1294 Results found.
Webinar replay – Navigating change: exploring the opportunities of New York鈥檚 1115 Medicaid waiver amendment
This webinar was held on January 24, 2024.
During this webinar, 量子资源网 panel guides you through the newly approved key provisions of New York’s 1115 Medicaid waiver amendment. This groundbreaking development opens doors to transformative changes in healthcare delivery, impacting both providers and beneficiaries alike, including enhanced Health Related Social Needs (HRSN) benefits, workforce and hospital investments, and further commitment to Value Based Payment (VBP).
Gain valuable insights into the innovative strategies and opportunities presented by the waiver amendment, paving the way for new social care networking activities, funding opportunities, and regulatory flexibilities that will improve access to vital services.
This webinar shared information on waiver-specific details and what they mean, what potential opportunities will become available, and heard from national experts on similar models implemented nationally.
Driving change in healthcare delivery: 量子资源网 Spring Workshop dives into metrics, coordination, and partnerships for value-based care
Within the healthcare sector, there is an imperative for a comprehensive understanding of the care delivery framework that will positively impact outcomes, equity, and the overall health of communities. Among the drivers for this imperative is renewed focus among Medicare officials and interest from states and employers to transition to alternative payment methods that focus on value for payers and patients. A variety of care delivery structures and metrics can be used, and all have a role in driving value-based care (VBC).
One critical element of VBC hinges on whether and how healthcare organizations focus their care delivery structures on patients. VBC also incorporates metrics that further validate the ability of the system to positively impact patient outcomes, reduce health disparities, and improve population health. Emphasizing technology, interdisciplinary collaboration, and streamlined communication can revolutionize the care delivery model.
The 量子资源网 workshop-style on March 5 and 6, is designed to delve deeply into the intricacies of these care delivery frameworks and metrics within the context of VBC. This unique workshop will challenge attendees to roll up their sleeves and actively engage to become part of the solution through an interactive conversation, allowing participants to discuss real-world scenarios, analyze data and metrics and, using small-group breakout sessions, engage in focused and in-depth knowledge sharing.
Break-out sessions facilitated and led by subject matter experts will challenge attendees to identify new solutions around care delivery structures and contractual metrics that improve outcomes, that may include:
- Engaging providers around consistent approaches to enhance patient outcomes, optimize treatment plans, and ensure the delivery of evidence-based, high-quality care.
- Developing approaches for patient engagement that improve care delivery and foster active involvement and collaboration between patients and healthcare providers.
- Crafting strategies for seamless coordination among healthcare providers, spanning sectors, and involving non-traditional providers and community organizations.
- Understanding components of effective provider network agreements and how they contribute to achieving healthcare goals through strong partnerships and collaborations.
The workshop promises to be a dynamic platform for professionals in the healthcare sector, offering valuable insights, practical strategies, and collaborative opportunities to secure a place for high-quality value-based care. By focusing on care delivery structures, patient engagement, care coordination services, and provider network agreements, attendees will be well-equipped to navigate the complexities of healthcare and contribute to a healthier, more equitable future.
To learn more about the 量子资源网 2024 Spring Conference Workshop and to register, visit the .
Devising a framework for non-profit fundraising
Money is always 鈥渢op-of-mind鈥� among non-profit leaders, from CEO鈥檚 at Federally Qualified Health Centers (FQHCs) to Executive Directors at Community-based Organizations. To supplement projects and retain the ability to further their missions, non-profit organizations (NPOs) need funding. When non-profits and funding sources are not well aligned, programs are cut, curtailed, or never launched. Assisting clients in pursuing alternative funding sources requires a creative yet methodical approach to promote success and boost organizational sustainability.
Devising a framework for non-profit funding presents challenges. Funding models/strategies cannot be too general nor too specific. There is not a single approach, a one size fits all model or sourcing strategy for non-profits to pursue. Instead, non-profit leaders must clearly articulate the funding model or strategy that best supports the growth of their organization and use that insight to examine the potential funding opportunities preeminently associated with organization-specific success. For example, a community health center serving patients covered by Medicaid and a non-profit organization doing development work in housing for the homeless are both funded by the federal government, yet the type of funding each receives and the decision makers controlling that funding are very different. Utilizing the same funding methodology for the two would not be productive. Fortunately, there are multiple methods and strategies to acquire funds. Non-profits should be strategic in seeking approaches suitable to their needs and capabilities and be creative in pursuing more than one model to acquire supplemental funds.
The core success of NPOs is based on a range of funding options, private grants and government grants, corporate sponsorships, private funding, endowments, and community fundraising. There is also a considerable amount of money available from the public sector, businesses, charitable trusts, foundations, in-kind donations, and local and state legislative bodies. The goal of any successful fundraising campaign is to convey fully what the money is or will be supporting and clearly articulate the projected positive outcomes that will be derived from the funding. Once the project is fully clarified, the next step is research. Many funding avenues exist. The NPO must decide which funding sources are best suited for each project and pursue those options.
When choosing potential funding sources, NPOs must consider the size of their organization, their mission, and various other defining characteristics. Once this internal due diligence is completed, revenue needs should be clarified, and a tactical fundraising strategy outlined. Creating a 鈥渞atio鈥� with the end-result in mind allows for revenue diversification and avoids the too heavy reliance on one income source. For example, an NPO might project obtaining 50% of needed revenues from grants, 20% from a corporate sponsorship, and the remaining 30% from a foundation. Once the funding sources have been identified, the types of decision makers and the motivations of these decision makers must be evaluated. Then, a tactical roadmap designed to obtain the needed funding should be implemented.
As society looks to the non-profit sector to solve important problems, a realistic understanding of funding models is increasingly important to realizing these aspirations. As consultants whose mission is to turn challenges into triumph for our clients, championing efficacious, high-yielding funding models ensures long-term viability for the organizations we serve.
Success relies on planning. It is much better to be proactive than reactive. Consider your organization鈥檚 funding needs, do your research, and lay the groundwork before diving into any fundraising pursuit. An assessment of your organization鈥檚 current funding strategies is essential. What is working; what is not? Is the current funding source reflective of the organization鈥檚 mission and values? Use the answers to these questions to make decisions and recommendations on which fundraising strategies to source. Get creative! Brainstorm unconventional ways your organization will stand out to potential funders, but be analytical. Balance creativity with data, keeping in mind which funding strategy reflects the best return. Focus time and energy on the funding model that will be most reliable, profitable, and feasible.
The non-profit world rarely engages in a succinct conversation about an organization鈥檚 appropriate long-term funding strategy. That is because the different types of funding that fuel non-profits have never been clearly defined. More than a poverty of language, this represents and results in a poverty of understanding and clear thinking. As consultants, 量子资源网 can provide an outside perspective and sort through the minutia presenting a clear, methodical, appropriate path to fundraising success.
Potential links to aid in your fundraising endeavors:
量子资源网 works with a wide variety of healthcare clients, including FQHCs, community-based organizations, hospitals, provider practices, behavioral health, and managed care organizations, and can help with:
- Grant Writing
- Technical Assistance
- Strategic Planning
- Financial planning, Implementation and Optimization
For more information about how 量子资源网 can help your organization鈥檚 grant and funding strategies, contact our experts below.
Rhode Island releases Medicaid managed care program RFP
This week our In Focus section reviews the Rhode Island statewide, capitated risk-bearing Medicaid managed care program request for proposals (RFP), which the Rhode Island Executive Office of Health and Human Services (EOHHS) released December 15, 2023. New program changes will include carving in long-term services and supports (LTSS) as an in-plan benefit for all populations and expanding managed care to include people who are dually eligible for Medicare and Medicaid. Contracts are expected to be worth $2.3 billion.
Background
Rhode Island鈥檚 Medicaid managed care program, which operates under the authority of a Section 1115 waiver and Section 1932(a) state plan amendment, consists of the following programs:
- RIteCare, which serves children and families, including children with special healthcare needs
- Rhody Health Partners, which serves aged, blind, or disabled (ABD) adults
- Medicaid expansion, which serves childless adults ages 19 to 64
At present, full-benefit dual eligible (FBDE) members are not covered through the Medicaid managed care organization (MCO) contracts.
RFP
New contracts will be implemented in three phases, starting with enrollment of core populations and the addition of LTSS in-plan benefits to Medicaid managed care for Medicaid-only enrollees beginning July 1, 2025. In the second phase, current fully dual eligible members will transition to Medicaid managed care plans on January 1, 2026. All bidders will be required to offer an integrated Dual Eligible Special Needs Plan (D-SNP) and managed LTSS (MLTSS) plan to dually eligible members, as Rhode Island transitions from the Financial Alignment Initiative (FAI) Medicare-Medicaid Plan (MMP) Demonstration, which sunsets December 31, 2025. In addition, beginning January 1, 2027, default enrollment will begin for Medicaid members who become newly eligible for Medicare.
EOHHS will award contracts to two or three MCOs.
Other changes in the RFP include increasing oversight and accountability for the use of pharmacy benefit managers (PBMs); requiring that EOHHS approve contracts for MCO major subcontractors; reducing unnecessary prior authorizations, particularly for behavioral health services; increasing financial sanctions for noncompliant MCOs; and increasing investments in population health and health equity with a focus on the identification of health disparities; and other changes.
Timeline
Proposals are due February 23, 2024. The new contracts will take effect July 1, 2025, and will run through June 30, 2030, with an option to extend the agreement for up to five additional years.
Current Market
Neighborhood Health Plan, Tufts Health, and UnitedHealthcare served approximately 313,000 members as of November 2023. These MCOs have signed contract extensions through June 30, 2025.
Evaluation
Rhode Island will not require cost proposals under this procurement, with capitation rates set by EOHHS actuaries. MCOs must meet the passing technical score of 85 points. Technical proposal requirements are shown below:
Driving change in healthcare delivery: payment models and risk management at 量子资源网 Spring Workshop on value-based care
Is the concept of value-based care (VBC) still relevant in today鈥檚 healthcare landscape or just a buzzword? Some argue that the financial challenges brought about by the pandemic have steered our healthcare delivery systems away from prioritizing value. However, many experts remain optimistic that value-based care is the key to achieving our overarching objectives of a more equitable, sustainable, high-quality healthcare system.
Kelsey Stevens, a principal at Wakely, an 量子资源网 Company, led a session on value-based care at the 量子资源网 Fall Conference. Her panelists felt strongly that value is critical to a functional and patient-focused healthcare system because the alternative is out of control spending and poor health outcomes. In fact, value-based care is flourishing in new ways as we look to integrate behavioral health and address health related social needs. There are lessons to be learned from early experiments, new models being built, and new models to be designed. Both public and private payers are pursuing new ways to take financial risk to deliver improved healthcare outcomes, focusing on solutions for higher risk populations or circumstances where quality of outcomes are indefensibly poor (i.e., maternal outcomes).
This enthusiasm felt by the wide variety of executives present at that fall meeting has inspired 量子资源网 to focus an entire conference on value. But not just another conference on value. Our internal experts felt strongly about hosting a forum for healthcare organizations to truly tackle the end-to-end challenges of VBC鈥� so we are doing that.
Those who join us March 5-6 in Chicago will experience a workshop designed to 鈥済et real鈥� about transforming healthcare quality and value. We are convening participants from all parts of the healthcare industry who have the collective experience to pinpoint common challenges and to build a path forward.
The workshop is organized into four cohorts:
- Payment and Risk Management Models,
- Policy and Strategy Frameworks,
- Data and Technology, and
- Care Delivery Frameworks
Each will produce concrete recommendations for action, as well as building new relationships among peers to sustain this change. In the cohort on Payment and Risk management, discussion will be focused on existing and new models for payment, pricing and attribution methodologies, risk mitigation levers along the value continuum, and approaches to engage employees in focusing on patient-centered value in the care they provide.
One of our fall panelists, Eric Mattelson, chief actuary at Zing Health, said 鈥淚鈥檓 still convinced that value-based care is the future of healthcare and the Sisyphean struggle to get there will ultimately be worthwhile.鈥� We echo this sentiment wholeheartedly, and if you share this conviction, we encourage you to secure your spot today and become a part of this exciting and transformative event.
Our sessions and networking events offer an opportunity to delve into approaches to develop and manage risk-based contracting across sectors, establish effective partnerships with safety net providers and community-based organizations, apply a value lens to deployment of technology and data analytics, and develop health equity plans aligned with value principles and policies.
Future blogs in this series will touch on elements from the other 3 cohorts on VBC that make up the balance of the workshop. To learn more and register go to page.
Discover the challenges and opportunities of implementing value-based care at the 量子资源网 Spring 2024 workshop
Policymakers have been working to move the U.S. healthcare system away from the costly and inefficient framework of fee-for-service to patient-centered structures focused on value and quality. Financial pressures, government regulation, and improvements in managed care all contribute to the drive toward value-based care, and that creates challenges for providers, payers, manufacturers, government, and others supporting the industry. Though some stakeholders are hanging on to the old ways of doing things, others are rightly moving toward putting their emphasis on value, changing their payment and workforce structures, and improving quality.
量子资源网 will host the spring workshop, Getting Real 量子资源网 Transforming Healthcare Quality and Value, March 5鈭�6, 2024, at the Fairmont Chicago Millennium Park Hotel in Chicago. The workshop starts with a kickoff event the evening of March 5 designed to foster meaningful connections for attendees, regardless of their role as a government official, provider, health system representative, payer, or vendor in public or private healthcare markets.
The full-day program on March 6 will feature a compelling keynote speaker and include multiple interactive workshop sessions focused on four key pillars of value-based care: Policy & Strategy Frameworks, Payment & Risk Management, Data & Technology, and Care Delivery Measures. 量子资源网 has expertise in working with commercial payers; primary, specialty, and behavioral healthcare providers; and publicly sponsored health plans at the local, state, and federal levels. Session discussions will help participants adapt to the new value-based market and are designed to provide a comprehensive exploration of the intricacies involved in healthcare transformation. Attendees will discuss what to expect during the early phases of transformation, as well as strategies, collaborations, and actions that have moved them closer to adding value on the ground.
Participants will be challenged to think critically about their organization鈥檚 cultural and operational readiness to create additional value for patients within the healthcare ecosystem. Drivers of policy, innovation, population health, risk management, IT, and data, as well as enablers and other stakeholders working in public and commercial markets, will meet in smaller groups to discuss and analyze scenarios, pose challenging questions, and identify tactical steps and solutions to thorny issues.
Other groups focusing on value will address multi-sector issues and perspectives that affect value-based care, including behavioral health, primary, and specialty care. From navigating the complexities of employee insurance plans for businesses to advocating for the needs of individual consumers, this workshop will address the formidable challenge of reshaping the healthcare landscape.
Don鈥檛 miss this opportunity to gain valuable insights and contribute to genuine and productive discussions that will shape the future of healthcare.
Whether you attend on behalf of your organization or with a team of colleagues whose roles touch upon different links in the value-based chain, you will bring back ideas and strategies that can be implemented upon your return. Register today!
January 3, 2024
Discover the Challenges and Opportunities Associated with Implementing Value-Based Care at the 量子资源网 Spring 2024 Workshop
量子资源网, Wakely, and The Focus Group Consultants available for meetings at the JPM Healthcare Conference in January 2024
量子资源网 consultants, including colleagues from Wakely and The Focus Group, will be attending the JP Morgan Healthcare Investor conference in San Francisco, January 8-10, 2024. In addition to meeting with clients, 量子资源网 will be cosponsoring a reception with Shepherd Mullin as well as participating on a panel hosted by KPMG.
鈥淲hile we鈥檝e acclimated to a more virtual business world, the JP Morgan conference represents a unique opportunity to get together in person with valued clients and partners to discuss healthcare policy dynamics, emerging investment themes, and the exciting capabilities 量子资源网 has added over the last year to support its investment clients,鈥� said Greg Nersessian, Managing Director of 量子资源网 Investment Services. 鈥淩ain or shine, we look forward to getting together and learning more about the trends that will shape healthcare investing in 2024.鈥�
, a former JPM analyst, and now a Principal and healthcare actuary at Wakely Consulting Group, an 量子资源网 Company, says 鈥淭he one inalienable truth about JPM鈥檚 annual event is that it sets the stage and tone for health care investing in the upcoming year…I鈥檒l be focused intensely on how investors see the myriad headwinds facing government-sponsored healthcare programs playing out in 鈥�24…they will surely inhibit growth but may also set the stage for opportunistic deal flow.鈥�
The Focus Group is a strategic consulting firm working on business transformation in healthcare and private equity portfolios, acquired by 量子资源网 in late 2021. Its Managing Director Alex Rich added 鈥渙ur team is eager to reflect on recent deals and provide perspectives on new theses. Based on our wide array of recent projects and experiences, we鈥檙e excited to share and prepare creative strategies for portfolio value creation in the year ahead.鈥�
Several 量子资源网 experts will be in attendance. Please with any of our team. For further information on 量子资源网 Investment Services, please contact Greg Nersessian.
量子资源网 collaborates on technical assistance report through the Medicaid Business Transformation D.C. Initiative
量子资源网 was engaged by the Washington, District of Columbia Department of Health Care Finance (DHCF) to lead their Medicaid Business Transformation D.C. Initiative, assessing the technical assistance needs of Medicaid providers and organizations in the areas of legal analysis, budgeting, and business development as they move toward value-based care arrangements. 量子资源网 partnered with the D.C. Behavioral Health Association (BHA), Medical Society of the District of Columbia (MSDC), D.C. Primary Care Association (DCPCA), and DHCF to engage, recruit, and collaborate with organizations and stakeholders across the District.
The 量子资源网 team implemented a mixed-methods assessment approach that included a literature review of national value-based payment (VBP) best practices, focus groups, interviews, and a technical assistance (TA) survey of District organizations, agencies, and stakeholders. This strategy identified the TA needs of District healthcare providers that informed the design of an intensive 3-month technical assistance program that included a variety of tools, webinars, and trainings. All resources and tools are available on the webpage.聽The report and other information about the program were published on the website.
Experts from 量子资源网 as well as Wakely Consulting Group and Lovell Communications, both 量子资源网 subsidiaries, contributed to this report. We offer our clients a wide range of deep technical, analytical, policy, and communications support to providers, state agencies, and recommendations on ways to improve value-based payment models.
Report authors include Caitlin Thomas-Henkel, Suzanne Daub, Art Jones, Hunter Schouweiler, Amanda White Kanaley, and Vicki Loner.
Link to Medicaid Business Transformation DC: Recommendations for Technical Assistance Report
To learn more about this effort, contact聽our experts below.
Be sure to block off March 5-6 for 量子资源网鈥檚 Spring Workshop in Chicago, IL, where our experts will be continuing the dialogue about value-based care. Early bird registration ends January 26, 2024.