Many new moms get kicked off Medicaid 2 months after giving birth. Illinois will change that.Many new moms get kicked off Medicaid 2 months after giving birth. Illinois will change that.Many new moms get kicked off Medicaid 2 months after giving birth. Illinois will change that.

Many new moms get kicked off Medicaid 2 months after giving birth. Illinois will change that.

In April, Illinois became the first state to be approved by the U.S. Department of Health and Human Services to extend Medicaid up to a full year after a pregnancy.

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Expanding insurance coverage is top priority for new CMS administratorExpanding insurance coverage is top priority for new CMS administratorExpanding insurance coverage is top priority for new CMS administrator

Expanding insurance coverage is top priority for new CMS administrator

“We’ve seen through the pandemic what happens when people don’t have health insurance and how important it is,” said Chiquita Brooks-LaSure. “Our focus is going to be on making sure regulations and policies are going to be focused on improving coverage.”

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Detroit, Miami, New York have biggest ‘payvider' opportunitiesDetroit, Miami, New York have biggest ‘payvider' opportunitiesDetroit, Miami, New York have biggest ‘payvider' opportunities

Detroit, Miami, New York have biggest ‘payvider' opportunities

Detroit, Miami, Phoenix and New York are among the markets with the most room for so-called "payvider" partnerships to grow, a new report finds.

The consultancy Guidehouse studied more than 100 U.S. markets' populations, insurance enrollment and cost and quality metrics to compile its report, which is designed to help providers and insurers in each area decide whether to partner up or go it alone. Increasingly, payers and providers are boosting their returns by teaming up on risk-based collaborations, either in the form of partnerships or formal joint ventures with asset transfers.

The industry is at an inflection point in terms of how payers and providers are incentivized to keep patients healthy, said Dr. Nicole Fetter, a director with Guidehouse.

"Payers need providers to perform on quality, cost and access more than ever to earn full revenue potential," she said, "and providers need payers and purchasers as they're insuring the patients and members that the providers serve."

Guidehouse found the metro areas around Detroit, Miami, Phoenix, Tampa and New York have the highest current Medicare Advantage and managed Medicaid penetration combined with expected enrollment growth. They also showed room for improvement on cost and utilization metrics such as Medicare per capita costs, Medicare Advantage star ratings and emergency department utilization.

Other metros in that category include Charlotte, N.C., Orlando, Cincinnati and Cleveland. Cleveland's rating, for example, suggests there is substantial opportunity to boost value with respect to cost and quality, the report said. There's also demographic shifts happening that will fuel growth in Medicare and Medicaid managed care membership.

Fetter acknowledged that the markets within each of the report's categories are very different from one another, and said it's because a variety of components go into the scores. For example, Miami scored low on value because its Medicare per capita costs are so high. In Detroit, by contrast, there's poor primary care access and higher age-adjusted mortality.

Guidehouse's report, the inaugural Center for Health Insights Payvider Market Index, only included metros with populations above 500,000 based on market size and future growth. It lists metros by population size, and Fetter noted that the larger the population, the bigger the opportunity for membership growth.

The report also grouped together Los Angeles, San Francisco, Riverside, Calif., Minneapolis and Albuquerque, N.M., and said those markets already have a lot of payers and providers coupled with strong cost and quality performance. Guidehouse said that means payers and providers could further differentiate existing value-based payment and delivery options.

In Albuquerque, there are several high-performing players and projected membership growth, the report said.

Another group that includes Seattle, Denver, San Jose, Calif., Salt Lake City and Des Moines, Iowa has relatively low value-based membership growth potential given projected demographic and payer changes, but the existing players score well on cost and quality. In the case of Des Moines, for example, potential Medicare Advantage and managed Medicaid growth is low, so players in that market may want to consider expanding their footprint elsewhere, Guidehouse said.

A fourth group that includes Chicago, Dallas, Houston and Washington, D.C. has low growth potential and didn't perform as well on cost and quality. In the case of Dallas, Medicare Advantage is already high with significant competition. The real opportunity there is for the provider community to differentiate its population health and cost management capabilities, Guidehouse said.

The payvider trend is driven in part by the increased importance of Medicare and Medicaid in the health insurance businesses, especially Medicare Advantage. The biggest and most obvious example of a payvider is UnitedHealth Group's Optum Care subsidiary, which has more than 53,000 doctors and 1,450 clinics nationwide.

Another example is the value-based care joint venture formed in 2016 between Phoenix-based Banner Health and Aetna that they ultimately extended with a longterm agreement in February 2021. Banner and Aetna said they've seen average cost savings of between 8% and 14%, better member experience and growth to approximately 350,000 members.

In the Detroit area, Henry Ford Health System formed a clinically integrated physician network in 2007 that brought together its medical group and independent providers to boost quality and efficiency. It's now one of the country's highest performing Next Generation ACOs and has a direct-to-employer partnership with General Motors.

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Beyond the Byline: Private equity's interest in healthcare draws congressional scrutinyBeyond the Byline: Private equity's interest in healthcare draws congressional scrutinyBeyond the Byline: Private equity's interest in healthcare draws congressional scrutiny

Beyond the Byline: Private equity's interest in healthcare draws congressional scrutiny

Modern Healthcare hospital operations reporter Alex Kacik and politics reporter Jessie Hellmann discuss why Democrats want more information about the role private equity and chain ownership of nursing homes plays in patient outcomes.

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உங்க வயிறு பானை மாதிரி பெருசா வீங்கியிருக்கா? அப்ப இத பண்ணுங்க சீக்கிரமா குறைஞ்சிடும்...!உங்க வயிறு பானை மாதிரி பெருசா வீங்கியிருக்கா? அப்ப இத பண்ணுங்க சீக்கிரமா குறைஞ்சிடும்...!

வீக்கம் கொண்ட வயிற்றைக் கொண்டிருப்பது ஒரு அசௌகரியமான உணர்வு. ஆனால் வீக்கம் காரணமாக உங்கள் வயிறு பெரிதாக இருக்கும்போது அது முற்றிலும் வேறுபட்ட பிரச்சினை. இதனால் நீங்கள் எடை அதிகரித்துள்ளீர்கள் என்று அர்த்தமல்ல. வயிற்று வீக்கம் உடல் எடை அதிகரிப்போ, தொப்பையோ கிடையாது. இது பெரும்பாலும் உங்கள் உணவு மற்றும் வாழ்க்கை முறை பழக்கவழக்கங்களால் ஏற்படுகிறது. வீங்கிய

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இந்தியாவில் போடப்படும் தடுப்பூசிகள் குறித்து ஒவ்வொருவரும் கட்டாயம் தெரிந்து கொள்ள வேண்டிய விஷயங்கள்!இந்தியாவில் போடப்படும் தடுப்பூசிகள் குறித்து ஒவ்வொருவரும் கட்டாயம் தெரிந்து கொள்ள வேண்டிய விஷயங்கள்!

கடந்த 2019 ஆம் ஆண்டு சீனாவின் வுஹான் மாகாணத்தில் இருந்து கொரோனா வைரஸ் பரவுவது முதலில் தெரிவிக்கப்பட்டது. இந்த நோய்த்தொற்று விரைவாக பரவ ஆரம்பித்தது மற்றம் உலகம் முழுவதும் வேகமாக பரவத் தொடங்கி, ஒரு புதிய உலகளாவிய பொது சுகாதார நெருக்கடியை உருவாக்கிறது. பின்னர் 2020 ஆம் ஆண்டு மார்ச் மாதம் உலக சுகாதார அமைப்பு (WHO)

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டீ குடிக்கும் போது இந்த பொருட்களை தெரியாம கூட சாப்பிட்ராதீங்க... இல்லனா பெரிய ஆபத்தாக மாறிடும்...! டீ குடிக்கும் போது இந்த பொருட்களை தெரியாம கூட சாப்பிட்ராதீங்க... இல்லனா பெரிய ஆபத்தாக மாறிடும்...!

பெரும்பாலான மக்களுக்கு நீண்ட சோர்வான நாளுக்குப் பிறகு புத்துணர்ச்சி அளிப்பது சூடான தேநீராகத்தான் இருக்கும். அதனால்தான் தேனீரை விரும்புபவர்கள் கோடிக்கணக்கில் இருக்கிறார்கள். எந்த நேரத்தில் தேநீர் குடித்தாலும் அது வழங்கும் புத்துணர்ச்சிக்கு ஈடில்லை. தேநீர் என்பது இந்தியாவில் மிகவும் பிரபலமான பானமாகும், இது நம் நாட்டின் தேசிய பானம் என்று எளிதாக கூறிவிடலாம். பால் தேநீர்

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சர்க்கரை நோய், இதய நோய், புற்றுநோய் எதுவும் வரக்கூடாதா? தினமும் 15 நிமிஷம் 'இத' செய்யுங்க போதும்...சர்க்கரை நோய், இதய நோய், புற்றுநோய் எதுவும் வரக்கூடாதா? தினமும் 15 நிமிஷம் 'இத' செய்யுங்க போதும்...

ஒவ்வொரு வருடமும் ஜூன் 3 ஆம் தேதி உலக சைக்கிள் தினம் கொண்டாடப்படுகிறது. இரண்டு நூற்றாண்டுகளாக பயன்பாட்டில் உள்ள சைக்கிள் ஓட்டுவதன் முக்கியத்துவம் மற்றும் அதன் நன்மைகளை உணர்த்தும் வகையில் உலக சைக்கிள் தினம் கொண்டாடப்படுகிறது. பழங்காலம் முதலாக ஓட்டி வரும் சைக்கிள் பல்வேறு ஆரோக்கிய நன்மைகளை கொண்டுள்ளது. சைக்கிளிங் பயிற்சி உடலை சீராகவும்,

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கருப்பு பூஞ்சை உங்களுக்கு எதன்மூலம் பரவுகிறது தெரியுமா? எந்தவகை கருப்பு பூஞ்சை மிகவும் ஆபத்தானது?கருப்பு பூஞ்சை உங்களுக்கு எதன்மூலம் பரவுகிறது தெரியுமா? எந்தவகை கருப்பு பூஞ்சை மிகவும் ஆபத்தானது?

இந்தியாவில் உள்ள மாநிலங்களில் மியூகோமிகோசிஸ் அல்லது கருப்பு பூஞ்சை தொற்று நோயாளிகளின் எண்ணிக்கை தொடர்ந்து அதிகரித்துக் கொண்டே வருகிறது. சமீப காலங்களில் கருப்பு பூஞ்சையால் பாதிக்கப்படுபவர்களின் எண்ணிக்கை 32% அதிகரித்து உள்ளதாக தரவுகள் கூறுகிறது. இதுவரை கிடைத்த தரவுகளின்படி கருப்பு பூஞ்சையால் அதிகம் பாதிக்கப்பட்டவர்கள் சமீபத்தில் கொரோனாவில் இருந்து மீண்டவர்களாக இருக்கிறார்கள். இதனால் அவர்கள் மீண்டும் மருத்துவமனையில் அனுமதிக்கப்படுகிறார்கள்.

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நம் முன்னோர்கள் நீண்ட காலம் ஆரோக்கியமாக வாழ்ந்ததற்கு இந்த உணவு தான் காரணமாம்...!நம் முன்னோர்கள் நீண்ட காலம் ஆரோக்கியமாக வாழ்ந்ததற்கு இந்த உணவு தான் காரணமாம்...!

இந்தியா முழுவதும் பரவலாக பயன்படுத்தப்படும் ஒரு உணவுப் பொருள் சோளம். இது ஜவாரி, ஜோவர், ஜோலா மற்றும் ஜோன்தலா என பல்வேறு பெயர்களில் அழைக்கப்படுகிறது மற்றும் இதனை பயன்படுத்தி ரொட்டி, தோசை போன்ற பல உணவு வகைகளும் தயாரிக்கப்படுகிறது. நம் முன்னோர்கள் சோளத்தை தான் அதிகமாக உட்கொண்டார்கள். நீங்கள் உடல் எடையை குறைக்க விரும்பினால் அல்லது ஆரோக்கியமாக

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Science chief wants next pandemic vaccine ready in 100 daysScience chief wants next pandemic vaccine ready in 100 daysScience chief wants next pandemic vaccine ready in 100 days

Science chief wants next pandemic vaccine ready in 100 days

Eric Lander painted a rosy near future where a renewed American emphasis on science not only better prepares the world for the next pandemic with plug-and-play vaccines, but also changes how medicine fights disease and treats patients.

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UN says pandemic created an 'unparalleled' employment crisisUN says pandemic created an 'unparalleled' employment crisisUN says pandemic created an 'unparalleled' employment crisis

UN says pandemic created an 'unparalleled' employment crisis

“Recovery from COVID-19 is not just a health issue. The serious damage to economies and societies needs to be overcome too."

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Oklahoma high court strikes down governor's Medicaid planOklahoma high court strikes down governor's Medicaid planOklahoma high court strikes down governor's Medicaid plan

Oklahoma high court strikes down governor's Medicaid plan

The Oklahoma Supreme Court ruled Gov. Kevin Stitt's plan to privatize much of the state's Medicaid program is unconstitutional.

In a 6-3 ruling Tuesday, the court determined the Oklahoma Health Care Authority did not have the legislative approval to move forward with the plan, dubbed SoonerSelect.

"We find no express grant of legislative authority to create the SoonerSelect program nor do we find the extant statutes implicitly authorize its creation," the ruling states.

The court also determined a constitutional amendment approved by voters last year to expand Medicaid to more low-income people also did not authorize a new managed-care program like SoonerSelect.

The court also found that the Oklahoma Health Care Authority, the state's Medicaid agency, should have made the rules governing competitive bidding widely known prior to implementing a request for proposal and the awarding of contracts.

The Republican governor has pushed the plan to outsource management of the state's Medicaid system to for-profit insurance companies, maintaining that the approach will maximize health care quality while cutting costs.

"The Supreme Court's ruling will unnecessarily delay Oklahoma's efforts to improve health outcomes through managed care, which the Legislature confirmed is the right path forward for our state through Senate Bill 131," Stitt said, referring to a bill approved by the GOP-controlled Legislature that placed some restrictions on the managed care plan. Stitt let that bill become law without his signature.

Stitt said he planned to work with the Health Care Authority to determine how to proceed.

A group of medical organizations filed suit in February seeking to stop the plan, including the Oklahoma State Medical Association, Oklahoma Dental Association, Oklahoma Osteopathic Association, Oklahoma Society of Anesthesiologists and the Oklahoma Chapter of the American Academy of Pediatrics.

"Oklahoma physicians were virtually united in opposition to this plan," Allison LeBoeuf, executive director of the Oklahoma Osteopathic Association said in a statement. "Oklahomans are best served when medical decisions are made between doctor and patient, and without interference from insurance bureaucrats."

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Vaccine protection may diminish need for yearly boostersVaccine protection may diminish need for yearly boostersVaccine protection may diminish need for yearly boosters

Vaccine protection may diminish need for yearly boosters

Evidence is mounting that immunity from the mRNA vaccines made by Pfizer and Moderna does not depend exclusively on antibodies that dwindle over time.

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Ohio State Wexner teams up with DispatchHealth to offer in-home medical careOhio State Wexner teams up with DispatchHealth to offer in-home medical careOhio State Wexner teams up with DispatchHealth to offer in-home medical care

Ohio State Wexner teams up with DispatchHealth to offer in-home medical care

Starting July 1, Ohio State Wexner patients and providers will be able to request same-day at-home care for viral infections and other illnesses.

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ONC gets $80M to diversify informatics and data science fieldONC gets $80M to diversify informatics and data science fieldONC gets $80M to diversify informatics and data science field

ONC gets $80M to diversify informatics and data science field

The Office of the National Coordinator for Health Information announced $80 million to train and certify traditionally underrepresented workers to the field of public informatics and data science.

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Congressional leaders propose permanent expansion of GME in health centersCongressional leaders propose permanent expansion of GME in health centersCongressional leaders propose permanent expansion of GME in health centers

Congressional leaders propose permanent expansion of GME in health centers

A bill from two key healthcare leaders in Congress would permanently fund and expand the Teaching Health Center Graduate Medical Education program.

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Rhode Island approves Prospect Medical purchase of two hospitalsRhode Island approves Prospect Medical purchase of two hospitalsRhode Island approves Prospect Medical purchase of two hospitals

Rhode Island approves Prospect Medical purchase of two hospitals

The state attorney general asked Prospect Medical Holdings to put $80 million in escrow to protect the safety-net hospitals' futures.

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Oklahoma Blues settles one provider contract dispute, but others remainOklahoma Blues settles one provider contract dispute, but others remainOklahoma Blues settles one provider contract dispute, but others remain

Oklahoma Blues settles one provider contract dispute, but others remain

Blue Cross and Blue Shield of Oklahoma reached an agreement with the state's largest physician group, just weeks before the transition period out of its contract with OU Health Physicians was set to end.

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BARDA venture capital program dedicates up to $500M for pandemic preparedness BARDA venture capital program dedicates up to $500M for pandemic preparedness BARDA venture capital program dedicates up to $500M for pandemic preparedness

BARDA venture capital program dedicates up to $500M for pandemic preparedness

HHS' Biomedical Advanced Research and Development Authority has launched a new program to spur development of technologies to combat future pandemics and health emergencies.

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