Alan Fabian

Exciting times at 4C Digital Health! Wilmington, Delaware - 4C Digital Health (4C), the preeminent organization delivering independent financial oversight and control solutions for self-funded employee health plans, recently announced the strategic expansion of its services into the Commonwealth of Kentucky. In late 2023, 4C successfully competed for an initial award issued by Kentucky’s Department of Employee Insurance, and Kentucky has since extended the initial contract to allow 4C to continue its important work on behalf of the Commonwealth, its employees, and its taxpayers. The Kentucky Employee Health Plan (KEHP) serves more than 288,000 members, which amounts to 1 in 16 Kentuckians. In addition, KEHP spends over $1.8 billion dollars in total healthcare benefits on behalf of its members per year and covers over 8.2 million claims per year. KEHP objectives include “improving employee health and well-being” and “providing state-of-the-art benefits while maintaining reasonable premiums.” Recognizing its important fiduciary responsibilities to its employees and its state health plan, the Commonwealth of Kentucky enacted Senate Bill 42 (2023) introduced by Senator Stephen Meredith for the purpose of ensuring that critical health plan dollars are being spent properly on behalf of state employees. The legislation requires that 4C analyze 100% of medical claims submitted for payment to KEHP; identify erroneous overpayments; and identify inappropriate or erroneous fees imposed by KEHP’s third-party administrator. Ron Templeton CEO of 4C Digital Health stated: “4C Digital Health is grateful to the Commonwealth of Kentucky for recognizing the fiduciary responsibility that state and local governments have to their employee health plans and for the opportunity to provide our services in support of this mission. We appreciate Kentucky’s goal of using 4C’s expertise and innovative solutions to improve healthcare outcomes and reduce healthcare costs for the Commonwealth, its employees, and its taxpayers.” About 4C Digital Health: 4C Digital Health (https://lnkd.in/eB-fJg4X) is a healthcare data analytics company that was founded for the purpose of developing a disruptive technology targeted at bringing transparency and honesty to the healthcare marketplace.

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🚨 Update on Baptist Health and Florida Blue Negotiations 🚨 Negotiations between Baptist Health and Florida Blue are ongoing and remain tense as the September 30 contract deadline approaches. Discussions have been underway since February 2024, but no agreement has been reached. The core issue is payment rates: Baptist Health seeks increases to cover rising costs, arguing that current rates are below market, while Florida Blue contends that these demands are excessive and significantly above inflation. With the potential for Baptist Health services to become out-of-network for Florida Blue members on October 1, many patients in Northeast Florida are left uncertain about their healthcare options. Both sides are committed to finding a resolution, but time is running out. 🔗 Sources: Action News Jax, Baptist Health, Health News Florida

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Purchased services are vital to healthcare, but they can also become financial drains if not managed properly. A mature purchased services strategy includes insight into all expenses, reduction in unnecessary variation, and prioritized patient care, outcomes, and experience. By focusing on these areas, health systems can lower costs, improve clinical care, and enhance patient experiences. Learn more in Advantus Health Partners article about how to create a mature purchased services strategy: https://lnkd.in/g4UwCjCW #HealthcareSupplyChain #ValueBasedCare #SupplyChainManagement

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🌟 Whether you’ve determined now is the time for you to begin the process toward FACHE or you’re still deciding, the next stop on your journey is our FACHE Overview Webinar. This webinar is free for you to attend but it requires registration. Learn more and save your place here: https://bit.ly/3MkxxT8

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This Thursday the Energy and Commerce Committee will hold a hearing on the Centers of Medicare and Medicaid Improvement (CMMI). Members of the Committee are expected to raise concerns and praise for the agencies' efforts to test and achieve savings in value-based payment models over the years. Since its inception in 2010, CMMI has tested many new payment models including bundled payments, multiple accountable care organization offerings, and the making care primary model. The agency continues to face challenges, such as finding ways to engage rural providers and solo or small physician specialty practices. Reps. Michelle Steel and Susie Lee and Sens. Markwayne Mullin, Kyrsten Sinema and Thom Tillis introduced the EASE Act (HR 7149 / S.4078) to encourage CMMI to create a new payment model for rural and underserved communities to reduce long wait times that many seniors and residents face in these communities when seeking care from a specialist. The bill was developed based on years of data collected and reviewed by OCHIN to help community health centers and rural hospitals improve care integration and create a new value-based payment model. While Congress looks for ways to improve outcomes and reduce costs; and medical schools continue to look for ways to grow the physician workforce, one pathway that would fill the needs of communities (especially rural areas) and prevent avoidable hospital admissions is the EASE Act which looks to utilize telehealth or e-consults to help our most vulnerable populations receive timely care

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Are you prepared for the coming additions to The Centers for Medicare and Medicaid Services (CMS) Medicare Advantage (MA) Star Ratings Measures? Beginning January 1, 2025, CMS is implementing additions and changes that will impact 2027 Star Ratings. MA Plans and providers must ensure they are fully prepared to identify beneficiaries for which these new measures apply and develop strategies to address their care needs — and time is ticking. Learn more: https://lnkd.in/eee7bAvu #FTIHealthcare Key Contacts: Mark Van Ert and Krunal Patel

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Centers for Medicare & Medicaid Services 2023 ACO REACH Model results highlight substantial progress in improving healthcare access, quality, and equity for underserved populations. By fostering collaboration and reducing costs, the model delivers positive outcomes for Medicare beneficiaries. However, challenges remain, such as care coordination complexities and the financial burden on smaller providers. Discover how Ensure Data Solutions can support your ACO REACH initiatives with our powerful tools—ENSUREQUAL©, ENSUREXCHANGE©, and ENSURECM©—designed to streamline operations, optimize care, and improve financial and clinical performance. Learn more today! ⤵️

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Full Medicaid expansion needed to retain Georgia’s physicians Georgia was ranked 5th worst place to practice in a recent Medscape article (“Best and Worst Places to Practice 2024”), using five criteria: physician compensation, cost of living, malpractice premiums, the health of the state’s residents, and physician burnout levels. As current and future physicians and health advocates, this column will add context by detailing our experiences practicing in Georgia. It is no surprise that three of the five worst-ranked states for practicing are among those that have not expanded Medicaid. In Georgia, refusal to expand Medicaid means that nearly 12 percent of residents (well over a million people) are uninsured, significantly limiting their access to healthcare. Only in Texas is coverage worse. Due solely to political concerns, Georgia chose to submit a Medicaid waiver and develop its own Medicaid expansion program, Pathways to Coverage. The governor’s office projected that the program would cover an additional 100,000 Georgians in its first year. But it has been an utter failure, with fewer than 3,500 covered at a cost to taxpayers of $26 million. Full Medicaid expansion would have added over 350,000 Georgians while cutting state spending by $710 million. These three states that refused to expand Medicaid are not surprisingly red. It is also unsurprising that the states with the greatest percentage of unhealthy residents are red. Hopefully, Georgia who thought they had a better way of expanding access to care with their own plan that squandered $26 million to cover 3,500 residents will realize that retaining physicians requires a more sensible approach to expanding access to care. #expandinghealthacess, #accesstocare, #limitingcoveragetoresidents https://lnkd.in/eefqH-9Y

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As announced in the CMS Proposed Rule for CY 2025 Outpatient Prospective Payment System released in July 2024, the ON-Q device is proposed for approval under the NOPAIN Act and to receive a unique code eligible for separate payment effective January 2025. This would mark the first time that the ON-Q® device would qualify for separate payment. Learn about NOPAIN: https://ow.ly/T9NQ30sHjnm #PainManagement #NOPAINAct

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Perfect way to mange the revenue cycle

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💡Interesting recent stat from Beckers! A consistent (3% to 5%) margin of revenue opportunity is lost due to the complexity of documenting and coding for complex inpatient cases. This uncaptured revenue is significant to a hospital's bottom line, with a 5% loss in a mid-size hospital potentially equaling $22 million to $38 million in lost revenue annually‼️ MDaudit can help with our Hospital and Coder audit workflows. Check out this short demo!

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Randy Sites, MBA and Arnab Sen discuss shifting from a retrospective approach of denials management to a proactive strategy of denials prevention in this webinar…the link to hear more is below!

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➡️ Whether you’ve determined now is the time for you to begin the process toward FACHE or you’re still deciding, the next stop on your journey is our FACHE Overview Webinar. This webinar is free for you to attend but it requires registration. Learn more and register here: https://bit.ly/4fVBYRC

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Living in GA and realizing the distance from key facilities in Atlanta, it raises questions about the value of investments. Could the focus be better on optimizing existing resources like Wellstar's facilities? Additionally, with healthcare professionals leaving rural areas, the staffing challenges for new hospitals come into question. #Healthcare #Efficiency #Investment #IHOPTIMIZE

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Hospital and Health System Transactions The volume of announced transactions grew significantly in Q3 2024. With 27 announced transactions, Q3 had the highest level of activity thus far in 2024 and in line with pre-pandemic activity levels. Announced sales resulting from the Steward Health Care bankruptcy represented a significant amount of this volume, with 11 of the 27 announced transactions involving Steward hospitals.

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Aspen Medical Products is becoming the clear leader in pain management bracing. Each year, more pain management providers exclusively trust Aspen over all other brands when choosing bracing as a conservative treatment modality. That’s because there is a significant difference in the way their products are designed, engineered, and delivered. If you’re in the Huntsville, Alabama area and want to learn why Aspen is different, please consider attending this education seminar. Dr. Michael Cosgrove and Michael Brantley Stricker will be presenting. Space is limited, so secure your spot now. #bracinginpain #painmanagement #opioidepidemic

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🚨 HCAHPS changes are on the horizon! Are you prepared? Tune in to NRC Health's latest podcast with Becker's Healthcare where Susan Edgman-Levitan and Kayce Kovanda break down the upcoming updates to the HCAHPS survey. Learn why these changes are happening and how they’ll benefit both patients and providers. 📈 Don’t miss their insights on boosting response rates and best practices for adapting. Check it out at the link below! #HCAHPS #HumanUnderstanding

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