澳门六合彩

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澳门六合彩 Insights: Your source for healthcare news, ideas and analysis.

澳门六合彩 Insights 鈥 including our new podcast 鈥 puts the vast depth of 澳门六合彩鈥檚 expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.

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Solutions

澳门六合彩 knows rural.

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Some  live in rural areas in the U.S. Many rural residents must navigate healthcare system challenges people living in urban and suburban areas generally do not face. Developing and supporting rural health programs requires understanding the unique characteristics of rural settings and how these dynamics influence healthcare policy, providers, payers, consumers, and health equity.

澳门六合彩 understands the multilevel challenges for delivery of quality healthcare and social services to rural populations. From workforce concerns to access issues such as lack of services, transportation difficulties, and socio-economic barriers, we know the difficulties that often keep rural providers and organizations from achieving their full potential to serve and support their communities鈥 needs.

Changing dynamics in many rural areas also create the need for building awareness and understanding of issues of equity and reducing disparities and how to effectively address them in rural communities. 澳门六合彩 has the hands-on knowledge for practical solutions.

澳门六合彩 brings together industry-leading policy, program, financial, community, and clinical experts to provide comprehensive solutions that make healthcare and human services work better for people living in rural and frontier areas across the country. With deep experience and through skilled analysis, guidance and technical know-how, our consultants help a wide range of clients successfully navigate the healthcare space. Our team is more than 900 members strong and growing, with expertise that spans the healthcare industry and stretches across the nation.

We offer a full suite of professional health and human services consulting services to clients serving rural and frontier communities, such as:

Critical Access and PPS Hospitals

Federally Qualified Health Centers, Rural Health Clinics, & Provider Practice Groups

Health Plans

National, Regional and Statewide Associations

Federal, State, & Local Governments

Tribal nations & Tribal Health Organizations

Community Based Organizations

Foundations

Our national, multisector, multisystem experience in healthcare and human services enhances our ability to support rural clients in making sustainable, positive impacts in their local communities. Whether your project has run into a snag in the final stages or hasn鈥檛 even gotten off the ground, we can provide the expertise and guidance to help you make it a success.

Our areas of expertise include:

Analytics

Behavioral Health

Care Integration

Clinical Services

Community Strategies

Crisis Systems & 988

Government Programs & the Uninsured

Healthcare Actuarial Services

Healthcare Delivery Development & Redesign

Healthcare IT Advisory Services

Investment Services

Justice-Involved Healthcare

Long-Term Services & Supports

Managed Care

Opioid Crisis Response

Public Health

Quality and Accreditation Services

Value-Based Care

Workforce development

PROJECT SPOTLIGHT

Health Equity & Access for Rural Dually Eligible Individuals (HEARD) Toolkit

With funding from Arnold Ventures, 澳门六合彩 created the HEARD Toolkit, a robust discussion of the access challenges facing dually eligible individuals in rural areas and a portfolio of actionable solutions to address these challenges. Dually eligible individuals in rural areas reside at the intersection of a major public health crisis and a fragmented Medicaid and Medicare delivery system. They experience poor access to services and to integrated care programs (ICPs) to address their whole person needs.

澳门六合彩 designed this Toolkit to help policymakers address access issue dually eligible individuals in rural areas have to navigate every day. For example, addressing access must encompass getting to a comprehensive Medicaid and Medicare services continuum that includes home- and community-based services (HBCS), as well as ICPs. A primary focus on equity can help states, local communities, payers, and providers begin to address issues of access for these very vulnerable individuals in rural communities. The Toolkit provides examples and ideas for rural providers and communities to address equity and improve services and supports for dually eligible individuals.

For example, 澳门六合彩 can assist rural communities and the organizations that support their needs with:

Rural-specific workforce solutions

Programs addressing Social Determinants of Health/Health-related Social Needs

Payment system reforms

Development of integrated care programs for Dual Eligibles

Substance Use Disorder/Opioid Use Disorder prevention, treatment, and recovery services

Behavioral health services and supports

Justice-involved carceral healthcare and transitions

Long-term services and supports and home and community-based services

澳门六合彩 understands the multilevel challenges for delivery of quality health care and social services to rural populations. From workforce and care access issues to transportation difficulties and technology barriers, to socio-economic differences, we can help rural providers and organizations overcome challenges and achieve their goals to serve and support their communities鈥 needs.

Other Rural Health Project Examples:

澳门六合彩 is supporting review and reform of the primary care payment environment in New Mexico working under a contract with Mercer. New Mexico鈥檚 Medicaid program had identified multiple challenges the primary care providers faced across the state, including rural sustainability and fiscal soundness. 澳门六合彩鈥檚 approach includes coupling data analysis with stakeholder engagement. Our work to date includes designing, testing, and evaluating new primary care alternative payment models (APMs); fiscal, policy, and/or programmatic implementation recommendations related to the multi-payor roll-out of a primary care APM; and supporting primary care practitioners related to NM Medicaid APM implementation. Additional project work will include more provider specific analysis, recruitment for pilot testing and provide education, analysis and training for providers, health plans and state regulators.

澳门六合彩 is working with the Colorado Department of Health Care Policy and Financing (HCPF) to perform a dynamic heat mapping as the first phase of a three-phase project that includes an environmental scan of home and community-based services (HCBS)/Medicaid. 澳门六合彩 is creating a tool that HCPF can leverage to update and track progress to close provider gaps. In subsequent work 澳门六合彩 will identify potential geographic regions which would benefit from reimbursement structure changes, including geographic adjustment factors to apply to preexisting fee-for-service rates or other mechanisms to effectively address identified care gaps. Based on these results, 澳门六合彩 will recommend strategies and best practices to expand the provider network in rural areas to avoid care deserts and assure access to services for all Medicaid members.

Over the past six years, 澳门六合彩 has supported tribal communities in Montana with an array of data and evaluation expertise specific to behavioral health system assessments and evaluation activities. To date, we have conducted feasibility assessments for tribes considering options to 638 their behavioral health services, evaluated high-fidelity wraparound services in tribal communities through the Montana Systems of Care program, supported efforts to discern a concept design for a joint tribally operated Substance Use Disorder (SUD) Continuum of Care, and assisted tribally operated clinics in best practices in opioid prescribing and addiction treatment.

The Georgia Health Policy Center provides technical assistance for grantees of HRSA鈥檚 Rural Health Programs. 澳门六合彩 created a and additional tools, including a webinar, designed to inform and support rural provider leadership on Value-Based Care. The primer serves as a self-paced guide helping organizations consider national trends and experiences, assess their current state and readiness, understand benefits and barriers of Value-Based Care. The primer and tools are used by the technical assistance team and rural health grantees.

澳门六合彩 has worked with HSHS for over 10 years, providing a wide range of services including:

Grant surveillance related to strategic plans, project management, grant program development, and narrative writing for multiple state and federal grants including USDA, HRSA, and SAMHSA. 

Expanding access to medication assisted treatment (MAT) in emergency departments by activating a team of 澳门六合彩 experts to implement a global assessment of readiness to adopt MAT, create a comprehensive training curriculum, assist with development of policies, workflows and standardized orders; and provide technical assistance required to address stigma and implement change. 澳门六合彩 also aided in writing the successful proposal for state funding for this project.

Stakeholder engagement for a hub-and-spoke model of telehealth network, assessed strategic priorities across multiple diverse stakeholders, and developed a strategic plan for HSHS鈥 Wisconsin rural healthcare provider telehealth network.

Development of the Illinois Telehealth network composed of 21 rural healthcare providers across Illinois. 澳门六合彩 provided technical expertise on the adoption of telehealth services and the development of clinical protocols and led strategic planning efforts. The network now functions to support the members in disseminating best practices, implementing telehealth service lines, sharing clinical protocols, removing barriers, and promoting evaluation.

澳门六合彩 is currently assisting HSHS鈥 rural behavioral health team in devising new models of community-based withdrawal management processes consistent with recent changes in Wisconsin鈥檚 regulations. 澳门六合彩 experts on residential substance use disorder and integrated care provide technical assistance, training, and evidence-based policy development.

澳门六合彩 supported the Texas Department of Agriculture, State Office of Rural Health (SORH) by leading SORH鈥檚 three-year strategic plan and design future programs. For the needs assessment, 澳门六合彩 conducted a systematic assessment that included an environmental scan of rural health key issues and trends, online survey of rural Critical Access Hospitals (CAHs) and prospective payment systems (PPS) hospitals in Texas identify needs and gaps, and an analysis of publicly available data to identify health needs and differences between rural and urban residents. Informed by this assessment and close collaboration with SORH staff, 澳门六合彩 developed a strategic plan to guide the next three years of SORH鈥檚 programming, as well as created work and evaluation plans for the SORH and Flex grant programs. Other tasks included assessment of Texas rural hospital telemedicine readiness, recommendations for value-based payment models for rural hospitals, and opportunities to support rural hospitals in reducing health disparities.

Our depth and breadth of experience has helped a diverse range of healthcare industry leaders focused on rural and frontier areas. What can we do for you?

Contact our experts:

Kathleen Cahill

Kathleen Cahill

Associate Principal

Kathleen Cahill is a solutions-driven C-Suite executive with more than 40 years of experience in healthcare operations, working for entities … Read more

Kenneth Cochran

Managing Director, Delivery Systems

Kenneth Cochran is a healthcare executive with more than 20 years leveraging his clinical, business and academic background to deliver … Read more
Dan Castillo

Dan Castillo

Managing Principal

Dan Castillo is a seasoned healthcare executive with over 20 years of experience in health administration. He specializes in health … Read more
Stephanie Denning

Stephanie Denning

Principal

Stephanie Denning has worked in healthcare and human services for more than 25 years. Her experience spans the public, non-profit, … Read more
Shannon Joseph

Shannon Brown Joseph

Senior Consultant

Shannon Brown Joseph is a dynamic and accomplished workforce development liaison with experience in federal and state funded programs, diversity … Read more
Rebecca Kellenberger

Rebecca Kellenberg

Principal

Rebecca Kellenberg specializes in assisting public and private health care organizations with Medicaid and CHIP policy analysis and implementation. With … Read more
Jill Kemper

Jill Kemper

Senior Consultant

Jill Kemper has extensive experience improving access to care and care delivery, especially for vulnerable or complex patient populations and … Read more
Margaret Kirkegaard

Margaret Kirkegaard

Principal

Dr. Margaret Kirkegaard has extensive front line experience and an impressive breadth of knowledge about health care and its delivery. … Read more
Sarah Oachs

Sarah Oachs

Associate Principal

A collaborative health and human services professional, Sarah Oachs has vast experience in organizational leadership and assessments, operations management, and … Read more
Bill Snyder

Bill Snyder

Principal, Leavitt Partners, an 澳门六合彩 Company

Solutions

Achieving and Sustaining Success in the Health Insurance Marketplaces: Considerations for States and Managed Care Organizations

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The successful operation of the remains a key federal and state policy priority and an important business opportunity for managed care organizations (MCOs). At 澳门六合彩 (澳门六合彩), we are prepared to support both states and MCOs to achieve success in the operation of and participation in the marketplaces as these markets continue to evolve in the coming months and years.

Our team is made up of former state-based and federal marketplace leaders, insurance commissioners, state Medicaid directors, other senior government officials, payer executives, and provider leaders鈥攎eaning that we have the first-hand experience to navigate the complexities of marketplace establishment, operations, and participation toward successful outcomes. Our consultants have had expansive experience in this market since its inception. We have worked as and for federal and state regulators, enabling us to understand regulator goals. Additionally, we have worked for and with local, regional, and national MCOs on market entry strategy and/or profitability strategy. Our team has looked at the same problems from many angles and has the broadest historical perspective on the challenges and opportunities in this market.

CONSIDERATIONS FOR STATES

For states, operating a state-based marketplace (SBM) that flexibly meets the health coverage needs of the population in an efficient and responsive way is a common and critical goal. 澳门六合彩 understands the importance of establishing and continually operating a strong and lasting SBM capable of weathering and protecting against current and future threats to access and affordability. Key SBM policy outcomes include:

Local Control and Better Coordination

SBMs can increase enrollment and reduce gaps in coverage for families through closer alignment with the Medicaid program, customer-centric policies and procedures, and local, tailored engagement and outreach.

Lower Costs and Improved Consumer Protections

SBMs can establish plan design standards, coverage requirements, and consumer protections to improve choice and competition, lower out-of-pocket costs, and protect access to the affordable care individuals need and deserve.

Universal Coverage

Through innovative enrollment initiatives, federal waivers, and affordability programs, SBMs can be a catalyst for additional reforms to put the state on the pathway to universal coverage.

To be able to successfully accomplish the policy aims outlined above, states must excel across and within a range of strategic and operational areas including: organizational development and implementation, governance and project management, vendor procurement and oversight, strategic policy development, maximizing federal funding and financial management, federal compliance, stakeholder engagement, and communications and training. 澳门六合彩 can support states in all these areas with services that enable operations, regulatory compliance, strategy, and policy advancement.

CONSIDERATIONS FOR MCOS

For MCOs, the marketplace represents a key business opportunity where existing capabilities can be leveraged as part of a successful growth strategy. With our extensive regulatory expertise and expansive state market knowledge, 澳门六合彩 understands that customized support is necessary to allow MCOs to succeed in the marketplace as either a new market entrant or an existing participant. For MCOs, the marketplace has the following features:

A Highly Regulated Environment

At the federal and state levels, the marketplace environment has strict standards in terms of plan design, rating rules, network adequacy, marketing practices, producer (broker and agent) activities, and marketing practices.

Significant Public Funding

As a result of the marketplace premium tax credits, most marketplace consumers qualify and as a result, significant public funding is involved.

An Evolving Market

The end of the Medicaid continuous enrollment condition as of March 31, 2023, which has been in effect throughout the Coronavirus Disease 2019 Public Health Emergency, makes providing coverage in the marketplace even more critical鈥攁s millions of individuals transition to this market after losing Medicaid coverage.

How 澳门六合彩 can help

澳门六合彩 can support clients every step of the way in the planning and execution of efforts to participate in and optimize performance for the marketplace. To achieve and maintain success in the marketplace, MCOs must excel across strategic, operational, and analytical areas including:

Market analysis and feasibility

Operational gap analysis

Product management scoping

Vendor procurement

Regulatory filings development and implementation

Actuarial analytics

Provider contract reimbursement analysis, and

Network development

澳门六合彩 can bring to bear a comprehensive continuum of services to solve your most pressing marketplace challenges.

If you have questions about how 澳门六合彩 can support your state or MCO related to the marketplace, please contact Zach Sherman, managing director or Patrick Tigue, managing director.

Contact our experts:

Zach Sherman

Zach Sherman

Managing Director

Zach Sherman is an Affordable Care Act (ACA) expert and Health Insurance Marketplace leader with extensive experience with start-ups and … Read more
Patrick Tigue

Patrick Tigue

Managing Director, Regional Managed Care Organizations

Patrick Tigue is an accomplished executive with experience leading and managing critical efforts to achieve strategic health policy goals on … Read more
Solutions

Privacy and Security Assessment and Support Services

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One of the most important challenges for a health data organization is ensuring that its policies and procedures remain compliant with the dynamic landscape of federal and state privacy and security statutes, regulations, and industry standards.

澳门六合彩 brings applicable experience and expertise to assist state agencies, non-profit organizations, and other entities that are responsible for all-payer claims databases, hospital discharge databases, and other datasets containing confidential and sensitive health data with:

Reviewing existing policies and procedures to identify gaps and needed updates to ensure compliance with regulations and adherence to best practices and industry standards.

Recommending revisions based on the assessment review and helping prioritize changes based on risk analysis.

Updating policies and procedures based on the approved recommendations.

Developing a training program for staff regarding the updated privacy and security policies and procedures via in person training, virtual training, and/or creating training videos.

澳门六合彩鈥檚 privacy and security assessment and support services capabilities include the following qualifications and expertise:

Holding leadership roles at state health data organizations and on the National Association of Health Data Organizations Board

Coordinating health information technology (HIT) for state Medicaid agencies

Leading state value-based purchasing agencies

Founding HIT strategic consulting firms

Experience with the National Association of County and City Health Officials

Project management and strategic planning support for multiple state agencies and data organizations

Privacy and security legal expertise

In addition, 澳门六合彩 offers the knowledge and experience of more than 700 consultants to supplement our privacy and security expertise with local healthcare knowledge and support to comprehensively address an organization’s needs.

Contact our experts:

Melissa Mannon

Melissa Mannon

Associate Principal

Melissa Mannon is an alternative payment model expert with experience developing, implementing, and evaluating alternative payment models in Medicaid and … Read more
Craig Schneider

Craig Schneider

Principal

Craig Schneider is a leader in developing and implementing payment reform strategies, promoting all-payer claims databases (APCDs), and engaging stakeholders … Read more
Stuart Venzke

Stuart Venzke

Managing Director, IT Advisory Services

Stuart Venzke has over 30 years of experience improving the effectiveness, efficiency and responsiveness of health and human services (HHS) … Read more
Solutions

Helping Clients Succeed in Value Based Payments

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As Medicare, state Medicaid agencies, Medicare Advantage plans, Medicaid managed care organizations, and commercial insurers increasingly adopt alternative payment models (APMs), 澳门六合彩 (澳门六合彩) provides a range of innovative and successful approaches to value-based care (VBC).

Our subject matter experts can help you succeed with
value-based payments (VBP).

WHAT WE DO

Offer insights for transforming the care delivery model to efficiently deliver optimal patient and population-level health outcomes while successfully managing total cost of care

Ensure quality is the primary goal of VBP program design and implementation

Develop payment models that align the incentives of payers and providers

Integrate physical and behavioral healthcare, and close gaps related to social determinants of health and health equity

Help clients successfully transition from fee-for-service to value-based payments by providing expertise in change management, analytics, network engagement, and IT infrastructure

Improve the patient and provider experience

Qualify, manage, and monitor health insurance risk

Prepare for and succeed in accreditation for VBP capabilities

ORGANIZATIONS WE SUPPORT

Those engaged in VBP or interested in engaging in VBP

Payers

Providers

Purchasers

Those interested in advancing the broader movement to value

Federal, State & Local Governments

Associations

Foundations

Investment Firms

澳门六合彩 Can Support You Through All Phases of Value-Based Care

From contract to care plan, we have the experience and guidance tools to support your organization鈥檚 move to value-based care and risk-based contracting.

value based payment graph

This graphic showcases the capabilities needed to address the complexities of risk-based contracting and deliver value-based care. As your organization moves from left-to-right along the glidepath to risk, additional strategies and capabilities must be developed. For example, utilizing Institute for Healthcare Improvement frameworks for quality improvement, regulatory and credentialing needs, and specialty access within a clinically integrated network. NEJM Catalyst. (2017). What is value-based healthcare?

Our philosophy involves applying a health equity model to close social determinant gaps and health disparities. Value-based healthcare is all about the care delivery model. Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects of emerging/rising risks and incidence of chronic disease, and live healthier lives in an evidence-based way.

Our Comprehensive Approach

Our collaborative approach will be tailored and customized to your needs to help you successfully implement VBP.

Our integrated process is based on the following model:

WHAT 澳门六合彩 PROVIDES

Determine readiness across key building blocks for moving to value-based payments and achieving continuous improvement across healthcare organizations.

Implementation that includes benchmarks and measurements of success. We facilitate stakeholder input to capture and analyze data from these interactions through surveys, focus groups, and interviews.

Aligning incentives with providers is key to successful value-based care strategies. Understanding methods for identifying and closing gaps in care pathways for common chronic conditions or addressing rising/emergent risks as well as how to create buy-in among providers and other members of the care team.

Including actuarial expertise required for contracting in key areas such as financial projections, reserves, total cost of care analysis, and benchmarking. We provide an assessment of third-party software to support APMs.

Including methods for incorporating whole-person care into clinical algorithms that apply to every interaction with the patient and their families. Integrating behavioral health with physical health and addressing social determinants of health/health-related social needs into VBC programs.

Assist with identifying key performance indicators (KPIs) and quality measurement incentives
for pay-for-performance or pay-for- value to support population health outcomes and support total cost of care in various VBP arrangements.

Provide support and consultation on scope of requirements to ensure VBC contract meets delegation requirements for operational, state, CMS regulatory and accreditation requirements.

OUR EXPERTS INCLUDE

Former CEOs, COOs, CFOs, and chief medical officers and other physician executives as well as executive quality leaders of the following organizations:

Providers including hospitals, academic medical centers, physician practices, community health centers, rural health centers, and federally qualified health centers

Medicaid, Medicare, Marketplace and Commercial MCOs

State and federal agencies

In addition, 澳门六合彩 offers expert actuaries, coders, analytic staff, and clinicians to support your transformation.

Contact our experts:

Brent Barkett

Brent Barkett

Principal

A purpose driven leader and recognized expert in healthcare value transformation, Brent Barkett has a unique combination of clinical application, … Read more

Caprice Knapp

Managing Director, Quality and Accreditation

A health economist and evaluator, Caprice Knapp has more than 20 years鈥 experience working on Medicaid and Children鈥檚 Health Insurance … Read more
Craig Schneider

Craig Schneider

Principal

Craig Schneider is a leader in developing and implementing payment reform strategies, promoting all-payer claims databases (APCDs), and engaging stakeholders … Read more
Solutions

Expanding Access to High Quality Sexual Health Care and STI Prevention

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In 2022, more than 2.5 million cases of syphilis, gonorrhea, and chlamydia were reported in the United States. There were alarming increases in syphilis cases in particular 鈥 there has been an 80% rise in syphilis cases since 2016 and in 2022, there were 3,755 cases of syphilis among newborns reported (163% increase since 2018). While sexually transmitted infections (STIs) occur in all populations, some groups are more affected, including young people, gay and bisexual men, transgender individuals, and pregnant people. There are deep inequities in the rates of STIs including disproportionate rates among racial and ethnic minorities which are the result of longstanding social and economic structural inequities. 

Sexual health services are being threatened and have inequitable resources which further complicates care for those individuals with lived experience with STIs, HIV, and viral hepatitis. They often experience additional and intersecting sexual health, behavioral health, and social needs that must be addressed concurrently.

STI Graphic CDC

澳门六合彩 brings together experts from a full spectrum of sexual health services including policy, clinical, operations, and research.

Our experts have significant experience with conducting needs assessments and gap analyses, supporting syndemic (HIV/STI/Hepatitis) planning, centering health equity, and leveraging policy and research findings to maximize impact and access. A syndemic is a situation in which two or more interrelated biological factors work together to make a disease or health crisis worse.

We work with clients to reach shared goals of supporting sexual health, expanding access to screening, vaccines and other preventative services, reducing high rates of STIs including HIV, and addressing deep and persistent racial disparities in STI rates and the inequities that drive them.

We can help organizations including:

State and municipal departments of health and public health

Health plans

Community-based organizations (CBOs)

Behavioral Health Service Organizations

Federally Qualified Health Centers

Title X Clinics

Planned Parenthood affiliates and other free-standing women鈥檚 health centers

Foundations

Associations and Coalitions

Our sexual health experts include:

Former senior officials from the Health Resources and Services Administration and the Center for Disease Control and Prevention.

Advocates and former senior leaders of community-based organizations, foundations, and other programs that support healthcare systems capacity to implement quality STI prevention, screening, diagnosis, surveillance, and treatment.

Clinicians with experience providing sexual health services and building programs at the intersection of sexual health, behavioral health, primary care and maternal and child health.

Social workers and behavioral health professionals working to integrate approaches that address social and behavioral health needs.

Program development, strategic planning, and technical assistance experts working to implement innovative solutions and evidence-based guidelines.

Researchers and evaluators with extensive experience examining the implementation and impact of policy and operational changes on sexual health services.

Our experts can support your work to expand equitable access to sexual health care.

With offices in more than 30 locations across the country and over 700 multidisciplinary consultants with a wide spectrum of industry experience, and longstanding expertise in all 50 states, 澳门六合彩 has experienced staff in syndemic needs assessments and planning, program evaluation, research and analysis, strategic/business planning, clinical services, stakeholder engagement, quality improvement, and workforce development. Our portfolio of companies also gives you access to actuarial, data analytics and communications expertise, and more.

OUR WORK

South Carolina Department of Health and Environmental Control (DHEC) contracted with 澳门六合彩 to conduct a statewide gap analysis to document the array of partner services and disease intervention STI inside and outside the department and identify gaps and duplication to improve services and strengthen the program. As part of this engagement, 澳门六合彩 conducted an analysis of South Carolina鈥檚 STI delivery system, staffing capacity and processes, and developed a service location map to highlight gaps and inequities. The final report summarized findings and included recommendations for closing gaps in service delivery, workforce development and improving the efficiency and effectiveness of service delivery.

澳门六合彩 supported the Washington State Department of Health鈥檚 Office of Infectious Disease in taking a syndemic approach to ending the HIV, STI, and viral hepatitis epidemics. A key activity of this project included supporting the Office of Infectious Disease to establish a new planning body that reflects the populations served by transforming their Statewide HIV Planning Group and launching a new communicable disease (syndemic) planning group. This work included conducting research on other statewide planning group structures, collecting community and stakeholder input, developing and operating structure, charter, and bylaws; recruiting and onboarding a diverse membership; and creating organizational change management, all with a focus and commitment to advancing racial equity. Through this work, 澳门六合彩 also drafted the state鈥檚 integrated HIV Prevention and Care Plan and Requests for Applications to help distribute state funds to local intervention efforts that advance the goals of this plan.

As part of our extensive area of work in strategic planning with state and local agencies, providers of health and human services, community-based organizations and many more, 澳门六合彩 has worked with clients that provide sexual and reproductive health care services to assess potential opportunities and approaches for expansion, delivery, and financing of care to reach underserved communities.

澳门六合彩 worked with the Wyoming State Department of Health to conduct their HIV needs assessment and developed their Integrated HIV Prevention and Care Plan. This work included collecting and analyzing data on HIV incidence and prevalence; developing HIV, STI, and viral hepatitis ecosystem maps; facilitating workgroup meetings; collecting additional community and stakeholder input through provider and community surveys and focus groups; and developing a written report of the assessment findings, all with a focus and commitment to advancing health equity.

澳门六合彩 worked closely with the Boston Public Health Commission to conduct an extensive HIV needs assessment. Activities included key stakeholder interviews, focus groups, surveys and data collection and analysis. Emphasis was placed on the intersection of HIV and drug user health. 

澳门六合彩 team members developed and implemented professional development training series entitled 鈥淭he Intersection of HIV and SUD鈥 on behalf of the Minnesota Department of Health. The 12-hour curriculum was developed in partnership with several community organizations representing Tribal, African American, and LGBTQIA+ communities. The training is delivered virtually and includes topics such as: understanding HIV; HIV risk reduction; SUD harm reduction; chemsex; HIV and stigma, pregnancy and HIV; and cultural, racial and sexual identities.

Contact our experts:

Julie Rabinovitz

Julie Rabinovitz

Principal

Julie Rabinovitz specializes in sexual and reproductive health policy, strategy, and operations. She assists healthcare organizations with program planning and … Read more
Charles Robbins

Charles Robbins

Principal

Charles Robbins has been transforming communities for the past three decades. His extensive community-based organization career spans healthcare, child welfare, … Read more
Kate Washburn

Kate Washburn

Associate Principal

Kate Washburn is a public health and program leader with over 20 years of experience in both public health departments … Read more
Solutions

CalAIM Justice-Involved Reentry Initiative Planning and Implementation Services

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Organizations are facing extensive challenges to improve health outcomes and healthcare quality through broad delivery, payment, and program reforms in CalAIM. With proven expertise in CalAIM policy, operations, and implementation, 澳门六合彩 (澳门六合彩) can help you with identifying needs, developing a strategy, and implementing those plans. We actively support clients across California implementing the CalAIM Section 1115 Waiver Demonstration Justice-Involved Initiative. Our team of Medi-Cal, managed care, and correctional healthcare experts 鈥 including physical and behavioral health clinicians, healthcare administrators, and former correctional leaders 鈥 are uniquely positioned to help clients navigate this delivery system transformation.

California is the first state in the nation to receive approval from the Centers for Medicare and Medicaid Services (CMS) to provide detained and sentenced individuals with 90-day pre-release healthcare services and behavioral health linkages. Through PATH JI grant funding, 澳门六合彩 is helping clients build administrative capacity, information technology, pre-release services, care management models, and Medi-Cal claiming infrastructure to meet their unique needs and leverage this significant opportunity. Our planning and implementation support spans the breadth of the CalAIM Justice-Involved Initiative including: the pre-release Medi-Cal application process, 90-day pre-release services, behavioral health links, Enhanced Care Management (ECM), and Community Supports services.

That鈥檚 why sheriffs鈥 departments, probation authorities, correctional health services agencies, behavioral health agencies, managed care plans, healthcare providers and community-based organizations see 澳门六合彩 as a trusted partner in helping to develop and implement 1115 waiver healthcare programs.

We provide:

Project management

State policy monitoring and compliance tracking

Current and future state process mapping

Partner and stakeholder collaboration and meeting facilitation

Process and quality improvement recommendations

Protocol development

Implementation plan and readiness assessment drafting

Training

Electronic health record recommendations

Contact our experts:

Rebekah Kharrazi

Rebekah Kharrazi

Associate Principal

Rebekah Kharrazi is an accomplished public health professional with a broad range of expertise and skills to help clients navigate … Read more
Julie White

Julie White

Principal

With more than 25 years of experience in comprehensive healthcare and justice-related service delivery, Julie White has developed policy, strategic … Read more
Solutions

School-based Mental Health

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Schools face resource challenges

Public schools face persistent pressure to serve as the central point for addressing children’s overall health and well-being. Behavioral health and access to care challenges were a growing concern affecting school populations even before the Covid pandemic.

Youth are experiencing behavioral health crises at an alarming rate, and schools are struggling with insufficient resources for students to receive the necessary person-centered care and support. Sustainable funding streams, including options like Medicaid and alternate funding methods, could help schools effectively cover expenses. New temporary funding streams are available (e.g., CMS School Based Health Services Program, Bipartisan Safer Communities Act, and multiple state funding initiatives) but schools often lack the necessary infrastructure, administrative support, and awareness of community resources to effectively utilize these funds.

Our Clients

澳门六合彩 works with state and local education agencies, school districts, county offices of education, departments of public instruction, social service agencies, public health, school boards, and family and parent organizations to support school-based mental health initiatives. 

Through innovations in community partnerships, evidence-based programming, and design that support healthy children and promising futures, there is opportunity to enhance school outcomes. Students’ well-being and mental health directly impact their overall educational experience and achievement. By addressing these challenges and investing in comprehensive BH support within schools, we can help schools design an environment that furthers the well-being and success of all students.

澳门六合彩 can help school systems:

Add capacity for project management support for whole-child approaches to improved health

Reduce duplication of services

Assess opportunities to better leverage new and existing resources and dollars through blended and braided funding and existing community-based supports to enhance utilization

Strengthen infrastructure and awareness and establish collaborations and partnerships to ensure effective utilization of available funding and shared resources

Break down bureaucratic silos and promote interagency cooperation

Improve information and data sharing

Emphasize preventative behavioral and physical care

Assess strategies for workforce shortages

Develop and implement evidence-based integrated care clinics within schools

Deliver training for administration, staff, parents, and community partners that helps achieve successful adoption

Implement targeted initiatives to address ongoing and pervasive stigma surrounding behavioral health, particularly in specific cultures and communities

澳门六合彩 has the right team

With our expertise and collaborative approach, we empower schools and school districts to proactively address the youth behavioral health crisis and create a supportive educational environment for all students.

Our team members have extensive careers in school-based mental health, direct clinical behavioral health practice, healthcare systems, as well as government social services and public health, community organizations, and school-based leadership. Our experts have worked with every type of stakeholder, gaining invaluable insights and understanding. We meet schools where they are and help to right-size service offerings. 澳门六合彩 can bring a fresh perspective on school-based services, and help you shift from reactive to proactive.

Contact our experts:

Annalisa Baker

Annalisa Baker

Associate Principal

Along with a comprehensive understanding of the behavioral healthcare continuum, Annalisa Baker鈥檚 experience includes business operations, project management, finance, and … Read more
Michael Butler

Michael Butler

Associate Principal

During his career, Michael Butler has directed hundreds of program evaluation, organizational development, and technical assistance projects in a wide … Read more
John Eller

John Eller

Managing Principal

John Eller is a seasoned executive with more than 23 years of service in public administration and health and human … Read more
Jennifer Hodgson

Jennifer Hodgson

Principal

Jennifer Hodgson is a licensed marriage and family therapist who maintained a private practice and taught in higher education for … Read more
Trish Marsik

Trish Marsik

Principal

Trish Marsik has extensive experience supporting providers, healthcare organizations, and state and federal governments to provide quality behavioral healthcare.聽 Prior … Read more
Solutions

Using Virtual Research Data Center (VRDC) Data to Answer Big Questions

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澳门六合彩 (澳门六合彩) is utilizing Virtual Research Data Center (VRDC) data to do what 澳门六合彩 does best: solve publicly funded healthcare鈥檚 most challenging problems. The combination of our deep analytics expertise and our nationally renowned subject matter experts can help you solve your toughest challenges.

We are committed to helping clients meet their needs through:

Market Analysis

Want to know how many psychologists are treating Medicaid patients in a county? Or how many duals got NEMT in a year? We can tell you that. How many folks on Medicare got drugs for Memory Loss last year? We can tell you that too. The VRDC allows us to examine the Medicaid and Medicare populations with significant precision to inform your decisions.

Consulting Services

We love hard questions. Carefully designed smaller queries can add up to answer big questions like 鈥淒oes access to Non-Emergency Medical Transportation help patients managing challenging chronic medical conditions?鈥 or, 鈥淎re services critical to patient success being delivered equitably to patient populations?鈥 澳门六合彩 can help you answer your hardest questions by breaking them into smaller questions that add up to big results. Outcomes Survey (HOS) specific to BH, and align data performance to quality improvement efforts.

Quality Improvement and KPI Benchmarking

澳门六合彩鈥檚 team of quality experts can help you identify metrics that matter internally to your organization as well as to your payers and providers. We can run metrics against these Medicaid and Medicare data to prepare you to manage risk through deep data analysis and creation of benchmarks that help manage access, cost, quality, and utilization.

澳门六合彩鈥檚 access to VRDC data through this agreement include:

Data representative of 100 percent of Medicare and Medicaid beneficiaries and their medical experience expressed as claims

Data representative of 100 percent of Part D Drug Event (PDE) data

Detailed Long-Term Care data for all Medicare and Medicaid beneficiaries through the MDS dataset

We can help organizations including:

State and municipal departments of health and public health

Health plans

Provider organizations

Analytics and technology vendors

Private equity

Correctional health

Contact our experts:

Jim McEvoy

Jim McEvoy

Data Analytics Resources Director

Jim McEvoy is accomplished in architecting robust technology solutions for state agencies, health plans and service providers. Jim understands the … Read more
Solutions

Consumer Assessment of Healthcare Providers Systems (CAHPS): Improving Member Experience

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Medicare and Medicaid plans are faced with a barrage of regulations, including quality rankings. To improve rankings plans can, and should, work to improve their Consumer Assessment of Healthcare Providers Systems (CAHPS) scores.

The CAHPS annual survey measures member experience with providers and Medicare and Medicaid health insurance plans. It has also become a critical metric used by the Centers for Medicare and Medicaid Services (CMS).

Plans can work to improve CAHPS scores by developing a comprehensive improvement plan involving a holistic year-around approach that involves monitoring the member experience from enrollment through disenrollment. With score improvement comes incentive payments tied to high quality performance.

CAHPS SCORES ARE USED BY:

The National Committee for Quality Assurance (NCQA) to STAR rate health plans in accreditation scoring

Potential members to compare plan scores against one another on the NCQA website

Several state Medicaid programs that require plans to report these surveys and use scores as part of their incentive programs

CMS, which has increased its STAR rating, CAHPS-related measure from double weighted to quadruple weighted in contract year 2021

Medicare Advantage Prescription Drug (MAPD) plans, which use CAHPS to calculate 32% of the overall aggregate score

CAHPS COHORTS THAT ARE MEDICARE STAR MEASURES

PART C CAHPS MEASURES (WEIGHTS)

Getting needed care (4)

Getting appointment and care quickly (4)

Customer service (4)

Rating of healthcare quality (4)

Rating of health plan (4)

Care coordination (4)

Annual flu vaccine (1)

PART D CAHPS MEASURES (WEIGHTS)

Rating of drug plan (4)

Getting needed prescription drugs (4)

ADDITIONAL STAR MEASURES AND ACTIVITIES THAT RELATE TO MEMBER EXPERIENCE

PART C MEASURES (WEIGHTS)

Complaints about the health plan (2)

Member choosing to leave the plan (2)

Plan makes timely appeals decisions (2)

Reviewing appeal decisions (2)

Call center, language interpreter and TTY availability (2)

Health plan quality improvement (5)

PART D MEASURES (WEIGHTS)

Call center, language interpreter and TTY availability (2)

Complaints about the drug plan (2)

Member choosing to leave the drug plan (2)

Drug plan quality improvement (5)

澳门六合彩鈥 expert colleagues can help plans outline an organizational assessment of member experience and customize interventions and solutions to increase scores.

Our team of quality and accreditation experts can help organizations improve customer service and scores by:

Establishing a year-around effort

Using an organizational effort to break down department silos and improve cooperation between departments

Assessing core functions within the plan and contractors that contribute to member experience including marketing, enrollment, disenrollment, UM, QI, member service, grievances, appeals, etc.

Identifying and addressing patient frustrations with providers and plans before they become problematic

Leveraging information technology to make websites more user friendly

Addressing care and service gaps to ensure member outreach is calibrated and tailored throughout the year

Recognizing social determinants of health (SDOH) are often overlooked in access to care-related issues, such as lack of transportation or lack of funds for co-payments

Outlining techniques for obtaining point-of-service feedback to help address potential member experience issues before they arise

Contact our experts:

Sarah Owens

Sarah M. Owens

Principal

A diligent and forward-thinking leader with expertise in managed accountable care and operations that bridges health plan and provider sides … Read more
Mary Walter

Mary Walter

Principal

Mary Walter is an accomplished executive leader with more than 30 years of experience in healthcare including extensive work in … Read more
David Wedemeyer

David Wedemeyer

Principal

David Wedemeyer is an established data expert and a seasoned consultant with expertise developing Healthcare Effectiveness Data and Information Set … Read more
Solutions

Star Rating: We Can Help You Navigate to a Higher Level

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What is the VALUE of a Star in your plan(s)?

What initiatives have you introduced to prepare for the changes in the Star Rating that may impact your overall Star Rating results?

What are you doing for health equity focus? What data are you collecting for health equity?

What do you think are your organization鈥檚 financial implications when Star Rating requirements change?

What are your Star Rating strategies for increasing your organization鈥檚 market share and viability?

What sort of interventions, data sources, analytics and reporting have you found to be successful to improving your Star Rating?

WE CAN HELP YOU BY:

Establishing a year-around effort to improve Star Rating performance

Assessing core functions within the plan and contractors that contribute to understanding members

Identifying and addressing customer concerns with providers and plans before they become problematic

Leveraging information technology to make websites more user friendly

Addressing care and service gaps to ensure member outreach is calibrated and tailored throughout the year

Working on health equity issues including sharing techniques for obtaining data

Leveraging all data and intervention efforts (such as risk and quality) to drive decision and focus

Contact our experts:

Sarah Owens

Sarah M. Owens

Principal

A diligent and forward-thinking leader with expertise in managed accountable care and operations that bridges health plan and provider sides … Read more
Mary Walter

Mary Walter

Principal

Mary Walter is an accomplished executive leader with more than 30 years of experience in healthcare including extensive work in … Read more
David Wedemeyer

David Wedemeyer

Principal

David Wedemeyer is an established data expert and a seasoned consultant with expertise developing Healthcare Effectiveness Data and Information Set … Read more
Solutions

澳门六合彩 Can Help You Prepare for The Joint Commission (TJC) Accreditation and Certification

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澳门六合彩鈥檚 team of experts have completed accreditation requirements with our clients as well as in our formal executive and operational leadership roles in the health care setting.  We work closely with our clients and with TJC and other accreditation programs with a focus on improving healthcare quality and favorable outcomes. Our team of seasoned healthcare executive consultants bring more than 100 years of experience in clinical, quality, and operations, with proven results. 澳门六合彩 offers a full continuum of accreditation services for hospitals, ambulatory surgical centers (ASCs), Federally Qualified Health Centers (FQHCs) and behavioral health (BH) care settings. We work closely with FQHCs to provide assistance for certifications and advanced certifications in health equity (HE). 澳门六合彩 can offer onsite or virtual mock survey and gap analysis preparation for TJC accreditation, as well as tactical and advisory support to prepare our client leadership teams for a winning accreditation survey results and supporting the development of a sustainable plan to achieve year over year success!

Our experts can help you by:

Assessing core functions supporting the implementation of the latest TJC standards and interpretation of the standards

Building the business case for TJC accreditation

Guiding your team through the new HE standards

Creating quality and assessment improvement plan (QAPI) to lead to a successful survey

Continuous survey readiness support via a sustainable plan

And so much more across the continuum

Contact us at [email protected]

Contact our experts:

Trisha Bielski

Trisha Bielski

Senior Consultant

A highly specialized critical care, trauma and flight nurse, Trisha Bielski has deep experience in nursing leadership, military healthcare, and … Read more
Ruth Danielzuk

Ruth Danielzuk

Senior Consultant

Driven by collaboration across the healthcare landscape, Ruth Danielzuk is a seasoned quality and innovation expert with experience managing programs … Read more
Matthew Sandoval

Matthew Sandoval

Principal

Matthew Sandoval is an accomplished leader in healthcare with a proven track record of managing the administration, operations, and quality … Read more
Mary Walter

Mary Walter

Principal

Mary Walter is an accomplished executive leader with more than 30 years of experience in healthcare including extensive work in … Read more
Solutions

Leading ideas and solutions for long-term services and supports

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Dedicated to supporting the effectiveness of publicly financed healthcare programs, 澳门六合彩 (澳门六合彩) is committed to promoting the design, financing and operation of effective models of person-centered long-term services and supports (LTSS) which:

Support an individual鈥檚 ability to receive services in the most integrated setting

Promote successful community living

Improve integration of LTSS with quality physical and behavioral healthcare

Support Medicare and Medicaid integration and coordination

Address the social determinants of health for people with support needs

Support direct care workforce initiatives for states, managed care organizations and long-term care providers

Support strategic planning focused on long-term care

Support managed care readiness initiatives

What we offer

With deep expertise in the field, our colleagues and the work we do help to shape current system trends. In addition, we support improved outcomes for beneficiaries and successful participation for the wide range of LTSS providers including managed care organizations, states offering critical services, and purchasers through:

LTSS Models of Care

Developing and promoting person-centered integrated, and holistic LTSS models of care

LTSS Quality Standards

Supporting the development of LTSS quality standards and metrics, including technical assistance for NCQA and other accreditation and credentialing

LTSS Regulatory Compliance

Facilitating readiness and compliance with federal and state regulations, including home and community-based settings of care, Medicaid managed care, the Fair Labor Standards Act, and the Americans with Disabilities Act

LTSS Integration

Implementing care management and service delivery models that promote integration of services across physical, behavioral, and LTSS providers and between Medicare and Medicaid including those developed under PACE, managed LTSS, and managed fee-for-service

LTSS Stakeholder Engagement

Supporting effective community engagement by public policy makers, and empowering advocacy organizations and other stakeholders in understanding, shaping, and responding to change

LTSS Delivery and Payment Models

Assisting organizations and providers to prepare and respond to payment and structural changes in LTSS (e.g., managed care, accountable care, value-based purchasing)

LTSS and Social Determinants Design

Designing innovative approaches to addressing the social determinants of health, including improved strategies for affordable and accessible housing, competitive employment for persons with disabilities, access to technology, and social equity-based care delivery models

LTSS Market Analysis

Providing expert market analysis for investors relating to LTSS providers, managed care organizations, service vendors, or emerging trends in the LTSS landscape

LTSS Research and Evaluation

Enabling the use of data to uncover opportunities for improvement and to demonstrate value to ACOs, hospital systems, payers, and funders

Our wide-ranging expertise includes:

Medicaid LTSS waiver and state plan authority options

Operation and oversight of managed LTSS

Public procurements

LTSS provider operations

Federal and state compliance

Care management and care coordination

Workforce development

Strategic planning and practice redesign

LTSS policy analysis

Value-based purchasing

Quality monitoring, evaluation and research

Community capacity and network adequacy

Readiness reviews

Our Clients Include:

Federal, state and local governments

For-profit, not-for-profit and public health plans

Institutional and home and community-based services providers and their associations

National, state and local advocacy organizations

National and regional foundations

Direct care workforce representatives

Investment services entities

Contact our experts:

Sharon Lewis

Sharon Lewis

Principal

Sharon Lewis is a nationally lauded expert in federal and state disability policy, including home and community-based services (HCBS), education, … Read more
Susan McGeehan

Susan McGeehan

Associate Principal

Susan McGeehan is a multi-faceted healthcare leader with extensive experience in dual eligible programs, long-term services and supports (LTSS), Medicaid … Read more