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

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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How do you find a patient? It seems all too common that a provider or health analyst would say “How many patients are taking a statin?” or “How many patients didn’t have their physical?”. These are the fundamental questions of population health. The advent of electronic health data was supposed to make answering these questions easy and compared to a system on paper it does. So, when we want to know
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Health Care Reform With an on-again, off-again alphabet soup of legislative mandates and variants moving forward – ACHA, BCRA, GCHF – health care organizations are doing their best to plan for an uncertain future. What this means for the solution providers – ourselves included – is that we need to invest in flexible, scalable frameworks to deploy new outputs in support of this rapidly changing landscape. Going Forward Without a crystal ball to know the future, I am certain of one thing – the questions that organizations ask in the future are unknown today.
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10 Heatmaps 10 Libraries I recently watched Jake VanderPlas’ amazing PyCon2017 talk on the landscape of Python Data Visualization. That presentation inspired this post. In programming, we often see the same ‘Hello World’ or Fibonacci style program implemented in multiple programming languages as a comparison. In Jake’s presentation, he shows the same scatter plot in several of the libraries he featured. Below, I am following the same formula. I am recreating a heatmap about airline flights, in ten different python visualization libraries.
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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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Is this the wearable revolution? Apple Watches to Aetna Many in the Heath IT (HIT) community are abuzz on a report from CNBC that Aetna and Apple are in discussions to roll out Apple Watches to all 23 Million Aetna customers. Last week, Apple and Aetna met to discuss bringing the Apple Watch to the insurer's 23M members. More: https://t.co/RJwyp811lf @chrissyfarr pic.twitter.com/kGr9ZMrrGQ — Rock Health (@Rock_Health) August 14, 2017
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Medication Days Over the past 150 years, some of the most influential medical breakthroughs have been medications that cure disease, relieve symptoms and ultimately extend life and wellness. Considering medication data is essential for measuring the health status of a patient or population, the standards we use to measure compliance with prescriptions should be widely available. Yet processing medication data into useful statistics presents a set of unique challenges.
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The CMS division of HHS produces a freely available algorithm for determining the diagnosis risk of cost for beneficiaries. The problem with this freely available algorithm is that it is written in a technology, SAS , that is not freely usable.1 We at Algorex Health have reimplemented the HCC algorithm in Python with two aims in mind. First, we want to promote truly free algorithms for value-based analytics, contributing to a community ethos of open-source population health libraries.
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Million Dollar Burden “Health care is complicated.” It’s the joke I keep hearing at every meeting over the past two months and with health data it’s absolutely true. Even the most advanced health information systems are left with data that is classified into hundreds of thousands of granular codes. The formats of the documents are then more complicated with either EDI transactions C-CDA documents, FHIR, or just trying to make sense of a flat-file created for a point-to-point exchange.
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Open Clinical Standards and Measure Calculation with MITRE This is part 2 in our series on Open Clinical Standards with MITRE. Here is a link to part 1 Last week, we were fortunate to have been invited up to meet the staff at MITRE’s MITRE CMS Alliance to Modernize Healthcare. If you have never heard of MITRE, they are part of a consortium of Federally-Funded Research & Development Centers. Basically, MITRE serves to explore new technologies and areas for research for the US Government.
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Open Clinical Analysis There is tremendous innovation going on in the world of health analysis and health applications. From companies like ours that are using data science to learn more about patients to consumer facing apps that help manage disease or engage patients with providers. Even with all of this innovation, it can be difficult to see how all these new capabilities should knit together and communicate. There is no healthcare equivalent of the ubiquitous ACH transactions used in banking, at least not yet.
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The Trouble with Good Intentions While attending the National Quality Forum Annual Meeting this Tuesday, Farzad Mostashari MD unleashed a 29-part tweet storm that was like a quick summary of almost a decade of challenges in quality reporting. If you don’t know Dr. Mostashari, he is the former National Coordinator of Health IT and the founder of Aledade, a firm dedicated to implementing the promise of value-based care. I encourage folks to read Dr.
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“Social Determinants” are fast becoming the new buzzword in population health. Recent findings have reiterated what many intuitively know. 60% of a patient’s total health is determined not by their clinical conditions but by other factors such as where they live, their household status, and their behaviors - collectively SDOH. source The following chart from the link above summarizes the social determinants by category: Health organizations including insurance plans and hospital systems don’t have great data on these factors.
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RISE Nashville I recently returned from the amazing RISE Association Risk Adjustment Conference. In my experience, there are two types of conferences. Puff conferences that are designed to be congratulatory to the sponsors/exhibitors and the participants. Puff conferences are filled with congratulatory sessions that are a hodgepodge tales and stories from the field wrapped in the veneer education credits. Then there are conferences where people have to learn something and are getting to work and sessions are largely lead by experts.
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Algorex Health Technologies

A blog for technology, policy, and grievances in the Open Health World

Opening the Healthcare Technology Doors

Boston, Massachusetts