A Listening Tour There has been much speculation about Amazon & JP Morgan & Berkshire Hathaway healthcare joint venture. Recently, the newly appointed CEO of the effort, Atul Gawande, announced he was embarking on a “listening tour” of the 1.2 million employees who work under that umbrella.
We thought we would compile the dream health care itinerary. Each stop, according to publicly available data, shines a light on the tremendous hurdles in the healthcare sector that any policy maker or executive needs tackle.
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The Trump administration, as portrayed in an recent Axios piece by Sam Baker is more than quietly revolutionizing Medicaid, it is reducing membership in the safety net payor through administrative gates, work requirements, and enforcing premiums as low as $1. Readers note: Medicaid has historically not charged premiums and this action reduces membership by adding additional barries. Additionally, most billings activities are more expense than the revenue gained. These efforts have one goal - reduce the number of individuals on Medicaid.
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Today the Health Care Cost Institute (HCCI) posted their annual report of United States health care spending. With an enviable data set of claims from commercial under 65-yr populations from. Aetna, Humana, Kaiser and UnitedHealthcare, HCCI concluded that health spending grew by 4.6% in 2016. In a vacuum that number may be seen as a success given historical year over year growth. Diving into the details we can view multiple trends that create opportunities in better managing care and ultimately supporting a reduction of costs in the future.
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Medicaid, the federally financed but state-run insurance program for the poor, now covers 1 in 5 Americans nationwide. In seven states, the number is higher ranging from 24% to 29%. The increasing size and scope is starting to draw attention from government budget directors and policy wonks, but has not drawn the attention of new technology or innovation investment given the tremendous size and market potential.
The California Health Care Foundation (CHCF), a nonprofit grantmaking philanthropy based in Oakland, is trying to change that.
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Innovation in Medicaid Medicaid continues to be an area for tremendous growth and disruption in the health care market. Served by traditional Medicaid programs, Medicaid Managed Care Organizations, and increasingly through Medicaid Accountable Care Organizations under state-based 115 waivers, the innovation and opportunities for new solutions is growing rapidly. The majority of our work focuses on bringing new solutions to Medicaid and other underserved populations. One key element that drives our work is the need for greater emphasis on non-clinical factors – specifically social determinants of health (SDOH).
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Social Determinants and Neighborhoods Social determinants of health (SDOH) are “the structural determinants and conditions in which people are born, grow, live, work and age.”via KFF. They are receiving increased attention as healthcare organizations begin to increasingly emphasize population health and value-based payment models. For Algorex Health customers, social determinants are moving to the forefront as several value-based payment programs, especially in Medicaid, begin to use social determinants to directly effect payment through risk-adjustment.
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A World Without Claims It’s an oft-repeated phrase that the fee-for-service healthcare system rewards volume not value. Thus, it incentivizes providers to simply render more care rather than render better care. The healthcare claim is the physical embodiment of that system. It is literally the bill on which a provider writes out a list a of the services and expected fees. If you have never seen one, I encourage you to look at the raw form for professional services or for institutional services.
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