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Read Full Article These Five Trends Are Steering Your Future Path To Value-Based Care By Theresa Hush, CEO and Founder of Roji Health Intelligence Buckle your seat belt. Health care is changing at warp speed. The Value-Based Care movement and leaps in technology and Artificial Intelligence are rapidly generating advances that will transform the health care environment. These factors will redefine health care providers and services, and how consumers access them. How you respond strategically will determine your survival as a health system, ACO, and health care provider. All of this rests on one essential fact: Value-Based Care in 2024 has graduated from a voluntary movement into certainty. There is arguably no one in health care who believes that there is an out.” While some participants in the health care system are furiously working to get as much as possible out of the elapsing Fee-for-Service engine, everyone understands that time is limited. To successfully navigate your organization through the turbulence, you must understand these major transitions and take steps to secure your future position in a system driven by value-based revenues. Let’s start with an overview of those trends... Read Full Article Gaining More Stars in 2024: A Look at Proven Improvement Tactics for Member Satisfaction Superior member engagement sets health plans up for Star rating success in 2024. This article shares six valuable strategies to improve member satisfaction and boost Star ratings... Read Full Article Thought Leaders Weigh in on Amazon’s One Medical Acquisition When Amazon acquired One Medical, we anticipated that we would see additional, non-traditional buyers in the primary care space. Names like CVS, Walgreens, and Walmart came to mind. CVS has already expanded outside of its traditional pharmacy role into the pharmacy benefit manager space with its acquisition of Caremark and into the insurance/payer space with its acquisition of Aetna. What these moves mean for the industry is that healthcare providers who traditionally were looking to sell to private equity/venture capitalist buyers now have a broad network of potential buyers for their practice Health Plan Shake-Up Could Disrupt Coverage for Low-Income Californians By Bernard J. Wolfson Almost 2 million of California’s poorest and most medically fragile residents may have to switch health insurers as a result of a new strategy by the state to improve care in its Medicaid program. A first-ever statewide contracting competition to participate in the program, known as Medi-Cal, required commercial managed-care plans to rebid for their contracts and compete against others hoping to take those contracts away. The contracts will be revamped to require insurers to offer new benefits and meet stiffer benchmarks for care. The long-planned reshuffle of insurers is likely to come with short-term pain. Four of the managed-care insurers, including Health Net and Blue Shield of California, stand to lose Medi-Cal contracts in a little over a year, according to the preliminary results of the bidding , announced in late August. If the results stand, some enrollees in rural Alpine and El Dorado counties, as well as in populous Los Angeles, San Diego, Sacramento, and Kern counties, will have to change health plans — and possibly doctors. I’m still shocked and I’m still reeling from it,” said John Sturm, one of about 325,000 members of Community Health Group, the largest Medi-Cal plan in San Diego County, which could lose its contract. Which doctors can I keep? How long is it going to take me to switch plans? Are there contingency plans when, inevitably, folks slip through the cracks?” Sturm wondered. Sturm, 54, who has three mental health conditions, largely because of childhood sexual abuse, said finding a psychologist and psychiatrist he could trust took a lot of time and effort. He pointed to the disruption caused by the rollout of Medi-Cal’s new prescription drug program this year, despite assurances it would go smoothly. I have concerns, and I know other people in the community have concerns about what we’re being told versus what the reality is going to be,” Sturm said. Arguably, the biggest loser in the bidding is Health Net, the largest commercial insurer in Medi-Cal, which stands to lose half its enrollees — including more than 1 million in Los Angeles County alone. St. Louis-based Centene Corp., which California is investigating over allegations it overcharged the state for prescription drugs, bought Health Net in 2016, in part for its Medicaid business, of which L.A. is the crown jewel. But the state’s health plan selections are not set in stone. The losing insurers are fiercely contesting the results in formal appeals that read like declarations of war on their competitors and on the state. Some of the losers essentially call their winning rivals liars. The stakes are high, with contracts in play worth billions of dollars annually. Insurers that lose their appeals with the state Department of Health Care Services, which runs Medi-Cal, are likely to take their complaints to court. That could delay final decisions by months or years, causing a headache for the department, which wants coverage under the new contracts to start Jan. 1, 2024. State officials hope to spend the rest of this year and all of 2023 ensuring the chosen health plans are up to the task, which includes having enough participating providers to minimize disruptions in care. Member access and continuity are really our top priorities as part of this transition, and we have dedicated teams that will be working with the health plans on the transition planning and the continuity planning,” Michelle Baass, director of the department, told KHN. Baass also noted that enrollees have continuity of care rights. For example, if a member is currently under the care of a doctor during the prior 12 months, the member has the right to continue seeing that doctor for up to 12 months, if certain conditions are met,” she said. The competitive bidding process is an effort by the department to address persistent complaints that it has not effectively monitored subpar health plans. Eight commercial insurers bid for Medi-Cal business in 21 counties. They were required to submit voluminous documents detailing every aspect of their operations, including past performance, the scope of their provider networks, and their capacity to meet the terms of the new, stricter contracts. The new contracts contain numerous provisions intended to bolster quality, health care equity, and transparency — and to boost accountability of the subcontractors to whom health plans often outsource patient care . For example, the plans and their subcontractors will be required to reach or exceed the 50th percentile among Medicaid plans...