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Several states (CA, OR, MA, NC, AR) are making progress in leveraging Medicaid 1115 Waivers to address the social (drivers) determinants of health (SDOH). We created an infographic to capture 4 Trends and 4 Untapped Opportunities. If you want to discuss how you might implement some of these ideas, we are offering a free two hour consult. Feel free to reach out. #SDOH #healthcareinnovation #interoperability #healthequity

Health equity is about supporting a fair and just opportunity for everyone to achieve health. It’s foundational to a just health care system. But payers and providers in fee-for-service contracts may find it difficult to move the health equity needle. The vast majority—between 80% and 90%—of health outcomes are driven by factors occurring outside the health care system. Value-based care contracts take this into account by incentivizing payers and providers to unite in support of better health outcomes—which necessarily means honoring the unique non-health care factors that contribute to patient health. Fee-for-service contracts don’t do that. They incentivize non-patient stakeholders to leverage patient interactions as vectors for payments. That’s reductive, harmful, and a proven way to perpetuate inequities. Value-based contracts represent a critical step on the journey toward health equity. #valuebasedcare #healthequity

Health Plans Now Presume Their Value There is a disturbing trend in Value-Based Care (VBC). Health plans are simply declaring their value and not waiting to measure it. Take Main Street Health—they boldly proclaim they are “a value-based healthcare company.” This may be clever marketing, but VBC is based on the idea of measuring healthcare costs and clinical outcomes to prove value for a given population. Kaiser Permanente likes the path chosen by Main Street. They have a new subsidiary, Risant Health, into which they have just placed a new acquisition, Geisinger Health, and they proclaim this to be the creation of a VBC organization. You may have thought VBC was a method of contracting, but health plans have deemed “value” to be a label too enticing to wait for the proof. United is not being left out of this. Their Optum division boasts of a new behavioral health paradigm called “value-based provider enablement.” In a white paper, they claim to have more than $650 million invested in VBC for behavioral health today. One must guess at the basis for such a large number when it is commonly known that VBC has barely penetrated behavioral healthcare. We have been waiting for VBC to replace fee-for-service care. This corruption of the value concept may ultimately bring VBC’s early demise. Why contract for value when you can simply decree it? #valuebasedcare

I read a post last week that has been gnawing at me ever since. The last line: "We are who we have been waiting for." The time for waiting is over. The first thing that struck me about this post (linked in the Comments) is that the author, Sachin H. Jain, MD, MBA, is the President and CEO of a Medicare Advantage health plan and senior-focused healthcare and home health organization. This is a role in a type of company most think of as part of the establishment, a protector and advocate for the status quo. What's simultaneously inspiring and discouraging is that Dr. Jain seems to be a one-off. It's rare to the point of unicorn territory to find an "insider" in a company leadership role who publicly advocates for a cultural revolution in the healthcare industry. It's rare to find someone in an establishment leadership role who publicly acknowledges that our healthcare system is broken and advocates for leaders of healthcare organizations to be primary change agents rather than guardians at the gate propping up a crumbling house of cards. Dr. Jain posits that "given the industry’s massive size and scale—I believe working from within may be the only way to create meaningful, scaled change." To that, I would say yes, and... We most certainly need more leaders like Dr. Jain who clearly care about the role of leaders on the inside of healthcare to create meaningful, scaled change. The "and" that I would add is that meaningful, scaled change requires a collaboration between insiders and outsiders. In the outsiders group, I would include patients, family caregivers, community health advocates and so many other constituencies affected by the dysfunction in our current health system. I would even go so far as to include doctors, nurses, and other care providers who are made to feel like outsiders trapped in a terribly flawed model not of their own design and often antithetical to what they have been trained to deliver and what they know to be in the best interest of their patients. To Dr. Jain and others who are committed to working from the inside to create meaningful change at scale, I would invite you to join insiders and outsiders who are working together in the Healthcare Reinvention Collaborative to connect, collaborate, amplify, and accelerate the progress and initiatives that can facilitate the change we all know we need and that we are all pursuing. "We are who we have been waiting for." #healthcare #reinvention #collaboration #changemakers

"The rules around being a payer in this environment are changing, and that's a good thing." In the next episode of our exclusive Payer's Place interview series in partnership with MedCity News, we sat down with Shantanu Agrawal, Chief Health Officer at Elevance Health, to discuss how the company is working with community-based organizations to achieve health equity. Watch the full conversation 📺 https://ow.ly/MCae50PZQcY #healthequity #healthcare #healthcarepayers

ICYMI On April 8th, the Brookings Center on Health Policy hosted the 28th "Wall Street Comes to Washington" healthcare roundtable. This annual event brings together equity analysts who share their expertise & insights in U.S. health systems, provider organizations, and hospital markets. These panelists deftly unpack the complexities of cross-vertical market factors and health industries. The group discussion, moderated by Paul Ginsberg, MD, covered a wide range of topics incl. trends in policy, resource utilization, reimbursement (by hospital setting), payers, employer sponsored plans, Medicare, MA/Medicare Advantage, finance/M&A and technology. #healthcare #healthpolicy #hospitals #healthsystems

Consolidation of hospitals has changed the health care landscape in communities across the country. More and more community hospitals are becoming a part of larger systems, and more and more physicians are in practices owned by hospitals and health systems. Consolidation creates opportunities for efficiencies but a substantial body of evidence shows it often leads to higher prices and health care costs, with no clear impact on quality. NEW: https://lnkd.in/gi2cknPs

“It's all about using the payment structure to be able to deploy resource in a different way and go upstream. And we continue to learn how to do that in a more and more effective way.” Listen to what Intermountain Health CEO Rob Allen had to say about how value-based care models are creating alignment between providers, payers, and community partners to better serve patients. https://lnkd.in/guuHRxs2 #futureofhealthcare #valuebasedcare #populationhealth

As the leader of engagement at apree health, I have seen firsthand the power of Care Guides and their ability to help people navigate the healthcare system. This incredible team helps people, who don’t know what the next best action for their health should be, and takes them by the hand to make sure they get the right care at the right cost. When we think about US healthcare, and the burden it puts on Americans to figure it out on their own, this solution at scale will be a game changer for driving better health outcomes and a lowered cost of care for consumers. #healthcare #healthcarecrisis #patientengagement

"We, payers and providers, must learn to speak a common language by defining shared terms, objectives, and most importantly, fostering open dialogue. If we can do this, we can align on what truly matters: the health and wellness of patients, members, and communities.” – Providence Health Plan President and CEO Don Antonucci. Through partnership and open communication, health plans can support providers as we work toward our common goal: easing the way for patients and helping them live healthier lives. Don discussed how it’s possible with #ValueBasedCare in a conversation with HealthPayerIntelligence at AHIP 2024. Check out the full article: bit.ly/3XQwFfU