September 27, 2022
Medical records can contain seemingly objective descriptions that are actually full of coded language and subtext. How does that affect care?
September 27, 2022
Four managed-care insurance plans may lose contracts with California’s Medicaid program, which would force nearly 2 million low-income residents to switch their health plans—and possibly their doctors. The plans are fighting back.
September 27, 2022
To stay competitive today and drive the preventive care impact desired, plans must shift from focusing on retrospective HEDIS® collection toward building a select, structured, and intelligent foundation for in-year HEDIS.
September 23, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH), including issues that prevent seniors from accessing care, an increase in Medicare enrollees who struggle with opioid abuse, a study on racial, ethnic disparities in maternal health complications, federal funding to address Black youth mental health, and new draft guidelines for screening adults for anxiety.
September 21, 2022
A new Kaiser Family Foundation review of 62 studies published since 2016 compares Medicare Advantage (MA) and traditional Medicare on measures of beneficiary experience, affordability, utilization, and quality.
September 21, 2022
The RISE Population Health Summit is back for its fourth edition as a live-streaming virtual event November 15-16. Here’s everything you need to know.
September 13, 2022
The codes used by U.S. medical providers to bill insurers haven’t caught up to the needs of trans patients or even international standards. Consequently, doctors are forced to get creative with what codes they use, or patients spend hours fighting big out-of-pocket bills.
September 13, 2022
The national mental health hotline switched on July 16 from a 10-digit number to an easier-to-remember 988. The first full month of performance data for the 988 Suicide and Crisis Lifeline (988 Lifeline) shows a 45 percent increase in overall volume and a significant improvement in answer rates and wait times.
September 12, 2022
In an industry obsessed with consumer satisfaction national patient surveys still don’t get at an important question: Are hospitals delivering culturally competent care?
September 12, 2022
The 62-page report, The Economic Burden of Mental Health Inequities in the United States Report, released by the Satcher Health Leadership Institute at Morehouse School of Medicine (SHLI), found that investment in mental health would have saved nearly 117,000 lives and $278 billion over a four-year period.
September 07, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
September 01, 2022
The proposed rule would reduce red tape and simplify applications, verifications, and enrollment.
August 31, 2022
RISE reviews the latest news related to the social determinants of health (SDoH).
August 30, 2022
The Centers for Medicare & Medicaid Services (CMS) said this is the fifth consecutive year the program has generated overall savings and high-quality performance results.
August 25, 2022
As Medicare Advantage (MA) continues to grow, a new Kaiser Family Foundation (KFF) analysis finds a gradual but significant reshaping of the Medicare program is taking place.
August 23, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
August 22, 2022
People in jails and prisons are particularly vulnerable to the fallout from the Supreme Court’s reversal of Roe v. Wade.
August 19, 2022
The proposed rule aims to standardize quality measures for Medicaid and the Children’s Health Insurance Program (CHIP) and promote health equity.
August 19, 2022
RISE summarizes recent regulatory news.
August 18, 2022
Medicare beneficiaries will pay less for their prescription drugs and the amount they pay each year for prescription drugs will be capped at $2,000.
August 15, 2022
Nonprofit federally funded health centers are a linchpin in the nation’s health care safety net because they treat the medically underserved. The average profit margins is 5 percent, but some have recorded margins of 20 percent or more in three of the past four years.
August 12, 2022
The legislation, which the House is expected to pass Friday, would allow the federal government, for the first time, to negotiate the price of some drugs that Medicare buys. It also would extend the enhanced subsidies for people who buy insurance on the Affordable Care Act marketplaces.
August 10, 2022
Large gaps in treatment persist nearly a decade after a highly effective cure for hepatitis C was approved, the Centers for Disease Control and Prevention (CDC) reported this week.
August 10, 2022
RISE summarizes recent regulatory news.
August 09, 2022
More than 150 million Americans with private health coverage have access to the free preventive services due to the Affordable Care Act. Millions of others in Medicare and Medicaid also benefit from the provision.
August 09, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
August 08, 2022
Since the U.S. Supreme Court overturned Roe v. Wade in June, ER doctors say they—and their patients—are trapped between state anti-abortion laws and the federal law requiring that care be delivered in emergency situations. Women’s lives hang in the balance
August 08, 2022
UPDATED August 12, 2022: The landmark legislation will lower health care costs for people across the country, according to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure. Here’s a look of the health care aspects included in the bill and what was left out.
August 05, 2022
Health and Human Services (HHS) Secretary Xavier Becerra announced Thursday that the outbreak of monkeypox is a public health emergency, 78 days after the first case was confirmed in the United States.
August 02, 2022
The Centers for Medicare & Medicaid Services (CMS) has released the fiscal year 2023 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) rule. Here is a summary of three major changes.
August 02, 2022
Five panelists who will speak about health policy at the upcoming RISE West 2022 conference join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.
August 01, 2022
RISE summarizes recent regulatory-related news.
July 29, 2022
RISE summarizes recent regulatory-related news.
July 28, 2022
During the special breakfast session that kicks off the second day of RISE West 2022 in Los Angeles, a panel featuring four Black women in health care leadership positions will discuss their career paths and what needs to change in the industry to further promote women across all sectors.
July 26, 2022
The proposed rule affirms protections on nondiscrimination based on sexual orientation and gender identity, and protection of access to reproductive health care.
July 26, 2022
In this article we look at the RISE West 2022 sessions planned as part of the Quality track and the Intersection of Risk Adjustment Quality, and Population Health track, two of the scheduled tracks to take place at the annual RISE West conference, September 1-2, in Los Angeles.
July 22, 2022
The Centers for Medicare & Medicaid Services (CMS) has released for the first time a voluntary quality measure set to promote consistent quality measurement within and across state Medicaid home-and community-based services (HCBS) programs.
July 20, 2022
The 2022 report from the Better Medicare Alliance (BMA), a research and advocacy organization that supports Medicare Advantage, gathers the latest data to provide a picture of the Medicare Advantage experience today–from beneficiary demographics and enrollment trends to supplemental benefit offerings and consumer savings, to health outcomes and bipartisan support in Washington.
July 19, 2022
RISE summarizes recent regulatory-related news.
July 13, 2022
A new Wall Street Journal report finds that one in six calls to National Suicide Prevention Lifeline ended without callers reaching a counselor.
July 12, 2022
RISE summarizes recent regulatory-related news.
July 08, 2022
The Centers for Medicare & Medicaid Services (CMS) on Thursday issued the Calendar Year 2023 Physician Fee Schedule proposed rule. If finalized, the rule would make significant changes to the Medicare Shared Savings Program and expand access to behavioral health services, cancer screening, and dental care, particularly in rural and underserved areas.
July 08, 2022
Two weeks after the Supreme Court’s bombshell ruling to overturn the constitutional right to abortion, President Biden has signed an executive order to protect a woman’s access to reproductive health care services.
July 07, 2022
The bulk of the funds provided in the gun reform law known as the Bipartisan Safer Communities Act are for expanding mental health services. Will it help improve mental health outcomes and stem violence?
July 06, 2022
RISE summarizes recent regulatory news.
July 05, 2022
Here are three ways to increase premium accuracy, close gaps in care, improve the member experience, and increase member retention.
July 05, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
July 01, 2022
Los Angeles taps Marta Segura, director of the city’s climate emergency mobilization office, as its first heat officer. Segura, the first Hispanic person to hold such a position in the country, will work across city departments on an early warning system while developing cooling strategies.
June 29, 2022
A new model by Deloitte reveals a pending financial and health crisis if nothing is done to address the skyrocketing cost of health inequities.
June 28, 2022
Xavier Becerra, secretary of the Department of Health and Human Services (HHS), spoke to reporters Tuesday about the Supreme Court’s unprecedented decision on Friday to overturn a long-standing constitutional right and how the department intends to respond.
June 28, 2022
RISE summarizes recent regulatory news.
June 27, 2022
By undoing that landmark decision, the law of the land since 1973, the court has empowered states to set their own abortion restrictions—so where people live will determine their level of access.
June 27, 2022
Ellen Fink-Samnick, chair of RISE's SDoH Community, reflects on the state of the industry in the wake of the Supreme Court's decision to overturn Roe v. Wade.
June 23, 2022
The U.S. Department of Health and Human Services approved Colorado’s request to amend a federal waiver and create a state option that increases enrollment and lowers health care costs beginning in 2023.
June 23, 2022
In the wake of the COVID-19 pandemic, the Commonwealth Fund Commission on a National Public System has issued a series of recommendations for Congress and the Department of Health and Human Services (HHS) to transform public health in the United States.
June 23, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
June 22, 2022
RISE summarizes this week’s regulatory news.
June 16, 2022
The departments plan to establish a committee responsible for science-based advice and recommendations to the U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) as they develop the Dietary guidelines for Americans, 2025-2030.
June 15, 2022
RISE summarizes recent regulatory headlines.
June 14, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
June 13, 2022
Doctors and researchers in kidney care have been active recently in reevaluating their use of race-based medical guidance.
June 10, 2022
The Biden administration is considering a requirement that the nation’s 15,500 nursing homes spend most of their payments from Medicaid on direct care for residents and limit the amount that is used for operations, maintenance, and capital improvements or diverted to profits.
June 08, 2022
As mental health concerns continue to rise, there's a push for primary care doctors to provide mental health care. But the way many insurance plans cover mental health doesn’t necessarily support integrating it with physical care.
June 08, 2022
Women, Black adults, and Hispanic adults do not have equal access to potentially lifesaving opioid treatment.
June 06, 2022
A new survey conducted by the University of Michigan found 81 percent of people ages 14-24 want their health care providers to ask about their social needs.
June 01, 2022
The new office is the latest initiative from the Biden administration to better address environmental inequities that impact vulnerable communities.
May 31, 2022
A recent study indicates that five-year colon cancer survival rates have only improved for white people in the last 20 years. Rates among Black, Hispanic, and Asian adults have had no improvement.
May 31, 2022
In a grand state experiment to improve the health of some of its sickest and costliest patients, one health plan in California’s vast Inland Empire, where more than half of adults have diabetes or are at risk of developing diabetes, is delivering medically tailored meals to select patients in hopes it will develop healthier eating habits long after the shipments stop.
May 25, 2022
Deft Research’s 2022 Medicare OEP and Disenrollment Prevention Study surveyed more than 2,400 Medicare Advantage (MA) members to better understand what causes many of them to reexamine their coverage during the 90-day rapid disenrollment period. The study provides insight so MA plans can better tackle short-term AEP prep as well as long-term AEP/OEP retention goals.
May 25, 2022
A spotlight on recent organizational efforts and partnerships that promote health equity in different ways.
May 25, 2022
The study identified inconsistencies among patients transitioning from hospitals and skilled nursing facilities due to social determinants of health (SDoH) and racial disparities.
May 25, 2022
United States Surgeon General Dr. Vivek Murthy has issued an advisory that highlights the urgent need to address the health worker burnout crisis across the country.
May 25, 2022
Overdose deaths are disproportionately affecting Native Americans due to continued underfunding of health care resources and limited access to quality care.
May 19, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
May 16, 2022
A year ago, the Centers for Disease Control and Prevention awarded states and local health departments $2.25 billion to help people of color and other populations at higher risk from COVID. But a KHN review shows public health agencies across the country have been slow to spend it.
May 13, 2022
Home visits help identify health risks before they become severe, preventing expensive adverse events and facilitating holistic condition management across care settings for better cost and quality outcomes.
May 11, 2022
New research from Creighton University underscores the significant impact finances have on an individual’s health.
May 10, 2022
Kaiser Family Foundation (KFF) researchers said the biggest losses will be among children, adults who became eligible for coverage under the Affordable Care Act’s (ACA) Medicaid expansion, and adults eligible for Medicaid other than due to a disability. These groups experienced the largest increase during the pandemic.
May 04, 2022
If the Supreme Court’s conservative majority affirms the leaked decision overturning abortion rights in the U.S., the effects would be sweeping for 40 million women in more than two dozen states where Republican-led legislatures have been eagerly awaiting the repudiation of the right to terminate a pregnancy.
May 03, 2022
The Blue Cross Blue Shield Association (BCBSA) and Blue Cross Blue Shield (BCBS) companies urge the health care industry to implement national industry standards for health equity data collection.
May 03, 2022
Even the savviest Medicare drug plan shoppers can get a shock when they fill prescriptions: That great deal on medications is no bargain after prices go up.
May 02, 2022
The Centers for Medicare & Medicaid Services (CMS) late Friday released its final rule for the Medicare Advantage (MA) and Part D prescription drug programs. The final rule revises MA and Part D regulations related to marketing and communications and makes changes to quality ratings, medical loss ratio reporting, special requirements during disasters or public emergencies, and reduces out-of-pocket costs for prescription drugs under Part D.
April 28, 2022
The 2023 Notice of Benefits and Payment Parameters Final Rule (final 2023 Payment Notice) finalizes many of the changes announced in the proposed rule.
April 28, 2022
When it comes to health policy, former Utah Republican Sen. Orrin Hatch, who died April 23 at age 88, leaves a complex legacy of major legislative achievements, changing positions, compromises, and fierce opposition. In many ways, though, Hatch’s evolution and leadership on health policy during his four decades in the U.S. Senate mirror that of the Republican Party.
April 25, 2022
The proposed rule aims to expand Medicare coverage and establishes five special enrollment periods.
April 21, 2022
A new report from The Autism Intervention Research Network on Physical Health (AIR-P) has found children with autism who are non-white or live in low-income households are more likely to face poor health outcomes and challenges with health care.
April 20, 2022
As the only non-association conference focused on special needs plans (SNP), the annual event provides key insights for operational, clinical, compliance, and marketing specialists. This year’s conference will be held live and in-person, June 22-24, at the Westin Times Square in New York City.
April 20, 2022
RISE summarizes recent regulatory news, including announcements and proposals from the U.S. Department of Health and Human Services, the Centers for Medicare & Medicaid Services, and the Centers for Disease Control and Prevention.
April 19, 2022
Shannon O'Connell, senior manager, Engagys, shares the biggest takeaways after moderating the consumer focus panel, Direct Insights into Addressing Social Determinants of Health from Patients Themselves, at The RISE Summit on Social Determinants of Health in Nashville last month.
April 19, 2022
A new analysis conducted by ATI Advisory for Better Medicare Alliance finds that Medicare Advantage (MA) beneficiaries report a 35 percent lower rate of cost burden compared to fee-for-service (FFS) Medicare.
April 14, 2022
Xavier Becerra, secretary of the Department of Health and Human Services (HHS), extended the COVID-19 public health emergency (PHE) another 90 days. The extension will allow most of the emergency waivers to remain in place through July.
April 14, 2022
The last of our country’s baby boomers are reaching retirement age, making them eligible for Medicare. When this younger group of ‘trailing edge’ boomers joins the ‘leading age’ boomers (seniors approaching 80 years), Medicare enrollment will catapult to 80 million beneficiaries by 2040.
April 13, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
April 06, 2022
According to a new report released by the Commonwealth Fund, women in the United States between the ages 18-49 have the highest rate of avoidable deaths compared to other high-income countries.
April 01, 2022
RISE summarizes the latest regulatory headlines.
March 31, 2022
This year’s summit drew a record-breaking number of more than 500 attendees live in Nashville to learn and discuss actionable solutions to social determinants of health (SDoH) challenges to achieve better outcomes for vulnerable populations.
March 31, 2022
According to part one of the 2022 Survey of America’s Physicians, six in 10 physicians said they feel they have little to no time to effectively address their patients’ social determinants of health (SDoH).
March 25, 2022
Sens. Robert Casey Jr. and Ron Wyden want a probe into what barriers are keeping Medicaid plans from reaching enrollees.
March 24, 2022
During an hour-long press conference late last week, Department of Health and Human Services (HHS) Secretary Xavier Becerra discussed a wide range of topics, including risk adjustment in Medicare Advantage, COVID, and telehealth.
March 23, 2022
RISE summarizes the latest regulatory headlines.
March 22, 2022
RaeAnn Grossman, EVP, Cotiviti, who co-chaired RISE National 2022 with Kevin Healy, CEO, Allymar Health Solutions, reflects on her experience at this year’s conference, which returned to Nashville as a live, in-person event for the first time since March 2019.
March 21, 2022
The director of community health promotions at Robert Wood Johnson Barnabas Health in New Brunswick received the RISE Health Care Hero Award on Monday, March 21 at The RISE Summit on Social Determinants of Health in Nashville.
March 18, 2022
The number of children ages 3-17 years diagnosed with anxiety or depression increased nearly 30 percent from 2016 to 2020, according to the study.
March 17, 2022
RISE rounds up the latest news on COVID-19.
March 15, 2022
Many Medicare Advantage plans send caregivers to the homes of seniors periodically to help with housework and provide companionship. But the workers may also prod seniors into activities that boost the plans’ Medicare ratings and federal reimbursements.
March 11, 2022
As the country enters Year 3 of the pandemic emergency, people with disabilities across the U.S. are still finding it difficult to use innovations in telemedicine, teleworking, and testing.
March 11, 2022
RISE summarizes the latest regulatory headlines.
March 11, 2022
According to the study, communities with higher levels of racial prejudice experience poorer health outcomes such as heart disease and mental health problems.
March 04, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
March 03, 2022
The White House has unveiled a national preparedness plan, which provides a roadmap to fight COVID-19 and return to a new normal. But execution of the plan requires congressional support and funding.
March 02, 2022
Here are the health care highlights from Biden's address.
February 28, 2022
Inoculation rates remain low despite massive outreach efforts and incentives from federal and state programs and Medicaid plan operators, leaving many low-income people vulnerable to the virus.
February 25, 2022
In health care, there are long-standing and well-documented disparities in care for Black and white patients. Those disparities have carried over into who gets funding for research and health startups.
February 25, 2022
RISE summarizes the latest regulatory headlines.
February 23, 2022
RISE’s annual summit will be held live in Nashville on March 20-22. This year’s event has more content than ever before with three preconference workshops, three content tracks, a record-breaking lineup of more than 80 speakers, and 28 thought-provoking sessions. Ahead of the summit, RISE spoke to a few of the esteemed speakers set to take the stage next month. Here’s a sneak peek at the push button topics they plan to address.
February 15, 2022
New CMS rule supports standardization of data to better understand drivers of health.
February 14, 2022
After months of disproportionate impacts amid the pandemic, COVID testing and vaccination rates are finally improving among the Hispanic community.
February 14, 2022
State Medicaid agencies for months have been preparing for the end of a federal mandate that has prevented states from removing people from the safety-net program during the pandemic.
February 04, 2022
After it became increasingly clear that the White House’s efforts to expand access to free testing didn’t make it easy for older Americans who need the tests the most, the administration has decided to rectify it.
February 03, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
February 02, 2022
RISE summarizes this week’s regulatory-related news.
February 02, 2022
The Centers for Medicare & Medicaid Services (CMS) on Wednesday released proposed payment policy changes for Medicare Advantage (MA) and Part D drug programs in 2023. Here’s a summary of the proposed changes to risk adjustment, Star Ratings, and the agency’s plans to advance health equity.
January 26, 2022
Health plans operating in the Medicare Advantage space will need to optimize their risk adjustment and quality prospective and retrospective strategies to optimally align and make provider engagement and data governance the foundation to an effective social determination of health and population health strategy.
January 26, 2022
RISE summarizes recent headlines in regulatory news.
January 26, 2022
The Racial Equity and Policy (REAP) framework serves as a tool for researchers, policymakers, and others to identify and examine racial equity implications of health policies.
January 24, 2022
The laws governing Medicare don’t provide coverage for self-administered diagnostic tests, which is precisely what the rapid antigen tests are and why they are an important tool for containing the pandemic.
January 21, 2022
Two rapid-testing initiatives the Biden administration released in the past week are inaccessible to some residents of multifamily housing, people who don’t speak English well, or those without internet access.
January 21, 2022
The funding announcements include $103 million in American Rescue Plan funds to reduce burnout and improve retention in the health care workforce as well as $13 million in funding to increase behavioral health in rural communities.
January 20, 2022
A new study found Black patients in a remote monitoring program had higher retention rates when providers reached out to them over the telephone rather than a smartphone app.
January 13, 2022
The Supreme Court on Thursday blocked a key Biden administration COVID-19 initiative—putting a stop, for now, to a rule requiring businesses with more than 100 workers to either mandate that employees be vaccinated against COVID or wear masks and undergo weekly testing.
January 13, 2022
RISE summarizes this week’s regulatory news from the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), and Office of Inspector General (OIG).
January 13, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
January 10, 2022
The annual event will be held live at The Omni in Nashville, Tenn., March 20-22. Here’s a look at what we have planned so far for preconference workshops, networking opportunities, keynote presentations, general sessions, track sessions, and our health and safety protocols.
January 07, 2022
The proposed rule would revise Medicare Advantage (MA) and Medicare Part D regulations related to marketing and communications, Star ratings, the criteria used to review applications for new or expanded plans, provider network adequacy requirements, medical loss ratio reporting, special requirements during disasters or public emergencies, and the use of pharmacy price concessions to reduce the out-of-pocket costs for prescription drugs under Part D.
January 07, 2022
The Supreme Court on Friday took up one of the most contentious issues of the COVID-19 pandemic, hearing a series of cases challenging the Biden administration’s authority to require workers to get a COVID vaccine or be tested for the virus regularly.
January 04, 2022
Here are our predictions for the health care industry in 2022 based on interviews with industry experts in 2021, presentations at RISE conferences, and observations from our editorial team.
December 30, 2021
Whether you want to learn more about health policy, COVID, health care costs, or the latest news, we’ve gathered our picks for health care podcasts to add to your listening library in 2022. And a shameless plug – of course RISE Radio is on the list!
December 28, 2021
The COVID-19 pandemic continues as we close out 2021. Here is the latest news.
December 23, 2021
The Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) issued guidance this week tied to legal standards and best practices for improving access to COVID-19 vaccine programs and ensuring nondiscrimination based on race, color, and national origin.
December 20, 2021
Our editorial team has had the pleasure of conducting dozens of interviews during 2021. We enjoyed them all and learned so much. Here’s a look back at a few of our favorite conversations.
December 20, 2021
As we head into 2022, here’s a look back at our most viewed articles of 2021. Trending topics included fraud lawsuits, Star ratings, and federal investigations into overpayments.
December 20, 2021
Member engagement was a priority for health plans this year, but consumers proved hard to reach, according to the Sixth Annual Survey of Healthcare Consumer Engagement Practices, which is conducted each year as a joint effort between RISE and Engagys. The annual survey tracks the consumer engagement tactics, budgets, challenges, and priorities of the nation’s leading health plans.
December 20, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
December 17, 2021
RISE summarizes the latest headlines that impact Medicare, Medicaid, and Medicare Advantage (MA).
December 16, 2021
A new report from Together for Better Medicaid reveals states’ commitments to address social determinants of health (SDoH) and health equity through their partnerships with Managed Care Organizations (MCOs).
December 15, 2021
Starting in January, California will embark on an ambitious experiment to control asthma in its most vulnerable patients.
December 10, 2021
In West Virginia, older residents often go without dental care, and a quarter of people 65 and older have no natural teeth, the highest rate of any state in the country. But a powerful senator from West Virginia, Joe Manchin, has rebuffed efforts to add a dental benefit to Medicare.
December 09, 2021
In a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, the Better Medicare Alliance proposed strategies to better serve Medicare Advantage (MA) members. The letter was sent as CMS prepares its Calendar Year 2023 MA rate and policy-setting process.
December 09, 2021
Accuracy issues raise red flags because the data is used to plan and direct resources in the nation’s continuing response to the COVID-19 pandemic.
December 06, 2021
A new report from the U.S. Department of Health and Human Services (HHS) found that massive increases in the use of telehealth helped maintain some health care access during the COVID-19 pandemic, with specialists like behavioral health providers seeing the highest telehealth utilization compared to other providers.
December 06, 2021
RISE summarizes the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.
November 30, 2021
A federal judge on Monday ruled that the Centers for Medicare & Medicaid Services (CMS) doesn’t have the authority to enforce a vaccine mandate of staff at Medicare and Medicaid-certified facilities in 10 states.
November 29, 2021
In California, health insurers blame long waits for therapy appointments on workforce shortages, but state lawmakers say that’s an excuse. A new law requires insurers to reduce wait times for mental health appointments to no more than 10 business days.
November 23, 2021
The analysis measured health equity for people of different races and ethnicities within and between each state and their health system’s performance for racial and ethnic groups.
November 22, 2021
Achieving health equity requires the participation of individuals, communities, businesses, government, social service agencies, and more.
November 19, 2021
In a Health Affairs blog post, Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure and Center for Medicaid & CHIP Services (CMCS) Director Dan Tsai described their policy agenda for Medicaid and Children’s Health Insurance Program (CHIP).
November 19, 2021
The House of Representatives on Friday voted 220-213 in favor of President Joe Biden’s Build Back Better Bill. Although it’s significantly scaled back from the originally proposed $3.5T package, it’s unclear whether it will pass the Senate, where it needs 51 votes.
November 17, 2021
Do you know someone who has made a significant impact in the lives of underserved populations through health care and/or social services interventions? If so, nominate them for the first-ever RISE Health Care Hero Award!
November 15, 2021
As independently owned pharmacies struggle to stay open amid competition with large retail drugstores, individuals in rural communities are left without easy access to a pharmacy.
November 08, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
November 04, 2021
The Centers for Medicare & Medicaid Services (CMS) has been busy. Here is a roundup of the agency’s recent news and actions.
November 03, 2021
The Centers for Medicare & Medicaid Services (CMS) on Tuesday released the 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule.
November 03, 2021
The survey of Medicaid directors in states and the District of Columbia explored current policies or planned changes for the current fiscal year.
November 01, 2021
Former CMS Administrator Seema Verma will share insights on high value, low-cost health care at The RISE Summit on Social Determinants of Health on Monday, March 21 at The Omni Nashville.
October 28, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
October 21, 2021
The Commission’s recommendations aim to modernize current data systems to address structural racism and advance health equity.
October 15, 2021
The hospital has implemented several programs targeting food insecurity, education attainment, health literacy, and health care access.
October 15, 2021
RISE summarizes recent regulatory headlines.
October 07, 2021
The Department of Health and Human Services and Better Medicare Alliance released separate reports this week that show promising findings about COVID-19 vaccinations and seniors, and hospitalization and mortality rates for Medicare Advantage members.
October 07, 2021
RISE summarizes this week’s regulatory headlines.
October 07, 2021
RISE is excited to return to in-person conferences. To ensure the health and safety of attendees, speakers, exhibitors, and staff, RISE will require proof of full COVID-19 vaccination status to attend the events. Here’s everything you need to know before you make your travel arrangements.
October 06, 2021
Blue Cross Blue Shield of Massachusetts plans to incorporate equity measures into its payment models to address racial disparities identified through its recent health equity analysis.
October 05, 2021
A recent review of persistent gaps in preterm birth rates between Black and white women underscores racism as a key factor.
October 04, 2021
RISE looks at current trends and challenges related to social determinants of health (SDoH) with Melissa Quick, co-chair, Aligning for Health, a coalition advocating to Congress for solutions to address SDoH across the country.
September 30, 2021
More than 2 million low-income adults are uninsured because their states have not accepted Medicaid expansion under the Affordable Care Act. Congressional Democrats want to offer them coverage in the massive spending bill being debated, but competition to get into that package is fierce.
September 30, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
September 28, 2021
Nominations are now open for RISE’s annual Martin L. Block Award for Innovation & Excellence. RISE’s highest honor recognizes excellence and clinical leaders’ passion to improve patient care.
September 24, 2021
For the third year in a row, health plans striving to improve population health efforts will convene to hear more than 20 industry experts’ and thought leaders’ expertise on the actionable strategies that take initiatives to the next level. The live-streaming virtual event, November 16-17, will spotlight critical issues in the population health space; from the dramatic increase in hospital readmissions post-pandemic to maternal health care among vulnerable populations to the mental health crisis, we’re covering it all.
September 22, 2021
The Department of Justice (DOJ) said 42 doctors, nurses, and other licensed medical professionals are among the 138 defendants facing criminal charges for their alleged involvement in health care fraud schemes that resulted in nearly $1.4 billion in alleged losses.
September 21, 2021
Sixteen states have an adult obesity prevalence at or above 35 percent, an increase from nine states in 2018, according to new data from the Centers for Disease Control and Prevention (CDC), which notes social determinants of health (SDoH) play an influential role.
September 20, 2021
The plans are designed for people who don’t get dental coverage through their jobs and can’t afford an individual plan. For about $300 to $400 a year, patients receive certain preventive services at no charge and other procedures at a discount.
September 17, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
September 15, 2021
The Census Bureau on Tuesday released its 2020 findings regarding Americans’ income, poverty, and health insurance coverage.
September 15, 2021
According to the report, COVID-19 and the subsequent economic downturn has reversed progress on eliminating poverty by four years, with 31 million more people around the world living in extreme poverty.
September 09, 2021
In a new blog post, Chiquita Brooks-LaSure, administrator, Centers for Medicare & Medicaid Services (CMS), reflects on her first 100 days in office and her vision for the future.
September 09, 2021
The Centers for Medicare & Medicaid Services (CMS) said the new action will protect patients, providers, and health care workers in Medicare and Medicaid settings.
September 09, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
September 08, 2021
Although Medicaid traditionally doesn’t fund clinics to supply legal assistance, Colorado is one of several states that have been given permission to use some of their Medicaid money to help pay for such programs.
September 02, 2021
The learning continued at our hybrid-event with two keynotes, a Medicare Advantage member focus group, legal insights, and a panel discussion on member engagement and experience. Here are a few highlights from our favorite sessions.
September 01, 2021
The Office of Inspector General (OIG) said the findings may help hospitals and health officials better prepare for and address the wide-ranging and extensive needs of COVID-19 patients, particularly when local communities experience a surge in cases.
August 31, 2021
RISE summarizes the latest regulatory headlines that impact Medicare, Medicare Advantage (MA), and Medicaid.
August 30, 2021
Older adults who live in disadvantaged neighborhoods become disabled two years earlier than those living in more affluent areas, according to researchers from Yale School of Medicine.
August 23, 2021
Though overall suicide rates have decreased in the U.S. in recent years, rates continue to rise in communities of color.
August 20, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
August 19, 2021
The pandemic has had a disproportionate impact on racial/ethnic groups, low-income earners, and women, according to a new review from Public Health Nursing (PHN).
August 11, 2021
RISE reviews the latest headlines, including the Office of Inspector General (OIG) reports, trending telehealth diagnoses, and the introduction of a new bill to improve the oversight of nursing homes.
August 05, 2021
While federal Medicaid rules prohibit costs related to non-medical services, such as social determinants of health (SDoH), there are opportunities for state Medicaid programs to address enrollees’ social needs both within and outside of managed care, according to a new report by the Kaiser Family Foundation (KFF). In the brief, KFF discusses the options and federal Medicaid authorities that states can leverage to address enrollees’ SDoH, as well as examples of initiatives launched in response to the COVID-19 pandemic.
August 05, 2021
A new report conducted by NORC at the University of Chicago on behalf of Better Medicare Alliance’s Center for Innovation in Medicare Advantage (MA) highlights innovative approaches that MA plans are doing to address social determinants of health (SDoH) for beneficiaries. However, researchers acknowledge that barriers remain.
August 04, 2021
RISE summarizes the latest health care news from the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and the Commonwealth Fund.
August 03, 2021
A recent study from the American Journal of Preventive Medicine (AJPM) found socioeconomic and racial/ethnic disparities in vaccine uptake have persisted over the last decade in adults. As COVID-19 vaccine roll-out continues throughout the United States, efforts to promote health equity among racial/ethnic minority and low-income populations are critical to improve population health.
July 28, 2021
RISE rounds up the latest news on COVID-19.
July 28, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
July 28, 2021
For the second year, FRA and RISE will join forces to produce a live-streaming virtual event August 24-25 to connect health care service providers, the investment community, and leaders in the health care industry to cultivate the business partnerships needed to foster change and achieve positive financial returns. Ahead of this year’s event, Alison Rein, vice president, health and human services, Quantified Ventures, who is a presenter at this year’s summit, shared with RISE an inside look at how the outcomes-based capital firm connects organizations with innovative program models in need of capital with the right investors.
July 26, 2021
Patients seem to like remote visits, and health care providers now depend on them. But outages, freezing, and other glitches cost time and money, and compromise quality of care.
July 23, 2021
A recent brief from Kaiser Family Foundation (KFF) found that after years of progression in coverage across all racial/ethnic groups, uninsured rates have increased through 2019.
July 20, 2021
Sen. Ron Wyden (D-Ore.), who is helping to negotiate the health care spending framework for the Democrats' budget plan, said lawmakers may have to settle for very basic versions of programs deployed in the package. But the key, he added, is to get the "architecture of these changes, bold changes," started and show people what is possible.
July 19, 2021
RISE West 2021 will bring together senior leaders from Medicare Advantage health plans, commercial marketplace sponsors, Part D health plans, providers groups, pharmacy benefit managers, and accountable care organizations to discuss the hot topics facing the industry. We talked to four of the 50 speakers about their sessions to learn what attendees can expect at this year’s hybrid event, which will take place live in Colorado Springs and virtually via livestream August 30-September 2.
July 15, 2021
Angela G. Huskey, PharmD, CPE, senior vice president and chief clinical officer at Millennium Health, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.
July 14, 2021
The Centers for Medicare & Medicaid Services (CMS) released the proposed 2022 Physician Fee Schedule on Tuesday. In addition to proposed payment rates for Medicare next year, the agency included policy proposals to address health equity and expand patient access to comprehensive care.
July 14, 2021
The new report sheds light on the health disparities that continue to exist by gender, geography, socioeconomic status, race and ethnicity, and educational attainment.
July 14, 2021
RISE rounds up the latest health care headlines that impact Medicare, Medicaid, and the Affordable Care Act.
July 14, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
July 13, 2021
HHS Secretary Xavier Becerra says the administration is eager for Congress to make changes to Medicare that will provide more benefits and make more older adults eligible for the program.
July 09, 2021
A coalition of more than 100 organizations have expressed their support for the reintroduction of the bipartisan bill.
July 08, 2021
Learn about the innovative strategies special needs plans (SNPs) can leverage to support individuals with significant, complex social needs while advancing health equity.
July 01, 2021
The Centers for Medicare & Medicaid Services (CMS) said the proposed changes mark the Innovation Center’s first direct effort to close health equity gaps.
June 30, 2021
RISE rounds up the latest regulatory headlines involving emerging infectious disease emergencies; mental health, deceitful health plan marketing practices, health care cost-related problems and racial disparities, health literacy, and the American Hospital Association’s lawsuit on site-neutral payments.
June 29, 2021
A new study indicates social determinants of health (SDoH) are associated with an increase in Medicare per beneficiary spending in certain geographic variations.
June 25, 2021
A look at community-based health care organizations’ proven-successful approaches to address food insecurity.
June 25, 2021
The pandemic will undermine Americans' health for years. Even those not infected by the coronavirus could suffer health problems related to poverty, job loss, eviction — or all of the above
June 24, 2021
In a sharp shift from Trump-era policies, President Joe Biden looks at expanding Medicaid eligibility to new mothers, inmates, and undocumented immigrants and adding services such as food and housing.
June 24, 2021
RISE rounds up the latest news concerning COVID-19.
June 24, 2021
The findings indicate that fewer Black patients would have died from COVID-19 if they were admitted to different hospitals.
June 18, 2021
New research shows global poverty trends are on the rise amid the pandemic for the first time in decades.
June 17, 2021
The latest episode of our podcast series, RISE Radio, focuses on the explosion of telemedicine during COVID-19 and what the future holds.
June 17, 2021
The Supreme Court on Thursday dismissed a challenge to kill the Affordable Care Act (ACA) and saved health care coverage for millions.
June 15, 2021
What an amazing RISE Summit on Social Determinants of Health it’s been! Day two delivered another impressive lineup of compelling speakers, timely discussions, and cross-sectional connection.
June 14, 2021
It’s been a busy first day at The RISE Summit on Social Determinants of Health! After a long 16 months, many of us have experienced a thrilling return to in-person attendance in Nashville, and others joined from the comfort of their home offices thanks to our reimagined hybrid conference experience. It is great to be back and reconnect, both in-person and virtually!
June 11, 2021
A new analysis by researchers at Brown University reveals that the current Star rating system for Medicare Advantage (MA) plans doesn’t always mean gold-level care for racial/ethnic minorities and socioeconomically disadvantaged enrollees in the plans.
June 08, 2021
The latest data reveals 31 million Americans are enrolled in health coverage through the Health Insurance Marketplaces and Medicaid expansion under the Affordable Care Act (ACA).
June 07, 2021
The new relief program aims to expand access to affordable water and assist low-income households impacted by the COVID-19 pandemic pay their water and wastewater bills, prevent shutoffs, and support water system reconnections related to non-payment.
June 07, 2021
RISE’s annual summit will be held as a hybrid event on June 14-15, with preconference workshops on Friday, June 11. Whether attending virtually via livestream or in-person in Nashville, participants will hear from cross-sectional thought leaders driving change in the transition to value-based care. Here’s an inside look at some of this year’s anticipated sessions.
June 04, 2021
Throughout the covid-19 vaccination effort, public health officials and politicians have insisted that providing shots equitably across racial and ethnic groups is a top priority.
June 03, 2021
The new head of the Centers for Medicare & Medicaid Services said the administration will focus on getting more people insured and is interested in finding a way to alleviate the gap keeping low-income families in states that haven’t expanded Medicaid from enrolling in Affordable Care Act health plans.
June 03, 2021
The latest episode of our new podcast series explores the positive aspects of working from home as well as the challenges of managing a remote workforce.
June 02, 2021
The industry trade association says its new mission and brand reflects its commitment to innovation, solutions, equity, and delivering results for every patient in every community.
May 26, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
May 25, 2021
The Senate voted 55-44 on Tuesday to confirm President Joe Biden’s nominee to oversee the Centers for Medicare & Medicaid Services (CMS).
May 21, 2021
RISE summarizes recent news in the Medicare Advantage (MA) space.
May 21, 2021
RISE looks at the latest news from the Department of Health and Human Services as well as studies that impact Medicare.
May 21, 2021
RISE is thrilled to host this year’s Summit on Social Determinants of Health as a hybrid event to provide all attendees, whether joining in-person in Nashville or virtually via livestream, ample time to network and collaborate with professionals across the ecosystem. Ahead of this year’s event, RISE talked to conference Steering Committee member Kristen Daugherty, chief executive officer, Emergence Health Network, about what she’s gained as a past attendee of the summit and what she’s looking forward to at this year’s event.
May 20, 2021
The annual report compiles the latest data to provide a full picture of the Medicare Advantage (MA) landscape from beneficiary demographics and enrollment trends to consumer savings and improved outcomes, as well as MA’s response to COVID-19 and the continued drive to health equity.
May 18, 2021
A little-discussed, long-term toll of the pandemic is that large numbers of older adults have become physically and cognitively debilitated and less able to care for themselves after sheltering in place.
May 17, 2021
The event, held on June 22-23, is the only non-association yearly gathering for Special Needs Plan (SNP) professionals who are mid- to senior-level management to stay current in a highly regulated and evolving environment.
May 14, 2021
Health plans can help advance the goal of achieving health equity.
May 13, 2021
Hispanics who have yet to receive a covid shot are about twice as likely as non-Hispanic whites or Blacks to say they’d like to get vaccinated as soon as possible, according to a survey released Thursday. The findings hint at fixable, though difficult, vaccine access problems for the population.
May 12, 2021
RISE summarizes the latest headlines that impact the health care industry.
May 10, 2021
The program addresses social determinants of health (SDoH) needs among members by making the most of its partnerships with health care provider organizations, community health workers, and a community referral platform.
May 06, 2021
RISE examines the latest research news on Medicare, Medicare Advantage, and Medicaid.
May 04, 2021
RISE is pleased to announce two keynote speakers for Qualipalooza 2021, which will take place June 28-29, 2021 in-person in Orlando and virtually via livestream for those unable to travel.
May 03, 2021
A report from the Government Accountability Office paints a picture of an already strained behavioral health system struggling after the pandemic struck to meet the treatment needs of millions of Americans with conditions like alcohol use disorder and post-traumatic stress disorder.
April 29, 2021
RISE summarizes recent headlines that impact Medicare, Medicare Advantage, and Medicaid.
April 28, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
April 23, 2021
The health plan’s programs aim to equip individuals and communities struggling with food insecurity with equitable access to healthy foods.
April 20, 2021
Health providers are seeing the consequences of pandemic-delayed preventive and emergency care, from longer hospital stays to more root canals.
April 20, 2021
Here’s how three organizations targeted social determinants of health (SDoH) and accomplished improved health outcomes beyond the clinical walls.
April 20, 2021
RISE summarizes the latest headlines that impact the Department of Health & Human Services, Medicare, and Medicare Advantage.
April 15, 2021
RISE summarizes the latest headlines that impact Medicare and Medicare Advantage.
April 14, 2021
Join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.
April 14, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
April 08, 2021
It’s been a digital year like no other due to COVID-19, causing Americans to rely on telehealth, virtual learning, and video chats as their new normal for health care, education, and social interaction. But the heightened reliance on digital tools has increased disparities and inequities among individuals without digital skills and access to internet, computers, or mobile devices.
April 08, 2021
RISE reviews recent headlines in the news that impact Medicare and Medicare Advantage.
April 08, 2021
A national survey conducted by the Kaiser Family Foundation and The Washington Post reveals worry and stress related to COVID-19 has negatively affected the mental health of most frontline health care workers.
April 08, 2021
Members diagnosed with depression tend to have comorbidities and often report more access issues and show less satisfaction with their health plan than other members.
April 06, 2021
Join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.
April 05, 2021
Here’s how UnitedHealthcare, a health insurance plan with benefit programs for individuals and families, employers, and Medicare and Medicaid beneficiaries, leveraged social determinants of health (SDoH) programs to better meet member needs, improve Star ratings, and close quality and HEDIS® gaps.
April 05, 2021
Social risk analytics hold immense potential in achieving business goals, reducing costs and improving the lives of consumers, patients and members. As organizations recognize socioeconomic data’s value, they can capitalize on its full potential with the right mechanism and collaboration.
March 26, 2021
A Texas federal judge, who previously ruled the Affordable Care Act unconstitutional, has signaled his openness to ending the law’s popular coverage requirement for preventive services.
March 26, 2021
Bipartisan legislation introduced this week would expand telehealth services for seniors during the COVID-19 pandemic.
March 25, 2021
RISE rounds up the latest headlines from the White House and the Centers for Medicare & Medicaid Services (CMS).
March 25, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
March 24, 2021
This year’s hybrid event on June 14-15 will bring together cross-sectional thought leaders who aim to drive change in the transition to value-based care. Whether attending in-person in Nashville or virtually via livestream, community-based organizations (CBOs), payers, hospitals/health systems, funders, and manufacturers or government entities will have two jam-packed days to discuss actionable and scalable solutions to address social determinants of health (SDoH) and achieve better outcomes for the most vulnerable populations.
March 22, 2021
RISE summarizes the latest regulatory news that impacts Medicare and Medicare Advantage.
March 19, 2021
What exactly does a hybrid event entail? Here’s your one-stop guide for what to expect at the June 2021 event.
March 19, 2021
Blue Cross Blue Shield Association (BCBSA) announced this week it has partnered with Feeding America® and its network of 200 food banks to educate Americans about the safety and the effectiveness of the COVID-19 vaccine.
March 19, 2021
Xavier Becerra was narrowly confirmed as secretary of the Department of Health and Human Services (HHS) on Thursday but health care organizations across the country applauded the move.
March 18, 2021
RISE reviews the latest headlines that have an impact on Medicare and Medicare Advantage.
March 15, 2021
Health provider conflicts, fraud, and access disparity temper the COVID telehealth revolution.
March 11, 2021
RISE reviews the latest headlines that impact Medicare and Medicare Advantage.
March 09, 2021
Experts say the two-year expansion of subsidies for most people who buy insurance through the government exchanges would be among the most significant changes to the affordability of private insurance since the passage of the Affordable Care Act.
March 08, 2021
This benefit season, more than any other, it’s critical to address medical services that target complex medical needs and non-medical services that target social factors, to stay competitive.
March 08, 2021
Luciana Borio, M.D., who warned the public in an opinion piece published in the Wall Street Journal in late January 2020 about the pending COVID-19 pandemic, will be a keynote speaker at RISE National, a virtual live-streaming event, later this month. In this interview, Dr. Borio talks to RISE about COVID, what’s on the horizon, and what health plans can do to support their members.
March 08, 2021
Join us for the third episode of RISE Radio, our new podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.
March 05, 2021
RISE summarizes the latest news involving Medicare, Medicare Advantage, and the Affordable Care Act.
March 05, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
February 26, 2021
RISE looks at recent headlines that impact Medicare and Medicare Advantage.
February 25, 2021
A recent analysis from Kaiser Family Foundation (KFF) found continued disparities based on state-reported data of COVID-19 vaccinations by race and ethnicity.
February 25, 2021
Engagys and RISE presented results, insights from fifth annual survey of health care consumer engagement practices during this week’s virtual RISE Medicare Marketing & Sales Summit.
February 18, 2021
RISE summarizes the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.
February 16, 2021
RISE’s Social Determinants of Health (SDoH) Community held its first Across the Ecosystem User Group meeting last week, led by Jessica Kahn, senior expert, McKinsey & Company, and Denise Harlow, CEO, National Community Action Partnership. The user group connects cross-sectional stakeholders (payers, providers, community-based organizations, government, and funders) to discuss actionable and scalable solutions to SDoH challenges and drive social good. Here are key takeaways from the initial discussion on executive orders from the new administration and the interactive McKinsey & Company dashboard.
February 10, 2021
The live-streaming virtual event will be a one-stop shop for state and federal legislators, health plans, providers, and community-based organizations (CBOs) to gain tactics to navigate a changing environment, move forward amid the pandemic, and further the drive for value-based care.
February 10, 2021
RISE summarizes recent research on the impact COVID-19 has had on outpatient Medicare fee-for-service claims, mental health, and patients with dementia.
February 08, 2021
A recent Department of Health and Human Services’ Office of Inspector General (OIG) report examines opioid use in Medicare Part D during the first eight months of 2020, the beginning of the COVID-19 outbreak. Here are the key takeaways from the report.
February 03, 2021
In a recent survey conducted by The Root Cause Coalition (TRCC), researchers found the general population considers economic stability and access to health care the most impactful social determinants of health (SDoH).
February 01, 2021
In a recent webinar for the RISE Association, FOX Rehabilitation offered an inside look at its geriatric house calls model to provide outpatient therapy to vulnerable seniors in the comfort of their homes. As an alternative option to the traditional models of post-acute rehabilitation, the program improves patient satisfaction while reducing total cost of care.
January 29, 2021
Black Americans are still receiving covid vaccinations at dramatically lower rates than white Americans even as the chaotic rollout reaches more people, according to a new KHN analysis.
January 28, 2021
RISE reviews the latest headlines that impact Medicare, Medicare Advantage, and the Affordable Care Act marketplace.
January 26, 2021
A San Francisco-based hospital’s emergency department social medicine (EDSM) team has improved care delivery to patients with psychosocial needs. Here’s what the team has accomplished so far since it formed in October 2017.
January 22, 2021
RISE summarizes the latest headlines that impact Medicare and Medicaid.
January 19, 2021
On the day before the inauguration of a new president, the country marks a once unthinkable milestone of 400,000 deaths. The winter surge of the pandemic claimed 100,000 Americans in just five weeks.
January 19, 2021
The report sheds light on the U.S. health disadvantage and the role business leaders can play in improving community health through engagement and investment.
January 15, 2021
Engagys and RISE have collaborated once again to release our 5th annual State of Healthcare Engagement Survey. Here’s a sneak peek on what the 2020 findings revealed. Engagys Managing Director Kathleen Ellmore will review the full survey findings during the RISE 2021 Medicare Marketing & Sales Summit, a live-streaming virtual event, Feb. 22-23.
January 14, 2021
The American Health Information Management Association (AHIMA) has released the results from its 2020 social determinants of health (SDoH) survey.
January 13, 2021
The Centers for Medicare & Medicaid Services (CMS) issued a final rule Tuesday that will speed Medicare beneficiaries’ access to the latest advanced devices.
January 13, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
January 12, 2021
RISE reviews the latest from the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS).
January 11, 2021
Dr. Emanuel, a member of President-elect Joe Biden’s transition COVID-19 advisory board, will kick off the first day of RISE National on Monday, March 29, with a keynote address on the future direction of the American health care system. Also slated to speak at the virtual conference: Tara Lipinski, internationally acclaimed figure skater and Olympic gold medalist; infection disease expert Dr. Luciana Borio, who warned the public in January 2020 about the pending COVID-19 pandemic; Dr. Wendy Sue Swanson, M.D., a leading innovator in digital health, innovation and prevention; and health care futurist Ian Morrison.
January 08, 2021
What’s in store for the RISE Association communities in 2021? We asked experts in Medicare Advantage, quality and revenue, consumer engagement, and social determinants of health for their predictions on trends that will impact the industry in the upcoming year. Spoiler alert: COVID-19 will continue to play a big role.
January 08, 2021
The Centers for Medicare & Medicaid Services (CMS) on Thursday issued new guidance for states to address social determinants of health (SDoH) in Medicaid and the Children’s Health Insurance Program (CHIP).
December 30, 2020
The new bill includes $3 million in funding to establish a social determinants of health (SDoH) pilot program.
December 22, 2020
Within just a few days, the logistical barriers of the vaccine made by Pfizer and BioNTech were laid bare. Many officials now hang their hopes on Moderna, whose vaccine comes in containers of 100 doses, doesn’t require deep freezing and is good for 30 days from the time it’s shipped.
December 17, 2020
Persuading vulnerable low-income and ethnic communities hit hard by the coronavirus to take a new vaccine may be challenging. But established local health leaders, like a group in Rochester, Minnesota, home of the Mayo Clinic, may be one answer.
December 11, 2020
High stakes and big challenges await as the U.S. prepares to roll out vaccines against COVID-19, with front-line health care workers and vulnerable nursing home residents recommended as the top priority.
December 09, 2020
Manatt Health, in collaboration with the Robert Wood Johnson Foundation and the Nemours Children’s Health System, released a report outlining how organizations can drive social determinants of health (SDoH) investments for children through a Children’s Health and Wellness Fund.
December 07, 2020
President-elect Joe Biden today announced his nominations and appointments of his health team and the names will be familiar to those in the health care industry.
December 04, 2020
Identifying risk attributes — social determinants of health (SDOH) — for populations can enhance an organization’s ability to develop sound, data-driven interventions that can influence change, enrich wellness, and improve profitability.
December 03, 2020
RISE looks at the latest news regarding social determinants of health (SDoH), including recent approaches from Medicaid programs.
November 25, 2020
RISE rounds up recent headlines concerning social determinants of health (SDoH).
November 23, 2020
Research indicates a concerning increase in relapse, fatal and non-fatal overdose, anxiety and depression, and other mental health conditions due to the pandemic.
November 23, 2020
Morrison will address the future of the health care marketplace, trends, and implications during RISE National 2021, which will take place March 28-30, 2021.
November 19, 2020
A new data brief finds that in 2021 more and more Medicare Advantage (MA) plans will offer supplemental benefits like adult day care services, home-based palliative care, in-home support services, and career support.
November 19, 2020
In a new interview with Kaiser Health News, the nation's top infectious disease expert breaks down how to survive the coming months and describes how hard it is when people still insist the coronavirus outbreak is “fake news.”
November 16, 2020
The Republican-led states are trying to prove they were harmed by the 2010 health law—and thus have “legal standing”—because their Medicaid costs increased, even though Congress eliminated the penalty for not having health coverage in 2019. At least one justice was skeptical.
November 16, 2020
While there is not a one-size-fits-all answer to social determinants or social needs, there is some basic information that can help you address the unmet needs of your member population.
November 13, 2020
The rule puts an end to overly prescriptive regulations that stakeholders have complained about since 2016, according to CMS Administrator Seema Verma.
November 11, 2020
The survey explored physicians’ perspectives on the COVID-19 pandemic and the future of the health care system. A key factor: social determinants of health (SDoH).
November 10, 2020
The U.S. Supreme Court will hear arguments today in a case that could overturn the Affordable Care Act. California Attorney General Xavier Becerra, who is defending the law with the backing of more than 20 other states, told California Healthline that he predicts the justices will uphold it.
November 09, 2020
The United States on Monday became the first country to surpass 10 million cases and public health experts warn numbers may continue to climb unless the Trump administration takes steps now to stop the spread of the deadly virus.
November 09, 2020
The Supreme Court on Tuesday will hear oral arguments in a case that, for the third time in eight years, could result in the justices striking down the Affordable Care Act (ACA).
November 06, 2020
The RISE team is looking forward to seeing conference attendees live and in person when the time is right. Here are the measures RISE has taken to create a healthier and safer conference experience− let us know when you’re ready.
November 05, 2020
The American Diabetes Association (ADA) conducted a scientific review of previous research and literature on the association of social determinants of health (SDoH) and diabetes risk and outcomes as well as the impact of targeted interventions.
November 04, 2020
As the votes continue to be counted in the tight battle between President Donald Trump and former Vice President Joe Biden, the federal role in health care is at stake.
October 30, 2020
Addressing social determinants of health (SDoH) has enabled one special needs plan to improve health outcomes for members and has led to a decrease in emergency room visits, inpatient admissions, and inpatient lengths of stay.
October 21, 2020
RISE is now accepting nominations for its annual Martin L. Block Award that recognizes excellence and clinical leaders’ passion to improve patient care. For 2021, RISE has broadened the criteria beyond risk adjustment and Stars to ensure the spirit of excellence and innovation lives on.
October 21, 2020
For the first time, the National Academy of Medicine recommended vaccine prioritization be given to individuals who struggle with social determinants of health (SDoH).
October 21, 2020
RISE reviews the latest headlines that impact Medicare, Medicare Advantage, Medicaid, and the Affordable Care Act marketplace.
October 21, 2020
In this video interview recorded prior to his retirement as executive director of the RISE Association, Kevin Mowll, discusses his work with RISE over the past seven years and what the future holds for the association and its related communities.
October 16, 2020
RISE looks at recent headlines in the news that impact the health care industry.
October 16, 2020
During the second day of RISE’s live-streamed virtual conference, Gillette will share his firsthand experiences and perspective on health care accessibility.
October 14, 2020
The health system’s model will enable primary care practices to effectively screen for social determinants of health (SDoH) to improve health equity in vulnerable communities.
October 14, 2020
Learn more about one of the exciting benefits of joining the RISE Association.
October 12, 2020
The COVID pandemic changed the landscape of the social needs that drive health overnight. Millions of people lost their jobs; millions of people were ordered to stay home. People lost access to food for themselves and their families because they couldn’t afford it, or they couldn’t get to a grocery store. Miles of cars waiting at drive-through food pantries dominated the headlines. People became more isolated and depressed. People’s ability to pay for their housing was jeopardized.
October 09, 2020
The new network seeks to break down barriers between clinical and social care to better address member’s socioeconomic needs in the Philadelphia area.
October 08, 2020
COVID-19 continues to dominate headlines in the wake of President Trump’s diagnosis and hospitalization. Here’s a roundup of the latest news.
October 07, 2020
Under normal circumstances, an older adult is treated every 11 seconds in an emergency department (ED) because of a fall.
October 02, 2020
RISE looks at the latest headlines that impact Medicare and Medicaid.
October 02, 2020
After downplaying the seriousness of the virus for months, President Donald Trump and the First Lady Melania Trump tested positive for the coronavirus. He is now under quarantine.
October 01, 2020
The principal of EFS Supervision Strategies, LLC, will work with the RISE Association to help guide our Social Determinants of Health (SDoH) Community.
September 29, 2020
Mark your calendars! We are excited to return to Nashville, Tenn. in March for RISE National 2021. Get a first look at the new tracks we’ve already planned for you.
September 29, 2020
RISE looks at recent headlines concerning social determinants of health (SDoH), including the impact of COVID-19 on Latino, Black, and Native American communities.
September 29, 2020
President Donald Trump’s executive order says that people with preexisting conditions can get affordable insurance. But it doesn’t explain how.
September 25, 2020
RISE summarizes the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.
September 22, 2020
The innovative model of care saves money, improves patient satisfaction, and may boost Medicare Advantage plan enrollment.
September 21, 2020
With the death of Justice Ruth Bader Ginsburg, a lawsuit brought by Republican state officials has become the latest existential threat against the federal health law, scheduled for oral arguments at the Supreme Court a week after the general election in November.
September 15, 2020
Learn best practices to improve outcomes for hard to reach and at-risk populations during a live-streamed virtual event on Oct. 27-28.
September 15, 2020
The live-streaming virtual event will feature two days filled with timely discussion on how to best pivot to the new landscape of population health in a post-pandemic world. The 2nd annual summit will take place November 17-18. Here’s an inside look at some of the speakers and hot topics included in this year’s event.
September 11, 2020
RISE Managing Director Ellen Wofford made the following announcement during RISE West on Friday:
September 10, 2020
A new study released by Better Medicare Alliance (BMA), a leading research and advocacy organization supporting Medicare Advantage, finds that MA beneficiaries have lower incomes, speak English as a second language, are more likely to rent their home, and are reliant on public transit. The findings, BMA said, show MA’s value to underserved populations.
September 04, 2020
The RISE Association’s webinar series recently featured a case study on a community-based, multi-hospital system medical respite program in Pittsburgh, Pa. that aims to provide care to people experiencing homelessness.
September 03, 2020
Learn more about the interactive virtual sessions and activities we’ve planned for RISE West 2020, which will take place Sept. 9-11.
September 03, 2020
Older Blacks are perishing quietly, out of sight, victims of the pandemic and a lifetime of racism and its attendant adverse health effects.
September 01, 2020
The Commonwealth Fund recently explored the quality of health coverage for U.S. working-age adults in the first half of 2020. Among the findings: Two in five adults do not have stable health coverage.
September 01, 2020
In this 10-minute video with RISE, Stephen Klasko, M.D., MBA, president and chief executive officer, Thomas Jefferson University and Jefferson Health, provides a glimpse into what a global pandemic would look like in 2030 based on what we’ve learned during the COVID-19 public health emergency of 2020.
August 27, 2020
RISE has once again teamed up with Engagys to find out how communications tactics have changed throughout the COVID-19 pandemic. Here are five findings from our most recent survey. Learn more when we discuss the complete results during a one-hour webinar at 1:30 p.m. EST, Wednesday, Sept. 16. The webinar is free to RISE Association members.
August 26, 2020
COVID-19 has made member engagement more important than ever before. In this article, RISE talks to three of the facilitators of RISE West’s upcoming preconference workshop that tackles the need for Medicare Advantage (MA) plans to double down on member engagement in the second half of 2020.
August 25, 2020
The agency’s most recent 10-year plan aims to prioritize critical public health issues including the COVID-19 pandemic and social determinants of health (SDoH).
August 21, 2020
A recent international survey found people in the United States are struggling more than people in other wealthy nations amid the global pandemic.
August 20, 2020
Part 2 of our interview with John E. McDonough, DrPH, MPA, professor of public health practice, Harvard T.H. Chan School of Public Health, who will be a featured speaker at RISE’s upcoming virtual event, RISE West 2020, Sept. 9-11.
August 19, 2020
RISE rounds up the latest news concerning COVID-19.
August 18, 2020
A New York federal judge on Monday stopped the Trump administration from enforcing a new rule that rolls back nondiscrimination protections for transgender patients.
August 14, 2020
As COVID-19 cases and deaths surge in several hot spots across the United States, many individuals and organizations continue to ask, “What else can we do to help protect ourselves, our families, our communities, and our nation?”
August 11, 2020
Consider the following framework to effectively assess the ROI of SDoH interventions.
August 11, 2020
The findings indicate that adults who experience one or more social determinant of health (SDoH) have an increased risk of stroke.
August 07, 2020
The death toll in the United States may reach nearly 300,000 by December 1, according to new data released Thursday from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine.
August 06, 2020
Researchers caution that a COVID-19 vaccine is likely to be less effective in obese adults.
August 04, 2020
Chief Derek Bergsten of the Rockford, Ill. Fire Department talks to RISE ahead of the RISE West virtual summit, where he will share the success of a collaborative social determinants of health (SDoH) program that has reduced emergency department visits, ambulance runs, and hospital admissions.
August 03, 2020
Experts say adults 60 and up must continue to limit exposure in the years to come—even after there is a vaccine for COVID-19.
July 31, 2020
A recent study found racial and ethnic disparities beyond underlying health conditions play a significant role in the disproportionate impact of COVID-19 on communities of color.
July 29, 2020
The live-streamed virtual event will take place Sept. 9-11 and features presentations from leading experts in risk adjustment, quality performance, documentation, HCC coding practices, member engagement, payer-provider collaboration, and social determinants of health. Take a look at the sessions we’ve planned.
July 28, 2020
The Centers for Medicare & Medicaid Services (CMS) on Tuesday released its first monthly update of data that reveals the impact of the coronavirus on the Medicare population, including American Indian/Alaskan Native Medicare beneficiaries.
July 24, 2020
Recent research indicates a hotspotting approach to meet physical, behavioral, and social needs of high-cost patients is too narrow to have a lasting impact.
July 24, 2020
RISE rounds up the latest news on COVID-19.
July 21, 2020
The pandemic has given the National Institutes of Health an opportunity to show the value of its $1.5 billion “All of Us” research program. A major effort to make the platform’s database representative of America resulted in minorities making up more than half of its more than 270,000 volunteers.
July 20, 2020
Here are five actionable steps that organizations can take to support communities of color hit especially hard by the global pandemic.
July 16, 2020
A study from Sutter Health underscores the role race and ethnicity play in how individuals access care and the health outcomes caused by existing inequities.
July 14, 2020
A new study by EmblemHealth, one of the largest nonprofit health insurers in the United States, reveals ownership of electronic devices, access to internet services, and overall lack of technology impinge on access to telehealth.
June 26, 2020
Learn about the actions BlueCross BlueShield of North Carolina (Blue Cross NC) took as part of a payer-based strategy to improve behavioral health access, quality, and efficiency.
June 25, 2020
The U.S. Department of Health & Human Services (HHS) Office of Minority Health (OMH) will partner with Morehouse School of Medicine to help the communities hit hardest by the global pandemic.
June 25, 2020
The Administration for Community Living (ACL) and the Office of the Assistant Secretary for Health created the challenge to find an online tool to help isolated Americans connect with others and engage in the community.
June 18, 2020
Client perspectives call for more action from plans and providers, community-based organizations (CBOs) thrive in cross-sector collaboration, and loneliness and mental wellness remain areas of concern.
June 16, 2020
The ABC news veteran shared his inspiring story during a keynote fireside chat at last week’s virtual RISE National Summit on Social Determinants of Health.
June 12, 2020
The benchmarking survey focused on how health plans and community-based organizations define success for programs that address social determinants of health (SDoH) and measure their outcomes and impact.
June 11, 2020
The survey examined the occurrence of loneliness among Americans and the link between factors such as age, social media use, income, and occupation.
June 03, 2020
RISE looks at recent news regarding social determinants of health (SDoH), including the different impacts the global pandemic presents to children and adults.
May 28, 2020
The guidance to stay sheltered as society slowly reopens wears on older Americans, who have a growing sense of isolation and depression.
May 28, 2020
The global pandemic has exacerbated existing inequities for the black and Latino populations, putting them at heightened risk for physical and mental health issues.
May 21, 2020
The virtual event on June 4 and June 5. will bring together industry experts to examine the impacts of COVID-19 on vulnerable population and strategies for adaptation in this uncertain time.
May 20, 2020
Leading experts from cross-sector health care organizations will share insights to address challenges related to social determinants of health (SDoH). If you’re a professional involved with community-based organizations (CBOs), payers, hospitals/health systems, funders, manufacturers or government entities, you’ll want to be a part of this drive for social good.
May 18, 2020
While people across the country continue to experience different impacts from the global pandemic, they all have one thing in common: Stress. Here are some tips to build resiliency in these uncertain times.
May 05, 2020
A recent report from the Centers for Disease Control and Prevention (CDC) confirms homelessness is a significant contributor to virus spread.
April 20, 2020
Social isolation due to COVID-19 has friends and families left to their own devices…literally. So much so, that grandparents are trying to learn new communication technologies to stay in touch.
April 15, 2020
The findings indicate that older adults, males, black Americans, and those with underlying health conditions are at a higher risk for hospitalization due to the virus.
April 13, 2020
The launch of the interactive mapping website, which curates publicly available data at the census tract level, provides an added resource to California-based researchers amidst the COVID pandemic.
April 01, 2020
Several proposals to expand the Medicare program are under consideration. Here’s a breakdown of each approach and what they could mean for those at risk of racial and ethnic health disparities.
March 27, 2020
While it’s vital that Americans hunker down at home to avoid spreading COVID-19, doing so may amplify another public health threat: loneliness. Research has shown that loneliness is as damaging to a person’s health as smoking 15 cigarettes per day.
March 26, 2020
The Department of Health and Human Services (HHS) has implemented efforts to better address social determinants of health (SDoH) for certain programs and groups of people, but others face worsened conditions, according to a Health Affairs blog post.
March 25, 2020
Gaps in the social safety net have become apparent as public health leaders try to halt the spread of the virus.
March 19, 2020
Mortality rates for low-income older adults who are dually enrolled in Medicare and Medicaid are twice as high compared to those more affluent and solely enrolled in Medicare.
March 18, 2020
RISE looks at recent headlines concerning social determinants of health (SDoH), including the impact social distancing has on those already most vulnerable.
March 17, 2020
A new blog post from Deft Research looks at the link between non-medical circumstances and the use of the emergency room for non-emergency and routine medical care.
March 10, 2020
RISE reschedules national conferences due to concerns over COVID-19.
February 25, 2020
Speaker update: Calder Lynch from the Center for Medicare & Medicaid Services has been added to a roster of more than 50 speakers at the annual event, March 15-17, 2020 at the Omni Nashville Hotel.
February 13, 2020
Leading experts in the community-based organization (CBO) space will join together for an open panel discussion about firsthand experiences, strength and constraint areas, and bridging the gap between health care partners-a necessity for continued improvement in social determinants of health (SDoH), according to Denise Harlow, chief executive officer, National Community Action Partnership. Harlow will moderate the panel on June 10, the first full day of this year’s virtual summit.
February 06, 2020
The Centers for Medicare & Medicaid Services (CMS) recently released its first report on the use of diagnostic codes for social determinants of health (SDoH) in Medicare claims since the Z codes were implemented in 2016. The main finding: It’s difficult for the government to capture consistent data because providers aren’t assigning Z codes even when patients reveal their SDoH concerns.
January 24, 2020
Gov. Gavin Newsom has earmarked nearly $600 million in his 2020-21 state budget plan to provide intensive care management to high-needs, high-risk patients around the state. The programs are similar to an initiative in Camden, New Jersey, that was called into question by a recent study finding hospital readmissions dropped, but at only about the same rate as patients who didn’t receive the same kind of intensive services.
January 15, 2020
RISE Association partners with Mossavar-Rahmani Center for Business and Government at Harvard Kennedy School senior fellow to identify the drivers of successful social determinants of health programs.
January 13, 2020
Jacob Reider, M.D., chief executive officer, Alliance for Better Health, former deputy national coordinator for health information technology at the U.S. Department of Health and Human Services (HHS), will moderate a fireside chat on the federal government’s plans to address social determinants of health at The RISE National Summit on Social Determinants of Health, which will be held virtually on June 9-11. In this article, Reider shares his thoughts on the value of cross-sector collaboration.
December 09, 2019
Cross-sector health care organizations will come together in Nashville March 15-17 to address challenges related to social determinants of health (SDoH). If you’re a professional involved with community-based organizations (CBOs), payers, hospitals/health systems, funders, manufacturers or government entities, you’ll want to be a part of this drive for social good.
November 25, 2019
Well-intentioned, payer philanthropy is the wrong approach to solving the social determinants of health (SDoH) needs in American communities, writes Jacob Reider, M.D., CEO of Alliance for Better Health, and the former deputy director of the Office of the National Coordinator Health Information Technology, in a piece published by Health Payer Intelligence.
November 19, 2019
The annual event will take place March 15-17, 2020 at the Omni Nashville Hotel and will feature cross-sectional collaboration as thought leaders discuss actionable, tactical, and scalable solutions to social determinants of health (SDoH). Virtual attendance option is also available for those unable to travel.
October 11, 2019
For the latest installment of our semi-regular series that recommends articles, white papers, or issue briefs of importance to RISE members, we turn to a recent blog post by Deft Research’s Richard Hamer, Steve Runfeldt, and Adam Johnson about some of the conclusions from the firm’s survey to measure social determinants of health (SDoH) and intervening factors. These factors, known as “frames of reference” are defined as “internalized concepts and experiences that predict health behavior” and may depend on the person’s upbringing, circle of friends, education, and experiences with health care.
October 04, 2019
With 70 percent of a person’s health attributed to environmental factors and lifestyle choices, it’s crucial to understand what social determinants are and how to apply them to support your population at an individual level.
August 28, 2019
For the fifth installment of our semi-regular series that recommends articles, white papers, or issue briefs of importance to RISE members, we suggest United Hospital Fund of New York’s white paper Complex Construction: A Framework for Building Clinical-Community Partnerships to Address Social Determinants of Health. The paper provides an insightful look into the hurdles that organizations face when they try to leverage the resources of community-based organizations to meet the social determinants of health needs of their patients in a medical setting.
August 15, 2019
Jason Helgerson, chief solutions officer of Helgerson Solutions Group and former Medicaid director for the states of New York and Wisconsin, will be a featured speaker at the National Population Health Summit, Nov. 12-13, in Orlando. In this article, RISE talks to Helgerson and his co-presenter, Juliette Price, solutions architect for the social determinants of health, Helgerson Solutions Group, on trends in value-based payment (VBP), population health, and social determinants of health (SDoH).
August 02, 2019
The two-day, dual-tracked event on Nov. 12-13 in Orlando will address the most pressing issues associated with population health, addiction treatment, and disease management.
July 03, 2019
WASHINGTON, D.C.—Don’t wait for lawmakers on Capitol Hill to solve problems related to health care. They aren’t going to do it, according to Rich McKeown, the keynote speaker at RISE’s National Summit on Social Determinants of Health. Instead of lawmakers, solutions will come from the 250 attendees of the conference who represent community-based agencies, health plan providers, service providers, and consultants who will drive necessary changes.
June 27, 2019
Speaker Kathleen Stillo, president and chief operating officer of the clinical redesign direct care delivery unit in UnitedHealthcare’s Community & State division, talks to RISE ahead of the September conference about the organization’s mission to provide its most medically and socially complex members with better care at lower cost.
June 07, 2019
One-third of Americans say they have trouble meeting their basic human needs, such as stable housing, adequate food, and reliable transportation, and they want health care providers to help identify and address these non-medical social needs, according to the results of a new national survey from Kaiser Permanente. Those who experienced unmet social needs were twice as likely to rate their health as fair or poor compared to those who did not.
June 03, 2019
The health care industry is focusing more attention to the impact that living conditions, lifestyle, and employment have on people’s quality of life and health outcomes. Information collected about these social, economic, and physical conditions, known as the social determinants of health (SDoH), are among the most difficult to share through health information exchanges (HIEs), according to a recent report from eHealth Initiative and Foundation and Orion Health.
May 15, 2019
Many health care organizations are establishing programs to address the social needs of their patients and members in response to the growing recognition that personal, social, economic and environmental factors have a greater influence on health status than medical care. RISE looks at some of these efforts, including the Centers for Medicare & Medicaid Services’ data-collection initiatives, and Kaiser Permanente’s rollout of a social health network to address needs on a broad scale.
April 11, 2019
Medicare Advantage (MA) plans have another new benefit to offer their members in 2020: telehealth services. The Centers for Medicare & Medicaid Services (CMS) recently announced it has finalized changes that would allow MA beneficiaries to access health care services from places like their homes, rather than require them to go to a health care facility for treatment.
April 11, 2019
As the health care industry turns its attention to models that address social barriers that prevent people’s access to better health, two big-name organizations have joined forces to push providers to use data for social determinants of health to improve and simplify how referrals are made to social services.
April 03, 2019
The Centers for Medicare & Medicaid Services (CMS) on Monday released its final policy and payment updates to Medicare Advantage (MA) and Part D programs for 2020. In addition to updated payment rates, the agency outlined policy changes to address the opioid crisis, star ratings enhancements, and social determinants of health. Here ‘s what you need to know about the Call Letter and payment updates:
March 26, 2019
NASHVILLE, Tenn.— More than 1,400 executives and senior leaders from hundreds of health plans, provider groups, integrated health systems and service providers across the country came together last week in Nashville to share strategies to address regulatory challenges, the latest trends and developments in the industry, member engagement strategies, and care outcomes.
February 05, 2019
The health care industry’s shift in focus to truly address the social determinants of health is a make it or break it opportunity, according to Jamo Rubin, M.D., founder and CEO of TAVHealth, who served as the chair of last month’s RISE Symposium on Partnering to Address the Social Determinants of Health in Fort Lauderdale. Social determinants left unaddressed or unresolved flow into the health care system as unintended consequences and become health care claims, he said. The two-day symposium highlighted the challenges and successes of organizations that have made progress tackling social determinants, including behavioral health, opioid addiction, housing, and transportation. Here are five takeaways from the conference:
January 16, 2019
Health plan leaders began the year 2019 just as they did in 2018 with uncertainty over the future of the Affordable Care Act (ACA). RISE turned to industry experts for their thoughts on the ACA and what other challenges the industry may face this year. Here are five predictions from Sean Creighton, managing director of the healthcare consulting firm Avalere; John Criswell, CEO of health care data analytics and technology company Pulse8; and John Broderick, M.D., FACEP, CPE, chief clinical officer-East for the risk-based provider group Landmark Health.
December 03, 2018
Alex Azar, secretary of the Department of Health & Human Services, made a surprising announcement earlier this month during a speech at the Hatch Foundation for Civility and Solutions when he said the agency wants to pay for services that address social determinants of health, the root cause of a large portion of U.S. health spending. Azar says social determinants are tied to the agency’s move toward a value-based healthcare system that delivers better outcomes at a lower cost. But will health plans be a part of the equation?
September 17, 2018
Social determinants of health was the hottest topic at RISE West 2018, an indication that in the upcoming year health plans will likely pursue models of care that aim to improve the health and quality of life of their members. Speaker Aaron Horsfield, administrative fellow, UPMC Health Plan, predicted that the industry will see rapid change in this area as more plans collaborate with community partners to address the housing and food needs of their patient populations.