and reduce obesity. 

The 2010 Accountable Care Web Summit included three faculty presentations:

• Piedmont Physicians Group Accountable Care Pilot Program - James C. Sams, MD, Medical Director, Piedmont Physicians Group
• The ACO Legal and Regulatory Environment: An Update for 2011 - Doug Hastings, Chair of the Board of Directors, Epstein Becker & Green, P.C.
• ACO Payment and Contracting Issues for 2011 - Terri L. Welter, Principal, ECG Management Consultants, Inc.

Why do presidents use so many pens to sign legislation? White House Staff Secretary Lisa Brown explains.with the signing of the Affordable Care Act by President Obama.

Documentary: In 1918-1919, the worst flu in recorded history killed an estimated 50 million people worldwide. The U.S. death toll was 675,000.

National Center for Immunization and Respiratory Diseases (NCIRD) - Stopping serious diseases before they start is what Vaccine Scene Investigation is all about. 

Overview of key trends presented by speakers during the 2006 Future Care Web Summit

Key trends and issues facing the business of healthcare in 2005. Presented during the 2005 Future Care Web Summit.

Drawing on the NLM's library of oral history transcripts and video interviews specifically focused on Health Services Research (HSR), this combines narrative with interviews to document the evolution of HSR

In an interview with Frank McGee on the "Today" show, Dr. Russell B. Roth, president of the AMA, outlines objections to the NBC television special, What Price Health? 

Narration regarding the signing of Medicare legislation in 1965

1955 Encyclopaedia Britannica Films: Narrated discussion of causes of treatment of tubercular infection, and tuberculosis as a social phenomenon, including footage of hospitals and clinics.

Dramatized history of industrial medicine in first half of 20th century, sponsored by General Motors. Produced by Jam Handy Pictures. (Part I)

Dramatized history of industrial medicine in first half of 20th century, sponsored by General Motors. Produced by Jam Handy Pictures. (Part II)

Dramatized history of industrial medicine in first half of 20th century, sponsored by General Motors. Produced by Jam Handy Pictures. (Part III)

Historical vocational film about careers in nursing

Full length movie: Lew Ayres is Dr. Kildare, Lionel Barrymore is Dr. Gillespie, and Lionel Atwill is Paul Messenger. The story is by Max Brand..

(1932) Dr. William H. Welch, First Professor of Pathology at The Johns Hopkins University, recounts his career in medical sciences and discoveries and developments in the field. Published by Films of Commerce, Inc.

1909 Silent film written and directed by D.W. Griffith. A doctor leaves his sick daughter to assist a neighbor that is gravely ill, and ignores his wife's requests to come home and take care of his own daughter who is getting worse. The cast includes: Kate Bruce as Poor Mother; Adele DeGarde as Poor Mother's Sick Daughter; Gladys Egan as Edith Harcourt – Daughter; Rose King as Maid; Florence Lawrence as Mrs. Harcourt; Mary Pickford as Poor Mother's Elder Daughter; Frank Powell as Doctor Harcourt