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Last year, CMS announced changes to Medicare Star Program measures, which raised the threshold for obtaining high-star ratings and signaled an increased focus on health equity. Is your organization ready? Here are four actionable ways to maintain or increase star ratings in 2024 and beyond.  ... #healthequity #starratings #medicareadvantage

A proposed CMS rule mandates #MedicareAdvantage plans to incorporate health equity into utilization management activities. Health plans can prepare by embracing data and integrating equity into their operational fabric: http://bit.ly/3RWS4zA   #healthplans #healthequity

Health is not just about individual choices or medical interventions. It's influenced by the social and environmental conditions we live in. Social Determinants of Health (SDoH) encompass various domains that impact our overall well-being. Education Access & Quality, Economic Stability, Social and Community Context, Health Care Access & Quality, and Neighborhood/Built Environment are the key domains within SDoH. Each plays a vital role in shaping community health. To address the significance of SDoH, the Centers for Medicare and Medicaid Services (CMS) have proposed the CY 2024 Medicare Physician Fee Schedule. This rule aims to enhance healthcare providers' ability to manage patients with social risk factors and improve health outcomes. In our latest article, we shed light on the importance of SDoH and advocate for the integration of SDoH considerations in provider/payer contracts. By appropriately compensating providers for managing patients with social risk factors, we can drive better health outcomes and reduce the total cost of care. Read it here> https://lnkd.in/gy4m4vdH #OWActuarial #SocialDeterminantsOfHealth #ManagedMedicaid

Thanks for this share, Tammy Clouse Tomczyk, FSA, MAAA, FCA. As we continue to emphasize the #need and #value of improving the integration of #SDOH into the #payment side of #HealthInsurance, it's incredibly important that all #stakeholders stay involve and aware of the #impacts and #outcomes. #PublicPolicy #ImprovingOutcomes #CollaborativeSolutions

Health disparities persist due to various factors beyond individual control. Social Determinants of Health (SDoH) encompass the environmental and societal conditions that significantly impact health outcomes and community well-being. Education Access & Quality, Economic Stability, Social and Community Context, Health Care Access & Quality, and Neighborhood/Built Environment are the key domains within SDoH. Addressing these domains is crucial for achieving health equity. In our latest article, we emphasize the importance of integrating SDoH considerations into provider/payer contracts. By appropriately compensating providers for addressing social risk factors, we can drive better health outcomes and foster healthier communities while reducing healthcare costs. Read the latest article here> https://lnkd.in/gV9iki7h #OWActuarial

Excellent article highlighting the importance of capturing SDoH. Not only must organizations consider how to capture the information, they also need to address how the information will be codified (ICD-10-CM) and reported downstream to ensure visibility.

What if i told you that traditional methods of predicting healthcare expenditures are much less accurate for those in lower income brackets? Our Oliver Wyman Predictive Insights (PI) group has partnered with Healthwise data to prove how risk predictions can be greatly improved when adding SDOH data! Exhibit 3 in this article is eye-opening.

2024 brought new HCPCS codes that Medicare, Medicare Advantage and some 3rd-party Commercial plans that they will now pay for. One of those codes is the G0136; that is the Social Determinate of Health (SDoH) assessment. It is not an add on code, but a stand-alone assessment. G0136 defined as “Administration of a standardized, evidence-based Social Determinants of Health Risk Assessment, 5-15 minutes, not more often than every 6 months.” Again, G0136 is not a screening tool that should be used on all Medicare patients at office visits or annual wellness visits. It is an assessment, not a screening. The assessment is performed at a visit after the physician/NPP has seen the patient and decides that it is necessary. And, if problems are found, follow-up is required.

Health equity means every patient has a fair opportunity to attain the highest level of health possible. To achieve this, stakeholders must work to address social determinants of health and health disparities among the populations they serve. As the industry shifts from fee-for-service to value-based care, incorporating health equity into alternative payment models (APMs) can help patients receive more equitable care. Edifecs https://lnkd.in/dzBk-8Wp