Warner Thomas

What does calling my cable company have to do with Medicaid? I had to call a certain notorious cable/internet provider recently. The one with customer service so bad that it was skewered in a classic South Park episode. I blocked out an hour and braced for my inevitable PCOM aneurysm rupture. Shockingly, it was a breeze. The rep was friendly, and my issue vanished in minutes—a far cry from their usual 'dial-one-to-scream-into-the-void' reputation. So, what changed? Competition happened. A decade ago, our choices for cable and internet were as limited as the soda options in a health spa. Now, thanks to a buffet of streaming services—even including live local TV—the old cable giants had to step up their game or step aside. Turns out, competition is more effective than caffeine at improving service quality. Why can't Medicaid beneficiaries get the same treatment? Currently, most Medicaid coverage is through Managed Care Organizations (MCOs), where the state pays a fixed monthly rate per patient. This model should spur cost-efficiency, but it often just limits the scope of care. Low payments to doctors, restricted access to necessary services—who does that help? Could strict government regulations guarantee better service? Maybe, but FA Hayek (and a basic reading of history) prove that bureaucracy alone can't engineer excellence. And choice for Medicaid patients? Virtually non-existent. Many areas offer just one MCO. If you're dissatisfied, too bad—there's no alternative. It's like being stuck with dial-up in the era of fiber optics. Long wait times for basic procedures, no freedom to seek better coverage... It's eerily reminiscent of the old cable monopoly days. In the private sector, at least there's a semblance of choice: HMOs, PPOs, HSAs... But for Medicaid recipients? Sorry, the state chooses for you. Hope you like it. Our Medicaid system desperately needs a dose of competition. Isn't it time we offer Medicaid patients the luxury of choice that drives quality up and costs down? https://t.co/C7XE6CpIIP Joe Grogan Lisa Grabert Joanne Spetz Cheerag Upadhyaya, MD, MBA, MSc, FAANS, FACS Brian R. Gantwerker, MD, FAANS, FACS Sanjay Dhall Larry Bucshon, M.D.

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September is National Suicide Prevention Month. Thank you Katrina Domingo, PsyD for nominating subject matter expert, Terra Morais, Psy.D., provide insightful tips for suicide prevention. Dr. Morais has worked for Kaiser Permanente for 9 years, and has been manager of its Psychiatric Consultation Service for 2 years. She has specialized training in the treatment of psychiatric emergencies in children and teenagers. We all have times when we feel sad or overwhelmed. For some people, these feelings can become so strong that they have thoughts of ending their life. Suicide is a leading cause of death in the United States and has been on the rise across all groups for years, but we can take steps to help prevent it.   SELF If you are having serious thoughts that you or your loved ones would be better off if you were dead, the most important action you can take is getting immediate help. You can call or text 988 to talk to someone who knows how to keep you safe. If you notice yourself having these thoughts occasionally, or find yourself feeling hopeless, here are some steps to help prevent those thoughts from getting worse: 1. Tell someone you trust how you are feeling. This can be scary, but it the people who care about us want to help us feel better and can be devastated by the thought that they could have helped if only they had known how their loved one was feeling. 2. Prioritize your sleep and reducing stress in any way you can. Lack of sleep contributes to problems with mood, thinking, and emotional regulation. 3. Make a plan to do something enjoyable with a loved one and ask them to help you stick to it. Research has shown that social connections and responsibilities are highly protective factors in preventing suicide deaths. OTHERS Here are some warning signs that someone may be having thoughts of suicide: https://lnkd.in/dyz2BZsd If you notice worrying changes in someone you know, here are a few ways to help: 1. Ask them if they have been feeling like hurting or killing themselves. Sometimes people worry that asking will “put the idea in someone’s head,” but in fact people struggling with thoughts of suicide are usually relieved that they can talk about it. 2. When someone tells you about their thoughts of suicide, listen without judgment or argument and ask if they want assistance reaching out for help. You can call or text 988 with them or make sure they have the number.   RESOURCES The National Suicide Prevention Lifeline (24/7 toll-free suicide prevention service): Dial 988, https://988lifeline.org/   Suicide Prevention Hotline in Spanish: 1-888-628-9454, https://988lifeline.org/   LGBT Youth Suicide Hotline: 1-866-488-7386, or text START to 678-678, https://lnkd.in/d656hGQy   The Crisis Text Line: Text "HOME" to 741741 for free, 24/7 crisis support #suicideprevention #suicidepreventionawarenessmonth #TPMG #DSA #health #wellness #leadership #tips #support

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According to this article in Modern Healthcare, discussing a report from the Center for Healthcare Quality and Payment Reform, we have 16 rural hospitals at risk of closing in Washington State, and another 8 in Oregon. It’s disheartening but not surprising when reimbursement rates don’t cover the cost to provide care and hospitals have been operating at a loss for much too long. Make no mistake, it is an issue of health equity when our neighbors in rural and underserved communities face hospital closure and risk further losing access to care.  #healthequity #healthcare #healthcareaccess https://lnkd.in/gHr4Qz-j

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When used purposefully and responsibly, artificial intelligence improves equity in every part of a hospital, including the emergency department. Previous research found Black patients have a 20% greater chance of being mis-triaged in the emergency department, potentially delaying urgently needed care. Now, the Kaiser Permanente Division of Research is developing a clinical decision support tool that runs on machine learning to improve emergency department patient assessments. #AI #EmergencyMedicine #HealthEquity https://ow.ly/Rlz450Ub6NP

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In a move to streamline care, LA Care Health Plan which managed Medi-Cal and several other plans for low-income Californians is cutting back 24% of its prior authorization requirements. "This change aims to reduce administrative burdens and speed up patient access to necessary treatments," the article explains. This is good to see. Could significantly benefit patient care by removing unnecessary delays in treatment approvals. Devil is in the details but still good progress, particularly for the most vulnerable. Check out the article by Nona Tepper in Modern Healthcare at https://lnkd.in/evVP3eqP

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The Association of Healthcare Value Analysis Professionals (AHVAP) celebrates Elizabeth Eisenberg, MSN, RN, CVAHP from Scripps Health for commitment to excellence in the specialty of healthcare value analysis! Liz has signified this commitment by signing the official Association of Healthcare Value Analysis Professionals (AHVAP) healthcare value analysis pledge. To learn more about the Association of Healthcare Value Analysis Professionals (AHVAP) Commitment pledge: https://lnkd.in/gqEWPBue. #AHVAP #valuebasedcare #excellenceincare #valueanalysis

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Join the conversation! Our team is facilitating the strategy task force of a hospital client in Washington State this week. We're analyzing surveys, focus groups, market, and organizational data to develop a strategic plan framework for the next three years. What are your favorite and least favorite strategic working session activities? Do you hate ice breakers? Love SWOT analysis? Share your thoughts! #strategicplanning #healthcare #hospital #WashingtonStateHospitals #taskforce #dataanalysis

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CompassPoint Health Introduces Healthcare 2.0 26 December, 2024 SACRAMENTO, CA CompassPoint Health (CPH) is set to introduce its revolutionary technology that will allow everyday Americans universal access to care. "America's healthcare system is broken, and patients' rights are at a historic low point" stated Founder and CEO Gary Brant. "I am proud to put CPH at the forefront of change, having a direct impact on millions of patients who will have the power in their hands to access life-saving care during medical emergencies". The California company is planning the first trials of its ground-breaking technology during the first quarter of 2025. Interested parties may sign up to be first in line for access to the CPH System by visiting https://lnkd.in/eC-C7hTC #healthcare #nursing #patients #california #medical #ambulance #emt #emergencyroom #hospital #clinic #doctors #medicalemergency

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  An excerpt from my recent interview with Becker's Healthcare (and looking forward to speaking at their April 2025 Annual Meeting):   “At UC Davis Health, we’re rechanneling the joy back into medicine based on several achievements in 2024, with more to unfold in the years ahead. This includes building a new paradigm of patient care (our Vision 2030) through innovative technology, a robust construction program ($7.5 billion, 600 capital projects), and workforce planning to meet regional healthcare needs for the next 50 years – all cultivating our position as a nation-leading model workplace. "We’re exploring the leading-edge uses of AI (AI Scribe is among 50 AI apps launched in clinical care so far), staying connected to the needs of our communities through our Anchor Institution Mission, serving as a valued partner for multiple FQHCs, and providing services the community needs …   “As always, humans come first in patient care. These achievements underscore our focus on using technology to improve what humans can do, bringing better quality outcomes and data-driven excellence to our care. With AI, doctors and nurses must always make the decisions, and the patient can be even more engaged in care decision-making, creating a true partnership that’s never existed before in healthcare. Luke Skywalker didn’t have to do it alone. Providers don’t have to, either.”   https://lnkd.in/gUnQUA3W

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How are you onboarding your new physicians? A recent report from the Association for Advancing Physician and Provider Recruitment highlights the importance of a positive onboarding experience for physician satisfaction. Leaders from City of Hope, MD Anderson, and UC San Diego Health share their strategies for creating a welcoming and impactful onboarding process. Key takeaways: Social onboarding: Building connections and fostering a sense of community is essential. Collaboration and mission alignment: Emphasize the organization's goals and create opportunities for collaboration. Dedicated support: Assign onboarding ambassadors to guide new physicians and provide ongoing support. What are your organization's best practices for physician onboarding? https://lnkd.in/g4EJzxgX

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A 2021 report by the The National Academies of Sciences, Engineering, and Medicine found that while more than 35% of health care visits in the U.S. are to primary care physicians, only about 5% of health spending is on primary care. That’s compared with about 13% for some other developed nations. #primarycare #prevention #publichealth #california https://lnkd.in/g37iugjS

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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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Enhanced Care Management (ECM) is a whole-person healthcare approach that improves care coordination and outcomes for California’s most vulnerable populations. This statewide benefit addresses the complex needs of high-risk members, from those experiencing homelessness to individuals with #MentalHealth and substance use disorders. Read the full CareThreads blog to learn how ECM provides dedicated care managers and leverages tools for efficient service delivery, ensuring timely interventions and better health outcomes for Californians: https://okt.to/n6Gx5N

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Suggestions on Choosing the Right Healthcare Proxy Choosing the right healthcare proxy is one of the most critical decisions you can make for your health and well-being. A healthcare proxy is someone who will make medical decisions on your behalf if you are unable to do so yourself. At Patient Advocates of Southwest FL, we understand the importance of this role. Based on first-hand and the experiences of more than a few clients, I’m here to share some key advice to help you make the best choice: 1.      Trust is Paramount: Select someone who understands your healthcare preferences and whom you trust implicitly to make decisions that reflect your wishes, not their own. 2.     Availability Matters: Your proxy should be generally available and can be present when needed, especially in urgent situations. Confirm they are willing and able to commit to this responsibility. 3.     Knowledge of Medical Matters: While they don't need to be a medical expert, choosing someone with a basic understanding of healthcare or who is willing to learn about your specific health conditions can be immensely helpful. 4.     Communication Skills: Your healthcare proxy should be a strong communicator. They will need to discuss your care with medical professionals and potentially other family members, advocating effectively on your behalf. 5.     Legally Prepared: Ensure that your healthcare proxy is legally documented. It’s always wise to consult with a legal professional to verify all paperwork accurately reflects your choices and is binding. Choosing the right healthcare proxy is about more than just fulfilling a role; it’s about ensuring that your healthcare decisions are in trusted hands. Your health deserves the utmost care and preparation. #HealthcareProxy #PatientAdvocacy #MedicalDecisions #HealthcarePlanning"

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Hospital Chargemaster Explained... is a 13,200% Markup Reasonable?!? The Hospital Chargemaster is a list or database of hospital supplies, medications and services (e.g. 15-min of operating room time) and their associated prices billed to insurance, Medicare and Medicaid. The Chargemaster includes: 1) Department number (unique to each hospital) 2) Charge Code (unique to each hospital) 3) Supply, Medication, Service Description 4) Revenue Code (standardized across hospitals) 5) CPT/HCPCS Code 6) Price (Billed Charges) Unfortunately, each insurance company, Medicare and Medicaid plans accept different combinations of Revenue Codes and CPTs codes... so a combination that may work for Blue Cross will be denied by Cigna. Therefore, hospitals are not told by insurance companies which combinations to use, so they have to just guess and go through a billing process of trial and error. Hospitals have no rational basis for the prices they charge on the Chargemaster. For example, the medication Oxytocin was marked up from a cost of $0.02 to a price of $264 billed to the insurance company... a 13,200X markup. Even with a 50% discount from the insurance network, that is still at 6,600X markup!! Final seconds of video and sources at AHealthcareZ YouTube Channel. #HospitalPrices #PriceTransparency #Chargemaster #Healthcare #HealthInsurance #HealthcareCosts

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Perfect way to mange the revenue cycle

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