Cora Opsahl’s Post

See Cora Opsahl. She has her healthplan data and through analysis can reduce waste and build a better healthplan. She also gets asked to testify to Congress because she has her data. Cora Opsahl and Ana X Talamas, MPH recently reviewed these concepts with Finance and HR leaders from The OrthoForum so we can use our data effectively. Do you have your data like Cora Opsahl? Everyone needs their plan data. Be like Cora Opsahl.

Excited to see the trio of federal releases today around SDOH and health equity. https://lnkd.in/eR26ZqfP "Collaboration with community partners, including in planning and advisory councils, can break down traditional silos, expand perspectives, and generate new insights by bringing together individuals with unique expertise, including lived experience, across multiple sectors to identify the needs and resources of a community, develop shared goals, and create and implement innovative, community-based solutions." #SDOH, #HRSN, #HHS

The Affordable Care Act (ACA) sets an annual out-of-pocket maximum for health plans covering essential health benefits (EHBs). This limit ensures that once reached, enrollees are not responsible for additional cost sharing for EHBs for the rest of the year. The ACA's out-of-pocket maximum protects against significant health expenses, reducing the risk of medical debt or bankruptcy. Learn more about this important aspect of ACA compliance in our Compliance Overview. https://bit.ly/4aFHAMW

Health Insurers & Housing Health insurers are increasingly investing in affordable housing, recognizing its impact on overall health. In 2023, UnitedHealthcare committed over $500 million towards affordable housing projects, supporting more than 20,000 units nationwide. Similarly, Kaiser Permanente invested $200 million in community health initiatives, including affordable housing, aiming to reduce homelessness and improve health outcomes. Studies show stable housing can reduce healthcare costs by 12% and emergency room visits by 18%.

This is important and cannot be understated. It also allows for managed care plans and others to move more quickly to operationalize inclusion of #CHWs in the delivery system at the community level. Precedent setting 👏🏼 Check out our latest blog by Mary Hunt Moore #healthsystemschange

💰 New Policies Target Private Equity in Health Care Evidence shows that hospitals, nursing homes, and physician practices controlled by #privateequity firms charge more and may even compromise quality of care. The pending bankruptcy of the Steward Health Care System in Massachusetts highlights how private equity’s rapid growth can threaten the availability of health care services in local communities. A critical question is whether policy interventions can moderate the growth and behavior of private equity–owned health care organizations. In an opinion piece for the Milbank Memorial Fund, health economist Richard Scheffler and health policy expert David Blumenthal, M.D., offer their perspective on recent state and federal regulatory efforts and the potential of this policy push to address concerns over private equity’s role in #healthcare.

Refresher: Washington State Partnership Access Lines Program (WAPAL)   While the WAPAL has been in operation for over a decade, the fee to fund the program was not established until 2020. The WAPAL requires reporting for both fully insured and self-insured health plans covering Washington residents and a covered lives assessment fee for major medical coverage. Washington uses the fee to help pay for four different state-organized psychiatric assistance programs.   This Alert addresses which entities are responsible for reporting and payment, the covered lives assessment fee, submitting the report and payment, applicable due dates, and related information. It is relevant to any employer providing health coverage to Washington residents, but it is most relevant to employers sponsoring self-insured health coverage.

🏥 This is a powerful article that brings up a pretty valid point for anyone in healthcare... #SDOH initiatives remain popular because they enable states and organizations to access substantial federal healthcare funds that would otherwise be less available for social services. However, to truly make an impact, the quality of research supporting initiatives to tackle social determinants of health (SDOH) needs significant improvement. Many studies on non-medical drivers in patient outcomes lack proper experimental controls, randomized controlled trials, and the ability to track impact over time. While SDOH interventions reflect a desire to tap into abundant federal healthcare funds, particularly Medicaid, expanding healthcare programs to cover non-medical services will not significantly reduce healthcare costs or effectively address social issues. Policymakers should resist expanding Medicaid for non-core benefits and avoid placing the responsibility for SDOH on healthcare providers. Effective social policies should be developed and funded independently of the healthcare system to ensure resources are allocated where they are most needed. By doing so, we can address social issues more effectively without burdening healthcare providers with tasks outside their expertise. 🗣 I would love to hear your thoughts on this in the comments below. #patientcare #healthpolicy #healthcareinnovation #healthcarefunding #patientadvocacy #healthequity

Here is a terrific take from Joseph Betancourt on the trends in health care and how The Commonwealth Fund is bringing data and expertise to understand the impacts--good and not so good. In the midst of all this change, the PCC strives to ensure the voices of people--patients, clinicians, community leaders--are heard and able to shape they system to produce better health outcomes for all of us. https://lnkd.in/e9UxeXtZ

In an era marked by advancements in healthcare, it's disheartening to witness persistent disparities in health outcomes. These disparities are often rooted in socio-economic factors that create barriers to accessing quality care. Defining Health Equity Disparities ✔Understanding the Scope: A comprehensive look at the various dimensions of health disparities, from access to care to health outcomes. ✔The Role of Social Determinants: Delving into how factors like income, education, and housing contribute to health disparities. Unraveling Financial Barriers to Healthcare ✔The Cost of Wellness: Examining the financial burden of healthcare, including out-of-pocket expenses, insurance coverage, and medical debt. ✔Hidden Costs: Shedding light on indirect expenses such as transportation, childcare, and lost wages due to illness. The Power of Financial Advocacy ✔Empowering Patients: Exploring how financial advocates provide individuals with the tools and resources needed to navigate the complex healthcare system. Community Outreach and Education ✔Raising Awareness: Discussing the importance of educating communities about available resources, financial assistance programs, and preventive care. ✔Promoting Financial Literacy: Empowering individuals with the knowledge to make informed decisions about their healthcare and finances. Visit us to know more: https://lnkd.in/d9Kv6R2R For Service call: + 1 864 650 6400 or, [email protected] #health #publichealth #qualify #copay #healthinsurance #insurance #deductible #financialadvocacy #healthcare #medicare #health #coinsurance #doctorvisit #insuranceclaim #medicalinsurance #medicalbilling #healthbenefits #baddebt #financialsupport #supportServices