Dawniece N. Lewis, MPH

Only 39 days until the event of the year, #HDAA2024! Registration is still open. Those hoping to get rooms in our hotel blocks should act fast. This is projected to be one of the biggest, if not the biggest, HDAA conferences ever. #HealthcareAnalytics #HDAA #DataForGood #LeadingTheWay

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Interested in running a productionized predictive model? If so, it's important to check for statistical bias in production risk scores. Pleased to announce a new study out in Health Services Research that assesses Hilltop's Pre-AH (avoidable hospital event) Model for race- and sex-based biases. In production for ~350,000 Medicare beneficiaries in Maryland, this model performs well and we find no evidence for meaningful race- or sex-based bias. Thanks to the The Hilltop Institute at UMBC research team Leigh Gayle Goetschius Fei Han, Ph.D. and Ruichen Sun and University of Maryland Baltimore County faculty member Ian Stockwell. #predictivemodels #bias #health https://lnkd.in/efmFRvjG

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Always appreciate the Center for Connected Health Policy's Fall updates, including this infographic that summarizes state #telehealth laws and Medicaid policies (through Sept 2024). Slow but steady progress in modality reimbursement and adoption of interstate compacts. Positive direction with the recent DEA ruling on controlled substances - fingers crossed on the broader Medicare waivers before year-end. Check out more details below. #digitalhealth #virtualcare #rpm #patientcare

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Interesting perspective on #TechnologicalDebt in health care by Dave Lamar focused on the provider market, but we seem the same issues within state depts and payers. While good data governance practices are key, there must be a better way to solve this common - if not universal - challenge in health care, if only by offloading some of the administrative responsibilities that require the individual management and administration of no-value-add administrative functions. #healthdata

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AI’s Impact on CDI A recent ACDIS Survey of ACDIS members gauging impact of AI on CDI processes and the CDI profession revealed some interesting points and sentiments towards AI. The most common impacts from the implementation of CDI technology are increases in remote work and in productivity (cited by 67% each), followed by identifying “low-hanging fruit” queries (65%) and improving documentation issues with high-volume DRG groups (54%). Additional responses appear in Table 4 below. Remote work is not conducive to effectively providing sustainable measurable physician documentation educational training. One-on-One training or small group training is most effective in ultimately changing overall physician behavioral patterns of documentation. Often, the best form of training is small bit size nuggets provided in a quick conversation specific to a case on the floor. Productivity is not a valid and reliable measure of CDI performance. The mere fact that the CDIS reviewed a record does not necessarily equate to achieved improvement/integrity of the record. Identifying low hanging fruit diagnoses through queries implies CDI has room for improvement in physician documentation education through reinforcement that improves physician's muscle memory of better documentation practices. Electronic querying serves to mechanize the query process and is no substitute for physician documentation training and knowledge sharing. Physicians do not want more queries, they prefer to document right the first time versus more repetitive transactional reactive queries. AI definitely can assist and serve as an effective tool in CDI activity. However, it must be considered as a tool and not a crutch. There simply is no substitute for good old fashioned CDI boots on the ground, helping physicians achieve clinical documentation excellence through documentation training with reinforcement and guidance. AI is the panacea for improving documentation. #AI, #documentationimprovment, #notapanacea

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Join us tomorrow for the first webinar of our Capital Planning for Health Center Growth! This session focuses on components of Capital Planning and how to integrate and align it with your organization's strategic goals. Register: https://ow.ly/GGbh50TPX7Z

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New TEFCA SOPs for Operations and Public Health (in addition to the Individual Access Services updates that relate to Epic's announcements last week) came out today. * Public Health: Defines Electronic Case Reporting and Electronic Lab Reporting. This aligns with the announcement earlier this month about Public Health already being live on TEFCA for eCR. It also aligns with the HTI-2 requirements for Public Health, although only two of the public health flows. We'll probably see more added over time. Interesting that responding parties can charge fees. * Operations: This covers a lot of ground in terms of Operations use cases by both providers and payers, laying out a general query and push capability, but also defining specific use cases (Care Coordination, HEDIS Reporting, Quality Measure Reporting). There's an 18-month period where responding is not required, but then kicks in as fully required. Responding parties can charge query initiators for this type of query. * IAS: Mostly covered thoughts in my post last week, but this call-out for health plans is net new here: "If the Responding Node is controlled by a Health Plan, the Responding Node MUST also share individual claims and encounter data (without provider remittances and enrollee cost-sharing information) that it maintains" Today patients can access their claims and encounter data including remittances and cost-sharing through CMS-9115's Patient Access APIs. I'm not clear why they omitted it. On a different note - My "this summer has been crazy for interop, but there's still more ahead" article keeps getting preempted by new news dropping. Please let me finish The Sequoia Project Assistant Secretary for Technology Policy

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Relaying the power of real-time data to improve the quality of care is the premise of the presentation by UNC Health's Eileen Ciesco MHA, Crystal Hoffman, MHA and Hunter Gay that's happening this 16th at #HDAA2024 - #AnalyticsTakesFlight "Providing real time information on quality measure performance in the outpatient setting is critical for targeting areas for improvement and optimizing workflows and resources. Determining which measures to focus on in the current environment of payer value care contract arrangements, clinical input from our internal quality leaders, government mandates, medical societies/agencies, and medical literature can be dauting. UNC Health, through its Primary Care Improvement Collaborative (PCIC), has created and implemented a systematic approach for selecting quality measures which all primary care practices across the system agree are important and committed to improve each year. But it doesn’t stop with the selection of the measures. Data, analytics, improvement work, and point of care tools are critical for providing real time performance information and for monitoring outcomes to achieve success. Dashboard visualizations are accessible to all PCIC participants. These visualizations display performance at the Collaborative (system – population), Entity, Practice, and Individual Provider levels. These views display data driven outcomes to show each practice which of their quality measures need the most attention and where they should consider directing efforts and resources for improvement work. Complementing this work are EPIC tools, Population Management support, and Coaching Improvement work. This presentation will provide insight into how PCIC is structured and its approach for selecting annual quality measures and goals. We will share how our measures are grouped by domain including health equity. We will demonstrate the PCIC Quality Measure Dashboard which is the most used dashboard across our UNC Health system and the PCIC Health Equity Dashboard. We will also illustrate how EPIC’s healthy planet module is essential for measure builds and point of care tools to deliver enhanced patient care." #HealthEquity #dashboard #datavisualisation #collaborativecare #healthdata #AI #datascience

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With massive variation in star ratings, health plans often resort to unsavory, non-transparent tactics to bolster their ratings. Here are a few: Novation: plans will merge a low performing contract in one geography with a higher performing contract in another geography, blending the performance of a low-performing cohort of people with a higher performing cohort in another / overlapping geography. Star ratings may look higher to the public but there has been no fundamental improvement in performance. Contract area expansion: a health plan will take a high-performing plan in one geography and file an expansion into a new geography (including one in which they already have a lower rated plan). This also reflects no fundamental improvement in performance—and deceives the public into thinking that a plan is better than it is. These tactics are clever. And can lead to transient “improvements” in star ratings that are hard to maintain. But they also waste the taxpayer’s money because it is rewarding a plan for no *real* improvement in performance. *Shareholders and equity research analysts of these plans (and potential acquirers) should also catch on to the fact that these tactics—which drive transient earnings bumps—don’t really reflect fundamental improvements* *And brokers should be aware of these shenanigans when lower rates plans suddenly show up in a market with markedly higher star ratings than they earned in previous years* *Even most employees of these companies don’t understand these tactics and how they are used to “enhance” ratings* ******* Novation and overlapping area expansions are dirty secrets of how health plans (not named SCAN) manipulate Star ratings without any underlying improvement. Health plans that engage these loopholes don’t serve the public well and the Centers for Medicare & Medicaid Services guided by the Medicare Payment Advisory Commission should work to close them in the best interest of American seniors.

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News from First Report Managed Care Volume 21, Issue 2: The Centers for Medicare & Medicaid Services (CMS)'s AHEAD model aims to improve population health management by awarding funding to states and promoting primary care investment and enhanced equity measures, but implementation challenges and cultural shifts may hinder its success. “States have relationships with many of the stakeholders whose perspectives and support will be vital to the success of this model,” Maureen Hennessey, PhD, SVP, director of value transformation at Precision AQ, told First Report Managed Care. Access the full issue here: https://lnkd.in/eKAWrpWp #FirstReportManagedCare #FRMC #CMS #AHEADModel #PopulationHealth

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Join this upcoming webinar from The Better Care Playbook on 11/22, 12–1:15pm ET, which will spotlight three state Medicaid agencies (CA, IA, and TN) that are a part of the Medicare Academy — an initiative which provides Medicaid and partner agencies with training to build Medicare knowledge needed to successfully advance integration goals. The state panelists will address how they are establishing and sustaining Medicare capacity. The event will also feature a dual-eligible enrollee who will share considerations for improving Medicare and Medicaid coordination to help enrollees navigate these programs. https://bit.ly/40yJwF7 The SCAN Foundation, Arnold Ventures, The Commonwealth Fund, California Department of Health Care Services, Iowa Department of Health and Human Services, TennCare

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Did you know that according to the WHO (World Health Organization), over 50% of what happens in a persons' life and healthcare jouney is determined by their Social Determinates of Health (SDoH)? SDOH are the condidtions in the environment where people are born, live, work, learn, play, worship and age that affect a wide range of health, functioning, risk and quality of life outcomes. (1) Your Health operates under a model of care that sends qualified health care professionals like Community Health Workers and nurses directly into patients homes, to assess and screen for SDOH issues that might not be appartent when a patient visits a clinic or conducts a virtual appointment. We are committed to whole-person, centric health care. Check us out today, because we're also hiring. #primarycare #yourlife #yourhealth #hiring #nurses www.yourhealth.org/careers 1. https://lnkd.in/ezX4ECwp

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AAPC recently published an article by one of our partners, Alyssa Foster, highlighting a key Medicare inpatient payment policy change for FY 2025 that can result in improved hospital inpatient payment for patients with documented inadequate housing or housing instability. #HealthPolicy #SocialDeterminantsOfHealth #Medicare #HealthcareInnovation #Reimbursement

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Medicaid Health Plan RFP Wins – Q3 YTD Highlights! Several major Medicaid health plans continue to make significant moves in 2024, expanding their Medicaid footprint and securing key contracts. Here’s a quick breakdown of the wins and losses: ✅AmeriHealth Caritas & UnitedHealthcare – Mixed results, with both wins and losses across their footprint. ✅Aetna – Big win in Pennsylvania’s CHC contract, despite a mixed track record. ✅Blue Cross Blue Shield affiliates – Solid growth! Resecuring contracts while making new moves in Kansas (win) and Rhode Island. ✅Centene – 100% defense! Successfully retained all eight contracts. ✅CareSource – New state entry! Secured a highly anticipated win in Mississippi. ✅Elevance & Molina – Strong defenses, but efforts to grow into new states fell short. 2024 Medicaid contract awards include: CO, FL, IA, KS, MA, MI, MS, NH, PA, and TX (STAR CHIP). Stay tuned for RI and VA – both currently under protest. Awards do not include BH-only contracts, dental-only contracts, PBM-only contracts, nor single population contracts (Foster Care/Children in State Custody). #Medicaid #MCO #healthplans #Growth #ContractWins #Thrive

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I Was Right about the #IRA “#Facilitator” and #340b Duplicates—Unfortunately I said weeks ago that I thought that #HHS and #CMS were going to throw up their hands and dump 340B duplicate identification on #drug makers under the #inflationreductionact. You optimists and #CMS defenders out there said I was being my overly pessimistic self, and I’d be proved wrong. But reading the Year 2 “price negotiation” proposed guidance, I think it confirms that I was 100% right. Mandatory/Voluntary: At the core of the CMS proposed guidance is a distorted, asymmetric structure: participation with the #MedicareTransactionFacilitator is “mandatory” for #pharmaceutical manufacturers, but “voluntary” for “dispensing entities”, including 340B covered entities and contract #pharmacies. What CMS Said: “Beginning January 1, 2025, the Submission Clarification Code value of ‘20’ and the Submission Type Code field with a value of ‘AA’ will be added to the PDE record to indicate a Section 340B claim. These indicators may be VOLUNTARILY applied to a Part D claim by the dispensing entity to indicate a Part D claim is being billed for a Section 340B drug.” The Kiss of Death: That “voluntary” word, as a practical matter, means that the MTF will be pretty much useless in identifying 340B duplicates. How can I say that? Well, because “past”, as Shakespeare said, “is prologue”. We have been down this road before. #PowersPyles and other law firms representing 340B interests took the position that CEs had no responsibility for #Medicaid #managedcare duplicates under the statute. As night follows day, the vast majority of CEs, as a consequence, would not lift a finger to help resolve a duplicate, refusing to even provide information that would facilitate a drug maker seeking to dispute a rebate with the state. If you are a #pharmaceutical company subject to “price negotiation”, you had better be working full bore with a technology partner to develop a robust duplicate identification system. The clock is ticking, folks, and nobody is coming to save you. I didn’t want to be right—but I was. Health Resources and Services Administration (HRSAgov), HHS #MTF #partd #Medicare

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A new #EBHC scoping review explores how health service and delivery systems in high-income countries define and operationalise #HealthEquity. 👉 https://ow.ly/ZxaY50ShGWU

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US economic data is released regularly. For example, monthly employment figures constitute a rhythm of reports that inform economic policy decisions across the nation. Health data, on the other hand, isn’t so easy to come by. Could better, real-time data infrastructure improve public health? More from Cristian L. in JAMA Health Forum here: https://goo.gle/3WVK99e

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