Elaine Ziegler

🚨 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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Who is your Ideal Client. Last week I was over in Deerfield Beach, FL speaking at the 2024 Private Care Symposium for the Home Care Association of Florida. We were talking about "Selling Home Care to Your Ideal Client." The premise of the program is that not all clients are created equal, and that as business owner you will be more successful and prosperous when you are clear about your ideal clients and how to reach them. There are two ways to identify your ideal client. One is to use Data Oriented Decision Making to analyze your own data to identify those clients that are the best fit for your company. The other is to use the more informal "Best Clients / Worst Client" analysis" to review a list of your best clients and identify common characteristics. One of the things that came out of our conversation was to describe the "Ideal Caller". Our analysis over the years has helped us to create the concept of "The Oldest Daughter Syndrome." This syndrome says that 60% of the time, the personal calling a Home Care company for care for an older person is the oldest daughter. Another 20% of the time it is another daughter. By looking at best fit clients for many Home Care companies over the years, we have identified a hypothetical model of what the "Ideal Caller" might look like. From that, we have been able to develop a sales and marketing strategy where Home Care companies can increase the likelihood of attracting and serving their ideal client. Whether you are in Home Care or another area of Senior Care, how does this description fit your business?

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New statistics are reflecting some good news in the senior living industry. Assisted living is coming in as a more affordable option when compared to other alternatives. The workforce numbers for the long-term services and support sectors (LTSS) were 4% lower in January of this year, but assisted living saw a 5% increase in workers. The pandemic caused a workforce shortage that is now, thankfully, beginning to turn around. With a growth in the aging population, more affordability, and workforce increase, assisted living has exciting growth and days ahead. #SeniorLiving #AssistedLiving #TrendsandGrowth

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Perfect way to mange the revenue cycle

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If you're a BGH member and curious about why independent COEs are exploding right now or how companies are using them to drive better outcomes and big savings, please join Lantern and Hilton for this discussion next week!

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If I can influence every Assisted Living Facility (ALF) to focus and work just 10% more every week on compliance and marketing, I will have accomplished my goal. Did you know that 10% of a 40-hour work week is just 4 hours? That's less than an hour a day! By dedicating this small amount of extra time, we can significantly improve our operations and ensure the highest standards of care and service. Let's make those 4 hours count each week and watch the positive changes unfold. #AssistedLiving #ALF #Compliance #Marketing #ElderCare #SeniorLiving #Healthcare #FocusOnQuality #BetterCare #ALFGoals #Productivity #FacilityManagement

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How do advanced security features benefit your residents? It’s important question to answer for those prospects and their families considering your community. After all, home should always be our safe space, right? Got something to add? Let’s connect in the comments.  #seniorliviing #seniorlivinginsights

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Kickstart your week by staying ahead on compliance! 📝 These 5 simple planning steps will help you stay organized, reduce stress, and ensure your assisted living facility meets all regulatory standards. Set clear compliance goals, schedule staff training, and conduct a facility walkthrough to identify any gaps. 🏥 Get your resident care plans in order and prioritize upcoming deadlines so you can run a smooth, compliant facility all week long. 💼 #CompliancePlanning #AssistedLivingSuccess #ALFCompliance #StaffTraining #Regulations #ResidentCare #ALFOperations #FacilityManagement #StayCompliant

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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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The path to high performant specialty care starts with the referral—ensuring the patient sees the right doctor, at the right time, the first time, and every time. What I’ve been most impressed with in my early days on the Conduce Health team is the ability to accurately and consistently make this possible and personalized at the patient level. Interested in learning more? Let’s connect!

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This is a unique meeting of healthcare executives who share strategies and use cases for innovative technologies (AI and cybersecurity)and operations. I highly recommend this meeting as an opportunity to meet some transformational leaders in healthcare. https://lnkd.in/gfffn2aH

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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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Senior living leaders (THIS MEANS YOU): Before requesting proposals for senior living master planning services, define the scope of work in your RFP. A market study, financial analysis, and property condition assessment are key components. Our experts share 3 common mistakes to avoid. #seniorliving #seniorhousing #livingforward https://okt.to/UuDSZF

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NAIC is pushing #CMS to allow members to leave their #MA plan if their provider terminates their MA plan contract. If this is successful, what would you do? ⏩ Would you rethink Provider contracts, payments, engagement or incentives? ⏩ Would it change your UM/MM, denials or #PriorAuthorization strategy? ⏩ If member retention was suddenly on the line, would you change your approach to provider contracting vis-à-vis #CAHPS and #memberexperience to protect #StarRatings? As more providers leave #MedicareAdvantage and the industry outcry grows, this is a great time for reflection: Could your plan adapt fast enough to not only survive, but thrive, if NAIC is successful? The future of member trust, satisfaction, and retention could depend on it. H/T to Amy Lotven for this great find! #ItTakesAVillage to keep up with all of the moving pieces now that 50% of seniors are in MA!

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"The future of senior living is here, and it’s something we’ve been preparing for all along." Today’s article from McKnight’s Senior Living forecasts service model changes for 2025—strategies we’ve been implementing with our customers for years, yielding enhanced service revenue and streamlined operations. How do we do it? Our consulting team collaborates closely with senior living providers to design service models that ensure all earned revenue from caregiver and nurse-provided services is captured, simply and effectively. Powered by our electronic health record (EHR) platform, we seamlessly link clinical operations to business operations. Think of it like ensuring every resident pays for everything in their cart before they leave the store—with pricing models that reflect the true cost of care while aligning with the financial goals of the operator. The results? Dozens of companies we’ve partnered with have reported: better care delivery systems, improved revenue capture, and greater alignment between care services and business outcomes. If you’re ready to optimize your service model and unlock new revenue opportunities, let’s connect! I’d be happy to share how this process can transform your operations.

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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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Incredibly proud of our team and the innovation we’ve brought to Senior Living! This is the first time I’ve seen a partner truly understand our world—what we do in Senior Living—and offer not just a solution, but the foundational solution. Sage is not an add-on. It’s a platform designed for the future of Senior Living. Unlike anything else out there, it leverages mission-critical systems to deliver data we’ve never had access to before. And let’s be clear: Sage is NOT an EHR. Speaking from my background as a caregiver and nurse, I can confidently say EHRs were never built for Assisted Living. Sure, people have tried to adapt, but the truth is they missed a key piece—care operations and the data behind it. We’re the first to recognize what’s truly missing. If you’re serious about transforming your business, I urge you—don’t get caught up in the checklist of features you think you need. Instead, take a hard look at your operations. What are you missing? Sage has the answer.

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