Insights & Articles

Population Health & SDoH

Embedded bias: How medical records sow discrimination

Medical records can contain seemingly objective descriptions that are actually full of coded language and subtext. How does that affect care?

Medicaid

Health plan shake-up could disrupt coverage for low-income Californians

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.

Revenue & Quality

Moving to in-year HEDIS®: 5 best practices to boost scores and member engagement

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.

Population Health & SDoH

SDoH in the news: Report reveals the top three barriers to senior health; Medicare enrollees continue to struggle with opioid abuse; and more

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.

Revenue & Quality

KFF report: Few big differences between traditional Medicare and MA on various measures

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.

Population Health & SDoH

RISE Population Health Summit: An inside look at this year’s virtual event

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.

Revenue & Quality

Medical coding creates barriers to care for transgender patients

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.

Population Health & SDoH

The 411 on 988: Nearly double the calls, texts to mental health hotline since transition to three-digit number

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.

Revenue & Quality

Patient satisfaction surveys earn a zero on tracking whether hospitals deliver culturally competent care

In an industry obsessed with consumer satisfaction national patient surveys still don’t get at an important question: Are hospitals delivering culturally competent care?

Population Health & SDoH

Report highlights the devastating cost of mental health inequities

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.

Revenue & Quality

CMS proposes rule to make Medicaid, CHIP enrollment easier

The proposed rule would reduce red tape and simplify applications, verifications, and enrollment.

Population Health & SDoH

SDoH in the news: HHS, DOJ announce millions in grants for underserved populations, overdose prevention

RISE reviews the latest news related to the social determinants of health (SDoH).

Revenue & Quality

ACOs saved Medicare $1.6B in Shared Savings Program in 2021

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.

Medicare Market

MA moves closer to becoming predominant way seniors get their health coverage and care

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.

Population Health & SDoH

SDoH in the news: Study links SDoH to mortality disparities; Feds issue guidance to expand mental health care for children; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Population Health & SDoH

Policies to roll back abortion rights will hit incarcerated people particularly hard

People in jails and prisons are particularly vulnerable to the fallout from the Supreme Court’s reversal of Roe v. Wade.

Revenue & Quality

CMS proposes mandatory quality measure reporting for Medicaid, CHIP

The proposed rule aims to standardize quality measures for Medicaid and the Children’s Health Insurance Program (CHIP) and promote health equity.

RISE West

Inflation Reduction Act becomes law: Seniors big winners in landmark health care legislation

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.

Population Health & SDoH

Community health centers’ big profits raise questions about federal oversight

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.

Revenue & Quality

Inflation Reduction Act contains important cost-saving changes for many patients

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.

Population Health & SDoH

CDC: Fewer than 1 in 3 insured hepatitis C patients receive timely treatment

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.

Revenue & Quality

Lawsuit could end free preventive health checkups

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.

Population Health & SDoH

SDoH in the news: 1 in 5 people were unable to get help for serious illness during pandemic; Study links climate hazards to an increased threat of infectious diseases; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Population Health & SDoH

Patients and doctors trapped in a gray zone when abortion laws and emergency care mandate conflict

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

Revenue & Quality

Senate passes Inflation Reduction Act: What it means for health care

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.

Revenue & Quality

HHS declares monkeypox a public health emergency

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.

Revenue & Quality

CMS final rule for inpatient, LTC hospitals: Updates payments, introduces new measures, and advances health equity

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.

RISE West

RISE Radio Episode 12: RISE West 2022 panelists on the most pressing policy issues facing health plans this year

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.

RISE West

RISE West speaker Osato Chitou previews panel session on empowering women in health care and why both men and women need to hear the discussion

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.

Compliance

HHS proposes rule to reinstate, strengthen nondiscrimination protections removed by Trump administration

The proposed rule affirms protections on nondiscrimination based on sexual orientation and gender identity, and protection of access to reproductive health care.

RISE West

RISE West 2022 track preview: Quality and the intersection of risk adjustment, quality, and population health

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.

Medicaid

CMS launches home- and community-based services quality measures for Medicaid

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.

Medicare Market

The state of Medicare Advantage in 2022: BMA compiles the latest findings on enrollment, access, value, and outcomes

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.

Population Health & SDoH

National mental health hotline—988—offers greater access to care, but may not have enough staff to manage demand

A new Wall Street Journal report finds that one in six calls to National Suicide Prevention Lifeline ended without callers reaching a counselor.

Revenue & Quality

2023 Physician Payment Rule: 5 things to know about the CMS proposal

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.

Revenue & Quality

Biden signs executive order to protect access to abortion, contraception

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.

Population Health & SDoH

Gun safety ‘wrapped in a mental health bill’: A look at health provisions in the new law

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?

Revenue & Quality

3 strategies to reduce risk score fluctuations when Medicare Advantage plan enrollment surges

Here are three ways to increase premium accuracy, close gaps in care, improve the member experience, and increase member retention.

Population Health & SDoH

SDoH in the news: ACAP launches new center for SDoH innovation; White House joins private health sector to reduce climate impacts, protect public health; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Population Health & SDoH

LA’s first heat officer says helping vulnerable communities is key to achieving climate goals

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.

Population Health & SDoH

Deloitte: Health care inequities could cost the country $1T by 2040

A new model by Deloitte reveals a pending financial and health crisis if nothing is done to address the skyrocketing cost of health inequities.

Revenue & Quality

HHS’ Becerra lays out 5-point action plan in response to Supreme Court ruling to overturn Roe v. Wade

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.

Revenue & Quality

5 things to know now that the Supreme Court has overturned Roe v. Wade

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.

Population Health & SDoH

The state of the SDoH on a day of major impact

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.

Revenue & Quality

Colorado to become first in the US to amend federal waiver, create public health option

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.

Revenue & Quality

Commonwealth Fund Commission: 4 recommendations to build a national public health system

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.

Population Health & SDoH

SDoH in the news: Virtual reality program aims to address SDoH; Health inequities could triple cost of health care by 2040; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Population Health & SDoH

HHS, USDA request nominations for 2025 Dietary Guidelines Advisory Committee

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.

Population Health & SDoH

SDoH in the news: More than half of US adults struggle with loneliness; HHS invests $15M to address drug use in rural communities; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Population Health & SDoH

Race is often used as medical shorthand for how bodies work, some doctors want to change that

Doctors and researchers in kidney care have been active recently in reevaluating their use of race-based medical guidance.

Medicaid

Medicaid weighs attaching strings to nursing home payments to improve care

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.

Population Health & SDoH

Patients seek mental health care from their doctor but find health plans standing in the way

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.

Population Health & SDoH

Study reveals persistent health disparities in opioid treatment access

Women, Black adults, and Hispanic adults do not have equal access to potentially lifesaving opioid treatment.

Population Health & SDoH

Gen Z patients want their providers to ask about SDoH

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.

Population Health & SDoH

HHS launches Office of Environmental Justice to address environmental inequities in health

The new office is the latest initiative from the Biden administration to better address environmental inequities that impact vulnerable communities.

Population Health & SDoH

Glaring racial disparities persist in early-onset colon cancer survival rates, study finds

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.

Population Health & SDoH

Medi-Cal delivers ready meals in grand health care experiment

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.

Medicare Market

Deft study explores factors that led seniors to switch during 2022 OEP and how MA plans can prevent disenrollments

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.

Population Health & SDoH

Programs prioritize health equity: 3 new initiatives aim to address equity throughout the US

A spotlight on recent organizational efforts and partnerships that promote health equity in different ways.

Population Health & SDoH

Study shows SDoH play key role in home care transition experience

The study identified inconsistencies among patients transitioning from hospitals and skilled nursing facilities due to social determinants of health (SDoH) and racial disparities.

Revenue & Quality

Surgeon General Advisory lists 6 proposals to address health worker burnout and resignation

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.

Population Health & SDoH

The Blackfeet Nation’s plight underscores the Fentanyl crisis on reservations

Overdose deaths are disproportionately affecting Native Americans due to continued underfunding of health care resources and limited access to quality care.

Population Health & SDoH

SDoH in the news: Older adults’ mental health issues, drug-related deaths worsened over last decade; ADA receives health equity grant to improve Black communities; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Population Health & SDoH

States have yet to spend hundreds of millions of federal dollars to tackle COVID health disparities

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.

Revenue & Quality

Home visits play a critical role in diabetes prevention and management for seniors

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.

Population Health & SDoH

Study: Financial education improves health outcomes

New research from Creighton University underscores the significant impact finances have on an individual’s health.

Medicaid

KFF: Up to 14M could lose Medicaid coverage after end of COVID public health emergency, fed continuous enrollment requirement

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.

Revenue & Quality

What’s next if ‘Roe v. Wade’ falls? More than half of states expected to ban or restrict abortion

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.

Population Health & SDoH

BCBSA calls for data standardization to further health equity

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.

Revenue & Quality

Medicare surprise: Drug plan prices touted during open enrollment can rise within a month

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.

Revenue & Quality

CMS issues the 2023 Medicare Advantage and Part D Final Rule: 10 things to know

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.

Revenue & Quality

Final 2023 Payment Notice for the ACA marketplace: Standardizes plan options, makes changes to risk adjustment models

The 2023 Notice of Benefits and Payment Parameters Final Rule (final 2023 Payment Notice) finalizes many of the changes announced in the proposed rule.

Revenue & Quality

Sen. Orrin Hatch’s legacy tracks the GOP’s evolution on health

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.

Medicare Market

CMS proposes rule to create special Medicare enrollment periods

The proposed rule aims to expand Medicare coverage and establishes five special enrollment periods.

Population Health & SDoH

Study identifies race and income as critical SDoH for children with autism

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.

Population Health & SDoH

Event preview: Join us at the top conference for Special Needs Plan leaders

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.

Revenue & Quality

Regulatory update: CMS outlines action plan to advance health equity; CDC launches National Weather Service-like forecasting center for infectious diseases; and more

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.

Population Health & SDoH

Actionable health care insights directly from consumers facing SDoH barriers

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.

Medicare Market

MA saves seniors $2K a year compared to FFS Medicare, study finds

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.

Revenue & Quality

As COVID cases rise again, US renews public health emergency

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.

Population Health & SDoH

Improve population health outcomes for Medicare beneficiaries

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.

Population Health & SDoH

US health care system fails to support women’s health, study finds

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.

Population Health & SDoH

5 takeaways from The RISE Summit on Social Determinants of Health

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.

Population Health & SDoH

Physicians don’t have time to address patients’ SDoH, study finds

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).

Medicaid

Senators ask GAO to examine Medicaid’s low COVID vaccination rates

Sens. Robert Casey Jr. and Ron Wyden want a probe into what barriers are keeping Medicaid plans from reaching enrollees.

Revenue & Quality

HHS Becerra on COVID, upcoding in Medicare Advantage, and telehealth

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.

RISE National

Conference chair reflections: 5 takeaways from RISE National 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.

Population Health & SDoH

Mariam Merced receives inaugural RISE Health Care Hero Award

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.

Population Health & SDoH

HHS study finds concerning increase in children diagnosed with mental health conditions

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.

Revenue & Quality

Medicare Advantage plans send pals to seniors’ homes for companionship—and profits

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.

Population Health & SDoH

Pandemic medical innovations leave behind people with disabilities

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.

Revenue & Quality

Regulatory roundup: Spending bill extends telehealth flexibility; 16M could lose Medicaid when PHE ends; and more

RISE summarizes the latest regulatory headlines.

Population Health & SDoH

Study finds racial prejudice causes poorer health outcomes

According to the study, communities with higher levels of racial prejudice experience poorer health outcomes such as heart disease and mental health problems.

Population Health & SDoH

SDoH in the news: Report underscores impact of climate change on health; 1 in 10 children struggle with food insecurity; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Revenue & Quality

Biden rolls out new pandemic strategy: Protect against and treat COVID-19, prepare for variants, avoid shutdowns

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.

Revenue & Quality

Fact check: Biden sets high bar in 1st State of the Union speech

Here are the health care highlights from Biden's address.

Medicaid

From Alabama to Utah, efforts to vaccinate Medicaid enrollees against COVID run into obstacle

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.

Population Health & SDoH

Health care firms were pushed to confront racism, now some are investing in Black startups

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.

Population Health & SDoH

The RISE Summit on Social Determinants of Health preview: 3 sessions sure to inspire

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.

Population Health & SDoH

Addressing social determinants begins with data

New CMS rule supports standardization of data to better understand drivers of health.

Population Health & SDoH

Covid precautions are part of Hispanic community’s efforts to tend to community good

After months of disproportionate impacts amid the pandemic, COVID testing and vaccination rates are finally improving among the Hispanic community.

Medicaid

Why millions on Medicaid are at risk of losing coverage in the months ahead

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.

Medicare Market

Medicare will cover free over-the-counter COVID-19 tests this spring

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.

Population Health & SDoH

SDoH in the news: National survey highlights disparities in telehealth use; Older adults in US more likely to report mental health condition than other countries; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Revenue & Quality

The 2023 Medicare Advantage and Part D Advance Notice is out: What you need to know about the proposed changes

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.

Revenue & Quality

Beyond the Z codes: Promoting health equity and population health through advancing the use of SDoH data

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.

Population Health & SDoH

The Commonwealth Fund outlines framework to assess racial equity in health policy

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.

Medicare Market

Why Medicare doesn’t pay for rapid at-home COVID tests

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.

Population Health & SDoH

Biden administration’s rapid-test rollout doesn’t easily reach those who need it most

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.

Population Health & SDoH

HHS announces funding initiatives to promote mental health among health care workers, improve behavioral health in rural communities

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.

Population Health & SDoH

Diverse patient engagement approaches reduce barriers to patient retention

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.

Revenue & Quality

Justices block broad worker vaccine requirement, allow health worker mandate to proceed

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.

Revenue & Quality

Regulatory roundup: CMS to reassess Part B premium after Alzheimer’s drug price cut; White House orders private insurers to cover at-home COVID tests; and more

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).

Population Health & SDoH

The RISE Summit on Social Determinants of Health: A day-by-day preview for our return to Nashville

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.

Revenue & Quality

CMS releases 2023 Medicare Advantage Proposed Rule: Aims to tighten marketing of MA plans

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.

Population Health & SDoH

Supreme Court weighs Biden’s workplace vaccine requirements

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.

Revenue & Quality

4 health care trends to watch in 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.

Revenue & Quality

20 health care podcasts you should listen to in 2022

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!

Revenue & Quality

The latest on COVID-19: As cases surge, CDC changes isolation guidance; Study finds unvaccinated patients cost health care system billions of dollars; and more

The COVID-19 pandemic continues as we close out 2021. Here is the latest news.

Population Health & SDoH

Feds issue new guidance to boost accessibility, equity in COVID-19 vaccine programs

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.

Revenue & Quality

Editor picks: Our favorite interviews from 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.

Revenue & Quality

Our 10 most-read articles for 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.

Medicare Market

RISE-Engagys annual survey: 5 findings on member engagement in 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.

Population Health & SDoH

SDoH in the news: CMS takes steps to improve maternal care outcomes; Mental health continues to take a toll amid pandemic; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Revenue & Quality

Regulatory roundup: National health spending rose nearly 10% in 2020 due to COVID; Medicare members aren’t receiving meds to treat opioid use disorder; and more

RISE summarizes the latest headlines that impact Medicare, Medicaid, and Medicare Advantage (MA).

Population Health & SDoH

Medicaid Managed Care programs enable states to address SDoH, report finds

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).

Medicaid

Mattresses and mold removal: Medi-Cal to offer unconventional treatments to asthma patients

Starting in January, California will embark on an ambitious experiment to control asthma in its most vulnerable patients.

Medicare Market

West Virginia Sen. Manchin takes the teeth out of Democrats’ plan for seniors’ dental care

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.

Medicare Market

Advocacy group urges CMS to allow MA plans to add benefits that address social determinants of health

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.

Population Health & SDoH

Health experts worry CDC’s COVID vaccination rates appear inflated

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.

Medicare Market

HHS report: Medicare telehealth use spiked 63-fold during pandemic

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.

Revenue & Quality

Regulatory roundup: CMS halts COVID-19 vaccination mandate for health care workers pending legal challenge; Urges Medicare members to get COVID booster shot; and more

RISE summarizes the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.

Population Health & SDoH

Fed judge blocks vaccine mandate for staff at Medicare, Medicaid-certified facilities in 10 states

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.

Population Health & SDoH

California joins states trying to shorten wait times for mental health care

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.

Population Health & SDoH

The Commonwealth Fund releases new health equity scorecard, reveals profound racial, ethnic health disparities across all states

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.

Population Health & SDoH

Strategies for health plans to achieve health equity

Achieving health equity requires the participation of individuals, communities, businesses, government, social service agencies, and more.

Medicaid

CMS administrator outlines strategic vision for Medicaid and CHIP

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).

Revenue & Quality

House narrowly passes $1.75T social policy bill; now heads to Senate

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.

Population Health & SDoH

Nominations open for the inaugural RISE Health Care Hero Award

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!

Population Health & SDoH

How rural communities are losing their pharmacies

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.

Population Health & SDoH

SDoH in the news: CMS reviewing first measures to assess SDoH; Majority of Americans say SDoH affect health of their community; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Revenue & Quality

CMS policy updates: The latest on final RADV audit rules, ESRD payment rule, risk adjustment model changes for ACA market, and so much more

The Centers for Medicare & Medicaid Services (CMS) has been busy. Here is a roundup of the agency’s recent news and actions.

Revenue & Quality

CMS OPPS/ASC final rule aims to increase patient safety and access to quality care

The Centers for Medicare & Medicaid Services (CMS) on Tuesday released the 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule.

Population Health & SDoH

KFF survey: State Medicaid program efforts to reshape policies in response to pandemic help further address SDoH, health equity

The survey of Medicaid directors in states and the District of Columbia explored current policies or planned changes for the current fiscal year.

Population Health & SDoH

Seema Verma to present keynote at RISE’s 2022 Summit on Social Determinants of Health

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.

Population Health & SDoH

SDoH in the news: Wearable health devices “game-changer” for clinicians; Efforts to address SDoH increase cancer survival rates, close gaps in racial inequities; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Population Health & SDoH

RWJF Commission releases recommendations to transform public health data systems, announces $50M in grant funding toward initiative

The Commission’s recommendations aim to modernize current data systems to address structural racism and advance health equity.

Population Health & SDoH

How Nashville General Hospital is addressing SDoH, promoting health equity

The hospital has implemented several programs targeting food insecurity, education attainment, health literacy, and health care access.

Revenue & Quality

COVID-19: Two new reports show vaccinations prevented thousands of deaths among seniors, lower hospitalizations among MA members compared to FFS Medicare

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.

Revenue & Quality

RISE’s new safety protocols require proof of COVID-19 vaccination to attend in-person events

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.

Population Health & SDoH

Blue Cross Blue Shield of Massachusetts to offer financial incentives to physicians who improve care for people of color

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.

Population Health & SDoH

Racism a strong factor in Black women’s high rate of premature births, study finds

A recent review of persistent gaps in preterm birth rates between Black and white women underscores racism as a key factor.

Population Health & SDoH

A pulse check on SDoH: Barriers, funding, and congressional activity in 2021 and beyond

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.

Medicaid

As Democrats bicker over massive spending plan, here’s what’s at stake for Medicaid

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.

Population Health & SDoH

SDoH in the news: HHS awards nearly $1B in American Rescue Plan funding to support vulnerable communities; SAMHSA distributes $825Min grants to CMHCs; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Revenue & Quality

RISE accepting nominations for 2022 quality award

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.

Population Health & SDoH

5 reasons to register for the virtual RISE Population Health Summit, a can’t-miss event uniting forward-focused innovators

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.

Revenue & Quality

DOJ health care fraud crackdown: 138 people charged in $1.4B schemes involving telemedicine, COVID-19, and illegal opioid distribution

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.

Population Health & SDoH

CDC: Number of states with high obesity prevalence nearly doubled since 2018

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.

Revenue & Quality

Dentists chip away at uninsured problem by offering patients membership plans

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.

Population Health & SDoH

SDoH in the news: San Francisco launches abstinence-based program for adults in justice system; Stress due to SDoH found to increase risk of heart disease; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Revenue & Quality

Census: Insured population holds steady, with a slight shift from private to public coverage

The Census Bureau on Tuesday released its 2020 findings regarding Americans’ income, poverty, and health insurance coverage.

Population Health & SDoH

Gates Foundation 2021 Goalkeepers report: Pandemic drove millions into extreme poverty

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.

Revenue & Quality

CMS Administrator Brooks-LaSure lays out her strategic vision for the agency

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.

Revenue & Quality

CMS mandates COVID-19 vaccinations for staff at all Medicare, Medicaid-certified facilities

The Centers for Medicare & Medicaid Services (CMS) said the new action will protect patients, providers, and health care workers in Medicare and Medicaid settings.

Population Health & SDoH

SDoH in the news: Staggering increase of youth-onset diabetes found among Black and Hispanic children; Aetna, ACES partner to improve quality autism care; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Medicaid

Colorado Clinic’s prescription for healthier patients? Lawyers

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.

RISE West

RISE West 2021: Highlights from day two of the conference

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.

Revenue & Quality

OIG report reveals the range of complex conditions experienced by Medicare beneficiaries hospitalized with COVID-19

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.

Revenue & Quality

Regulatory roundup: Sutter Health to pay $90M to settle MA fraud charges; COVID-19 a leading cause of death in US; and more

RISE summarizes the latest regulatory headlines that impact Medicare, Medicare Advantage (MA), and Medicaid.

Population Health & SDoH

Disadvantaged neighborhoods a key SDoH in older adults’ disability status

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.

Population Health & SDoH

Pandemic unveils growing suicide crisis for communities of color

Though overall suicide rates have decreased in the U.S. in recent years, rates continue to rise in communities of color.

Population Health & SDoH

SDoH in the news: Disproportionate health care spending on white individuals; Depression and anxiety rates doubled in children amid pandemic; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Population Health & SDoH

3 conclusions from the latest review of SDoH and health outcomes among adults during COVID-19

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).

Revenue & Quality

Regulatory roundup: OIG audit targets Aetna MA program; Medicare continues to make overpayments for chronic care management services; and more

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.

Population Health & SDoH

Kaiser Family Foundation report: Medicaid authorities and options for states to address social determinants of health

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.

Revenue & Quality

Report: MA plans need stronger CMS standards, modifications to Star ratings and risk adjustment to truly address social determinants of health

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.

Revenue & Quality

Regulatory update: CMS inpatient rule repeals MA rate disclosure requirement; Premium for Medicare Part D projected to increase 5% in 2022; and more

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.

Population Health & SDoH

Low vaccination rates among racial/ethnic minorities stress need for COVID-19 vaccine equity

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.

Population Health & SDoH

SDoH in the news: Medicare eligibility associated with reduction in racial disparities; Mental health response teams achieve greater outcomes than police; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Population Health & SDoH

The 2021 Health Care Investing Summit: A tailored experience to unite investors and emerging solution providers

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.

Revenue & Quality

The pandemic made telemedicine an instant hit. Patients and providers feel the growing pains.

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.

Population Health & SDoH

Decline in health coverage under ACA for 3 consecutive years amplifies health disparities among racial/ethnic populations

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.

Revenue & Quality

Sen. Wyden: $3.5T budget may have to trim but it can set a path to ‘ambitious goals’

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.

RISE West

Sneak peek at RISE West 2021: 5 hot topics on the agenda at this year’s hybrid event

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.

Pharmaceutical & Biotech

RISE Radio Episode 9: Dr. Angela Huskey on emerging drug threats, the rise in substance use among the elderly

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.

Revenue & Quality

CMS’ Physician Fee Schedule proposed rule aims to expand telehealth reimbursement for mental health, improve health equity, patient access

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.

Population Health & SDoH

Health disparities report identifies persistent, widening gaps in maternal mortality, mental and behavioral health, and food insecurity

The new report sheds light on the health disparities that continue to exist by gender, geography, socioeconomic status, race and ethnicity, and educational attainment.

Revenue & Quality

Regulatory roundup: 3.5T budget package would expand Medicare; COVID cases on the rise again; and more

RISE rounds up the latest health care headlines that impact Medicare, Medicaid, and the Affordable Care Act.

Population Health & SDoH

SDoH in the news: Climate change as a social determinant; HHS releases new interoperability standards for electronic exchange; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Revenue & Quality

As Congress wrestles with plans to expand Medicare, Becerra says any one will do

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.

Population Health & SDoH

BCBS, Humana, Centene, and more sign letter of support for Social Determinants of Health Accelerator Act

A coalition of more than 100 organizations have expressed their support for the reintroduction of the bipartisan bill.

Population Health & SDoH

5 ways SNPs can support special needs populations with SDoH programs to drive health equity

Learn about the innovative strategies special needs plans (SNPs) can leverage to support individuals with significant, complex social needs while advancing health equity.

Revenue & Quality

CMS proposes rule to reduce health care disparities for patients with chronic kidney disease, ESRD

The Centers for Medicare & Medicaid Services (CMS) said the proposed changes mark the Innovation Center’s first direct effort to close health equity gaps.

Revenue & Quality

Regulatory update: OIG says CMS unable to ensure hospitals are ready for future pandemics; 3 big name California health insurers sued over ‘ghost networks’; and more

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.

Population Health & SDoH

SDoH linked to increased Medicare spending

A new study indicates social determinants of health (SDoH) are associated with an increase in Medicare per beneficiary spending in certain geographic variations.

Population Health & SDoH

4 strategies programs can take to increase food access in vulnerable communities

A look at community-based health care organizations’ proven-successful approaches to address food insecurity.

Population Health & SDoH

Black and Hispanic Americans suffer most in biggest US decline in life expectancy since WWII

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

Medicaid

Biden quietly transforms Medicaid safety net

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.

Revenue & Quality

COVID-19: OIG on impact of pandemic in nursing homes; spike in Medicaid enrollment during PHE; threat of variant grows

RISE rounds up the latest news concerning COVID-19.

Population Health & SDoH

Study: Increased COVID-19 mortality rate among Black patients due to disproportionate hospital quality

The findings indicate that fewer Black patients would have died from COVID-19 if they were admitted to different hospitals.

Population Health & SDoH

COVID-19 interrupts global poverty decline

New research shows global poverty trends are on the rise amid the pandemic for the first time in decades.

Revenue & Quality

RISE Radio Episode 8: Dr. Abdullah Albeyatti on the acceleration of telemedicine during COVID

The latest episode of our podcast series, RISE Radio, focuses on the explosion of telemedicine during COVID-19 and what the future holds.

Revenue & Quality

Supreme Court dismisses GOP-led challenge to Affordable Care Act, leaves law intact

The Supreme Court on Thursday dismissed a challenge to kill the Affordable Care Act (ACA) and saved health care coverage for millions.

Population Health & SDoH

The RISE Summit on SDoH 2021 Day Two Recap: Innovative financing models, sustainability, and what the future holds

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.

Population Health & SDoH

The RISE Summit on SDoH 2021 Day One Recap: Powerful keynote address, timely panel discussions, and an update on what's happening on the Hill

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!

Population Health & SDoH

Study: 5-Star ratings don’t necessarily mean all MA members receive top-level care

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.

Revenue & Quality

New HHS report shows record number of Americans have health coverage through the ACA

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).

Population Health & SDoH

HHS announces water assistance program for low-income households

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.

Population Health & SDoH

The RISE Summit on SDoH: Sessions to spotlight innovative food access programs, partnership across sectors, and more

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.

Population Health & SDoH

In Missouri and other states, flawed data makes it hard to track vaccine equity

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.

Revenue & Quality

Expanding insurance coverage is top priority for new Medicare-Medicaid chief

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.

Revenue & Quality

RISE Radio Episode 7: Colleen Gianatasio & Dean Ratzlaff on managing a remote workforce

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.

Revenue & Quality

AHIP rebrands, updates mission to advocate for all Americans

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.

Population Health & SDoH

SDoH in the news: CHWs reduce hospital readmissions; U.S. hospitals ranked on racial inclusivity; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Medicare Market

Senate confirms Chiquita Brooks-LaSure as CMS administrator

The Senate voted 55-44 on Tuesday to confirm President Joe Biden’s nominee to oversee the Centers for Medicare & Medicaid Services (CMS).

Revenue & Quality

Regulatory roundup: Lowering age of Medicare eligibility to 60 may create winners and losers; HHS gives states billions to address behavioral health; and more

RISE looks at the latest news from the Department of Health and Human Services as well as studies that impact Medicare.

Population Health & SDoH

The RISE Summit on Social Determinants of Health: Claim your seat at the table for cross-sector collaboration

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.

Revenue & Quality

The 2021 ‘State of Medicare Advantage’: 7 findings from BMA’s annual report

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.

Population Health & SDoH

As pandemic eases, many seniors have lost strength, may need rehabilitative services

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.

Revenue & Quality

RISE’s Special Needs Plan Leadership Summit: A live-streaming virtual event to improve member outcomes for hard to reach, at-risk populations

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.

Revenue & Quality

Purposeful member engagement and outreach can be a vehicle for reducing health disparities and advancing health equity

Health plans can help advance the goal of achieving health equity.

Population Health & SDoH

Latinos are the most eager to get vaccinated, survey shows — but face obstacles

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.

Revenue & Quality

Regulatory update: HHS restores transgender health protections; 1M enroll in ACA coverage during SEP; AMA vows to advance health equity; and more

RISE summarizes the latest headlines that impact the health care industry.

Population Health & SDoH

Horizon Blue Cross Blue Shield of New Jersey finds success in SDoH pilot program, expands community partnerships

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.

Revenue & Quality

Research roundup: AEP switchers take advantage of OEP; MA beats Medicare in quality, outcomes, and costs; and more

RISE examines the latest research news on Medicare, Medicare Advantage, and Medicaid.

Revenue & Quality

CMS chief medical officer, customer experience expert to present keynotes at Qualipalooza 2021–a RISE hybrid event

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.

Population Health & SDoH

Mental health services wane as insurers appear to skirt parity rules during pandemic

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.

Revenue & Quality

Regulatory roundup: New survey looks at insurers’ role in improving COVID-19 vaccine uptake; CMS wants to repeal requirement that hospitals post private MA rates

RISE summarizes recent headlines that impact Medicare, Medicare Advantage, and Medicaid.

Population Health & SDoH

SDoH in the news: HHS announces actions to improve maternal health; Blue Cross Blue Shield sets goal to reduce racial disparities

RISE looks at recent headlines concerning social determinants of health (SDoH).

Population Health & SDoH

Blue Cross NC launches prevention programs to address food insecurity, nutrition

The health plan’s programs aim to equip individuals and communities struggling with food insecurity with equitable access to healthy foods.

Revenue & Quality

From rotten teeth to advanced cancer, patients feel the effects of treatment delays

Health providers are seeing the consequences of pandemic-delayed preventive and emergency care, from longer hospital stays to more root canals.

Population Health & SDoH

How to achieve true member centricity with a grassroots approach

Here’s how three organizations targeted social determinants of health (SDoH) and accomplished improved health outcomes beyond the clinical walls.

Revenue & Quality

Regulatory roundup: HHS to spend $150M to support underserved communities with COVID-19 response; Medical associations protest CMS prior authorization requirements; and more

RISE summarizes the latest headlines that impact the Department of Health & Human Services, Medicare, and Medicare Advantage.

Revenue & Quality

Regulatory roundup: Nearly 1 in 3 American seniors lack knowledge about their Medicare options; Study examines changes in Medicare spending during COVID-19; and more

RISE summarizes the latest headlines that impact Medicare and Medicare Advantage.

Revenue & Quality

RISE Radio Episode 5: Dr. Heather O’Toole on population health, quality measures, COVID, telehealth, and opioid safety in the ambulatory setting

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.

Population Health & SDoH

SDoH in the news: The impacts of COVID-19 one year later; NIH to address COVID testing disparities in vulnerable communities; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Population Health & SDoH

Pandemic brings digital inclusion to light as critical SDoH

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.

Revenue & Quality

Regulatory roundup: Legislation introduced to overturn controversial Sunset Rule; OIG report indicates MA could improve the use of NPIs; and more

RISE reviews recent headlines in the news that impact Medicare and Medicare Advantage.

Population Health & SDoH

Survey reveals frontline health care workers face serious mental health challenges due to pandemic

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.

Medicare Market

The intersection of depression and health plan satisfaction: How MA plans can improve satisfaction in an unsatisfied population

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.

RISE National

RISE Radio Episode 4: Ana Handshuh on COVID, behavioral health, and takeaways from RISE National 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.

Population Health & SDoH

How one health plan improved member engagement, Stars, and quality performance by addressing SDoH

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.

Population Health & SDoH

How to accelerate SDOH interventions: Insights from RISE’s webinar on social risk analytics

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.

Revenue & Quality

‘Incredibly concerning’ lawsuit threatens no-charge preventive care for millions

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.

Revenue & Quality

House bill would expand telehealth coverage to include audio-only for MA members

Bipartisan legislation introduced this week would expand telehealth services for seniors during the COVID-19 pandemic.

Revenue & Quality

News notes: CMS extends special enrollment period, releases snapshot on COVID-19; Murthy to serve as US surgeon general for a second time

RISE rounds up the latest headlines from the White House and the Centers for Medicare & Medicaid Services (CMS).

Population Health & SDoH

SDoH in the news: US aims for an equitable vaccine rollout; Medicare beneficiaries struggle to manage chronic conditions due to COVID-19; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Population Health & SDoH

Top 5 features of The RISE Summit on Social Determinants of Health

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.

Revenue & Quality

Regulatory roundup: HHS responds to lawsuit, postpones effective date of Sunset Rule; CDC director warns of avoidable surge in COVID cases due to relaxing protocols; and more

RISE summarizes the latest regulatory news that impacts Medicare and Medicare Advantage.

Population Health & SDoH

A reimagined conference experience: The RISE Summit on Social Determinants of Health goes hybrid

What exactly does a hybrid event entail? Here’s your one-stop guide for what to expect at the June 2021 event.

Population Health & SDoH

BCBSA, Feeding America partner to drive education of COVID-19 vaccination

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.

Revenue & Quality

Health care leaders welcome Becerra’s confirmation as HHS secretary

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.

Revenue & Quality

Regulatory roundup: MedPAC issues telehealth recommendation in Congressional report; Senate set to confirm Becerra as HHS secretary; and more

RISE reviews the latest headlines that have an impact on Medicare and Medicare Advantage.

Revenue & Quality

The boom in out-of-state telehealth threatens in-state providers

Health provider conflicts, fraud, and access disparity temper the COVID telehealth revolution.

Revenue & Quality

Regulatory roundup: MedPAC disputes AHIP’s blog post on Medicare Advantage spending; Health care groups sue HHS over Sunset Rule; and more

RISE reviews the latest headlines that impact Medicare and Medicare Advantage.

Revenue & Quality

Pandemic aid package includes relief from high premiums

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.

Revenue & Quality

Designing Medicare Advantage health plan benefits for our changing times

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.

RISE National

RISE National preview: Infectious disease expert Dr. Luciana Borio on COVID—the past, the present, and the future

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.

Revenue & Quality

RISE Radio Episode 3: How RISE evolved during COVID and what the future holds

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.

Revenue & Quality

Regulatory roundup: Calls to make Medicare reimbursement for telehealth services permanent; COVID relief package could bring major changes to the ACA; and more

RISE summarizes the latest news involving Medicare, Medicare Advantage, and the Affordable Care Act.

Population Health & SDoH

SDoH in the news: Children’s mental health claims doubled amid pandemic; Health equity medical school curriculum found to improve understanding of SDoH; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Revenue & Quality

Regulatory roundup: OIG reports hospitals may upcode severity levels for Medicare patients; AHIP disputes MedPAC report on MA spending; and more

RISE looks at recent headlines that impact Medicare and Medicare Advantage.

Population Health & SDoH

Latest data reinforces racial/ethnic disparities persist in COVID-19 vaccination rates

A recent analysis from Kaiser Family Foundation (KFF) found continued disparities based on state-reported data of COVID-19 vaccinations by race and ethnicity.

Medicare Market

Study: Email, SMS text soar as effective health care consumer engagement channels in 2020, reflecting urgency of COVID-19 communications

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.

Revenue & Quality

Regulatory update: Biden to nominate Brooks-LaSure to head CMS; Calls for HHS to revamp value-based payment and rein in Medicare spending; and more

RISE summarizes the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.

Population Health & SDoH

Key takeaways from the first meeting of the SDOH Community’s Across the Ecosystem User Group

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.

Population Health & SDoH

6 reasons to register for RISE’s virtual Medicaid Managed Care Leadership Summit

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.

Revenue & Quality

COVID-19 update: Lockdown led to huge drop in Medicare FFS claims; the link between pandemic and increase in mental health troubles and substance use;

RISE summarizes recent research on the impact COVID-19 has had on outpatient Medicare fee-for-service claims, mental health, and patients with dementia.

Population Health & SDoH

OIG: Thousands of Medicare beneficiaries died of opioid overdoses during onset of the COVID-19 pandemic

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.

Population Health & SDoH

What Americans really think about social determinants of health

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).

Population Health & SDoH

An innovative home-based outpatient therapy model for geriatrics saves money, boosts patient satisfaction

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.

Population Health & SDoH

As Vaccine Rollout Expands, Black Americans Still Left Behind

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.

Revenue & Quality

Regulatory roundup: New bill would allow audio-only telehealth services to count toward MA risk adjustment; MA satisfaction hits new high;

RISE reviews the latest headlines that impact Medicare, Medicare Advantage, and the Affordable Care Act marketplace.

Population Health & SDoH

How an emergency department social medicine team can improve care for complex needs

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.

Revenue & Quality

Regulatory roundup: Biden appoints acting heads for CMS, HHS; Medicare ACO participation dropped in 2021

RISE summarizes the latest headlines that impact Medicare and Medicaid.

Population Health & SDoH

On Trump’s last full day, nation records 400,000 COVID deaths

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.

Population Health & SDoH

Surgeon General releases first report on importance of community health

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.

Medicare Market

3 findings from the RISE-Engagys 2020 survey on the state of consumer health care engagement

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.

Population Health & SDoH

AHIMA releases 2020 SDoH survey results

The American Health Information Management Association (AHIMA) has released the results from its 2020 social determinants of health (SDoH) survey.

Population Health & SDoH

CMS final rule offers fast-track path for seniors to get access to latest medical technology

The Centers for Medicare & Medicaid Services (CMS) issued a final rule Tuesday that will speed Medicare beneficiaries’ access to the latest advanced devices.

Population Health & SDoH

SDoH in the news: Behavioral health most common treatment in telehealth; Pharmacy deserts linked to vulnerable communities; and more

RISE looks at recent headlines concerning social determinants of health (SDoH).

Revenue & Quality

Regulatory update: CMS approves first Medicaid block grant; HHS extends COVID-19 public health emergency

RISE reviews the latest from the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS).

RISE National

Dr. Ezekiel Emanuel to lead blockbuster lineup of keynote speakers at RISE National 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.

Revenue & Quality

4 health care trends to watch in 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.

Population Health & SDoH

CMS issues new SDoH guidance for states to improve beneficiary health outcomes and lower costs

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).

Population Health & SDoH

Social determinants of health funding included in COVID-19 omnibus bill

The new bill includes $3 million in funding to establish a social determinants of health (SDoH) pilot program.

Revenue & Quality

Inside the first chaotic days of the effort to vaccinate America

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.

Population Health & SDoH

Trusted messengers may help disenfranchised communities overcome vaccine hesitancy

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.

Revenue & Quality

Supply is limited and distribution uncertain as COVID vaccine rolls out

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.

Population Health & SDoH

How to finance SDoH initiatives for children, a critical step to their wellbeing and health

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.

Revenue & Quality

Biden names picks to lead HHS, CDC

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.

Population Health & SDoH

Financial and Overall Health are Deeply Connected: How Accurate Data Can Improve Outcomes

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.

Population Health & SDoH

SDoH programs aim to address Medicaid members’ social needs

RISE looks at the latest news regarding social determinants of health (SDoH), including recent approaches from Medicaid programs.

Population Health & SDoH

Social determinants in the news: AMA adopts new policies to address SDoH; Cardiovascular death linked to food insecurity; and more

RISE rounds up recent headlines concerning social determinants of health (SDoH).

Population Health & SDoH

COVID-19 escalates opioid epidemic and other addictions, intensifies mental health issues

Research indicates a concerning increase in relapse, fatal and non-fatal overdose, anxiety and depression, and other mental health conditions due to the pandemic.

RISE National

Health Care Futurist Ian Morrison named keynote for RISE National 2021

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.

Medicare Market

MA supplemental benefits grew 64% in 2021

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.

Revenue & Quality

Take it from an expert: Fauci’s hierarchy of safety during COVID

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.”

Revenue & Quality

Red states’ case against ACA hinges on whether they were actually harmed by the law

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.

Population Health & SDoH

Social Determinants of … HELP!

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.

Medicaid

CMS offers new flexibilities in final Medicaid, CHIP final rule

The rule puts an end to overly prescriptive regulations that stakeholders have complained about since 2016, according to CMS Administrator Seema Verma.

Population Health & SDoH

2020 Survey of America’s Physicians: COVID-19 Impact Edition results underscore focus on SDoH

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).

Revenue & Quality

Justices bound to see ACA as ‘indispensable,’ says Californian leading defense

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.

Population Health & SDoH

COVID-19 update: Experts warn Trump to take action to stop spike in cases; Biden names members to coronavirus task force; Pfizer offers encouraging news on vaccine

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.

Revenue & Quality

What to know as ACA heads to Supreme Court—again

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).

Population Health & SDoH

RISE prepares to welcome attendees back to in-person conferences

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.

Population Health & SDoH

SDoH and diabetes: American Diabetes Association unveils scientific review on risks and outcomes

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.

Revenue & Quality

No winner for president yet and health care hangs in the balance

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.

Population Health & SDoH

7 strategies to improve care delivery by addressing social determinants of health

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.

Revenue & Quality

2021 nominations now open for RISE quality award

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.

Population Health & SDoH

New report proposes to include individuals with social vulnerabilities in first round of COVID-19 vaccine

For the first time, the National Academy of Medicine recommended vaccine prioritization be given to individuals who struggle with social determinants of health (SDoH).

Revenue & Quality

Regulatory roundup: CMS OKs Nebraska Medicaid expansion program; MA plans offer more supplemental benefits in 2021

RISE reviews the latest headlines that impact Medicare, Medicare Advantage, Medicaid, and the Affordable Care Act marketplace.

Medicare Market

Video interview: Kevin Mowll reflects on his tenure at RISE and the future of the association

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.

Revenue & Quality

Regulatory roundup: CMS expands list of telehealth services for Medicare FFS; Health care policy implications under a newly configured Supreme Court;

RISE looks at recent headlines in the news that impact the health care industry.

Population Health & SDoH

RISE Population Health Summit to feature an interview with four-time U.S. Paralympian Lex Gillette

During the second day of RISE’s live-streamed virtual conference, Gillette will share his firsthand experiences and perspective on health care accessibility.

Population Health & SDoH

Equality Health integrates SDoH efforts in primary care practices to improve care delivery

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.

Revenue & Quality

Have you checked out the RISE Talent Hub?

Learn more about one of the exciting benefits of joining the RISE Association.

Population Health & SDoH

The COVID “pivot”: How programs to address social drivers of health are responding to and learning from the COVID crisis

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.

Population Health & SDoH

SDoH partnership: Independence Blue Cross and Signify Health to launch community health network

The new network seeks to break down barriers between clinical and social care to better address member’s socioeconomic needs in the Philadelphia area.

Revenue & Quality

COVID-19 update: Fauci warns 400K Americans may die; Azar reauthorizes public health emergency; NEJM editorial slams Trump’s handling of coronavirus

COVID-19 continues to dominate headlines in the wake of President Trump’s diagnosis and hospitalization. Here’s a roundup of the latest news.

Population Health & SDoH

The unintended consequence of social distancing on older adults

Under normal circumstances, an older adult is treated every 11 seconds in an emergency department (ED) because of a fall.

Population Health & SDoH

Trump tests positive for COVID-19 as cases surge in the United States

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.

Population Health & SDoH

Meet Ellen Fink-Samnick, RISE’s new lead for the SDoH Community

The principal of EFS Supervision Strategies, LLC, will work with the RISE Association to help guide our Social Determinants of Health (SDoH) Community.

RISE National

RISE National 2021 to feature new tracks on digital health care delivery, member experience, and compliance/regulatory updates

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.

Population Health & SDoH

SDoH in the news amid COVID-19: Loneliness rates double in adults; communities of color suffer disproportionate financial strain; and more

RISE looks at recent headlines concerning social determinants of health (SDoH), including the impact of COVID-19 on Latino, Black, and Native American communities.

Revenue & Quality

Trump’s executive order on preexisting conditions lacks teeth, experts say

President Donald Trump’s executive order says that people with preexisting conditions can get affordable insurance. But it doesn’t explain how.

Revenue & Quality

Regulatory roundup: Trump signs exec order on preexisting conditions; OIG officials weighs in on MA investigations; and more

RISE summarizes the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.

Population Health & SDoH

Geriatric house calls can increase access to care in a COVID world

The innovative model of care saves money, improves patient satisfaction, and may boost Medicare Advantage plan enrollment.

Revenue & Quality

Without Ginsburg, judicial threats to the ACA, reproductive rights heighten

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.

Population Health & SDoH

Spotlight on RISE’s upcoming Special Needs Plan Leadership Summit

Learn best practices to improve outcomes for hard to reach and at-risk populations during a live-streamed virtual event on Oct. 27-28.

Population Health & SDoH

Top 5 features of RISE’s Population Health Summit

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.

RISE West

RISE Association Executive Director Kevin Mowll to retire in mid-October

RISE Managing Director Ellen Wofford made the following announcement during RISE West on Friday:

Population Health & SDoH

Study: MA serves beneficiaries with higher social risk factors

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.

Population Health & SDoH

SDoH case study: 3 takeaways from RISE’s webinar on medical respite innovations

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.

RISE West

Countdown to RISE West 2020: What you need to know to make the most out of your virtual experience

Learn more about the interactive virtual sessions and activities we’ve planned for RISE West 2020, which will take place Sept. 9-11.

Population Health & SDoH

Why Black aging matters, too

Older Blacks are perishing quietly, out of sight, victims of the pandemic and a lifetime of racism and its attendant adverse health effects.

Population Health & SDoH

New survey reveals health care affordability crisis amid COVID-19 pandemic

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.

RISE West

Video interview: Jefferson Health’s Dr. Stephen Klasko on the pandemic of the future and what the health care delivery landscape will look like

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.

Medicare Market

5 takeaways about member communications from the second RISE/Engagys COVID-19 response survey

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.

RISE West

RISE West 2020 to shine a spotlight on member engagement during new preconference workshop

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.

Population Health & SDoH

HHS releases Healthy People 2030 initiative to address public health priorities and challenges

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).

Population Health & SDoH

Survey indicates Americans face greater mental health and economic challenges from COVID-19

A recent international survey found people in the United States are struggling more than people in other wealthy nations amid the global pandemic.

RISE West

The long-term effects of COVID-19 on health care: Part 2 of a video interview with John McDonough of the Harvard T.H. Chan School of Public Health

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.

Revenue & Quality

Judge blocks Trump’s anti-transgender health care rule one day before it was to take effect

A New York federal judge on Monday stopped the Trump administration from enforcing a new rule that rolls back nondiscrimination protections for transgender patients.

Revenue & Quality

Rolling back the surge: New Cotiviti map helps forecast COVID-19 health risk severity

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?”

Revenue & Quality

Measuring the ROI of social determinants of health interventions

Consider the following framework to effectively assess the ROI of SDoH interventions.

Population Health & SDoH

Study: Social determinants of health increase likelihood of stroke among adults below age 75

The findings indicate that adults who experience one or more social determinant of health (SDoH) have an increased risk of stroke.

Revenue & Quality

Researchers warn COVID-19 deaths could spike to 300K in the US

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.

Population Health & SDoH

America’s Obesity Epidemic Threatens Effectiveness of Any COVID Vaccine

Researchers caution that a COVID-19 vaccine is likely to be less effective in obese adults.

RISE West

RISE West 2020 to shine a spotlight on SDoH cross-sector community paramedic program

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.

Population Health & SDoH

What seniors can expect as their new normal in a post-vaccine world

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.

Population Health & SDoH

COVID-19 disparities derive from racial and ethnic differences in health risk, job characteristics, and household composition

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.

RISE West

RISE West 2020 goes virtual: Sneak a peek at this year’s agenda and speakers

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.

Population Health & SDoH

New CMS data shows the impact of COVID-19 on Medicare beneficiaries

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.

Population Health & SDoH

3 strategies to address unmet social needs in larger patient population

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.

Revenue & Quality

COVID-19 update: HHS extends public health emergency, takes over hospital data reporting as cases surge

RISE rounds up the latest news on COVID-19.

Population Health & SDoH

NIH project homes in on COVID racial disparities

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.

Population Health & SDoH

Communities of color impacted disproportionately by COVID-19 due to social risk factors

Here are five actionable steps that organizations can take to support communities of color hit especially hard by the global pandemic.

Population Health & SDoH

Study finds Black Americans more likely to be hospitalized or die from COVID-19 due to racial disparities

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.

Population Health & SDoH

Telehealth study: Technology disparities correlate with health disparities

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.

Population Health & SDoH

5 step approach for payers to improve behavioral health access and quality amid COVID-19

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.

Population Health & SDoH

HHS announces $40M initiative to combat COVID-19 in racial, ethnic minority, and vulnerable communities

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.

Population Health & SDoH

HHS launches MENTAL Health Innovation Challenge to tackle social isolation amid pandemic

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.

Population Health & SDoH

Social determinants of health: 3 takeaways from RISE’s virtual summit

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.

Population Health & SDoH

From poverty to Emmy Award winning journalist: How John Quiñones managed to defy the odds

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.

Population Health & SDoH

Exclusive insight into the results of RISE’s benchmarking survey on SDoH

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.

Population Health & SDoH

Staggering rate of loneliness identified in Cigna study

The survey examined the occurrence of loneliness among Americans and the link between factors such as age, social media use, income, and occupation.

Population Health & SDoH

Social determinants in the news: Patients postpone care amid pandemic; School closures leave children neglected and hungry; and more

RISE looks at recent news regarding social determinants of health (SDoH), including the different impacts the global pandemic presents to children and adults.

Population Health & SDoH

For seniors, COVID-19 sets off a pandemic of despair

The guidance to stay sheltered as society slowly reopens wears on older Americans, who have a growing sense of isolation and depression.

Population Health & SDoH

Drastic health disparities intensify in communities of color amid COVID-19

The global pandemic has exacerbated existing inequities for the black and Latino populations, putting them at heightened risk for physical and mental health issues.

Population Health & SDoH

RISE virtual seminar series returns: Managing Behavioral & Mental Health During & Post Pandemic

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.

Population Health & SDoH

5 reasons to register for RISE’s Virtual National Summit on Social Determinants of Health

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.

Population Health & SDoH

7 tips to tackle stress and create resiliency amid COVID-19

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.

Population Health & SDoH

New CDC data emphasizes role homelessness plays in COVID-19 spread

A recent report from the Centers for Disease Control and Prevention (CDC) confirms homelessness is a significant contributor to virus spread.

Population Health & SDoH

A simple phone call goes a long way when it comes to loneliness amid coronavirus

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.

Population Health & SDoH

CDC study examines demographics behind coronavirus hospitalizations

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.

Population Health & SDoH

New population health website enables researchers to examine SDoH in California as it relates to COVID-19

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.

Population Health & SDoH

Medicare eligibility expansions could improve existing racial and ethnic health disparities

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.

Population Health & SDoH

Social distancing may exacerbate loneliness in older adults, putting their health at serious risk

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.

Population Health & SDoH

Select progress on social determinants of health harms other essential safety-net programs

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.

Population Health & SDoH

Social determinants of health intensify alongside coronavirus

Gaps in the social safety net have become apparent as public health leaders try to halt the spread of the virus.

Population Health & SDoH

Study confirms strong link between socioeconomic status and health for older adults

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.

Population Health & SDoH

Social determinants in the news: Social distancing may put those most vulnerable at risk; rural communities more likely to skip preventive care; and more

RISE looks at recent headlines concerning social determinants of health (SDoH), including the impact social distancing has on those already most vulnerable.

Population Health & SDoH

Deft Research report: Social determinants drive ‘convenience use’ of emergency rooms – but not for the reasons you may think

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.

Population Health & SDoH

RISE Nashville, National Summit on Social Determinants of Health postponed to late June 2020

RISE reschedules national conferences due to concerns over COVID-19.

Population Health & SDoH

CMS official to speak at The RISE National Summit on Social Determinants of Health

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.

Population Health & SDoH

The National Summit on Social Determinants of Health: CBOs are ready and willing to partner with health systems

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.

Population Health & SDoH

CMS report reveals the most commonly used codes for social determinants of health

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.

Population Health & SDoH

Despite new doubts, ‘hotspotting’ help for heavy health care users marches on

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.

Population Health & SDoH

RISE Association announces the launch of research project on social determinants of health

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.

Population Health & SDoH

The National Summit on Social Determinants of Health: Jacob Reider, M.D., on the progress made so far with social determinants and what to expect in 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.

Population Health & SDoH

5 reasons you need to register for The RISE National Summit on Social Determinants of Health

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.

Population Health & SDoH

RISE recommended reading: Dr. Jacob Reider’s op-ed on payer philanthropy and social determinants of health

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.

Population Health & SDoH

RISE announces agenda for National Summit on Social Determinants of Health and virtual attendance option

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.

Population Health & SDoH

RISE recommended reading: Deft Research’s blog post on social determinants of health and health outcomes

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.

Population Health & SDoH

How to make social determinants of health actionable

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.

Population Health & SDoH

RISE recommended reading: United Hospital Fund’s white paper on the social determinants of health

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.

Population Health & SDoH

The National Population Health Summit: Jason Helgerson on trends in population health and the move to value-based payment

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).

Population Health & SDoH

Community health takes center stage at RISE’s inaugural National Population Health Summit

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.

Population Health & SDoH

Collaboration is key—the biggest takeaway from The National Summit on Social Determinants of Health

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.

Population Health & SDoH

RISE West to take a deep dive into UnitedHealthcare’s housing, wraparound care model that tackles social determinants of health

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.

Population Health & SDoH

Social determinants of health: 68% of Americans surveyed have experienced at least one unmet social need in the past year

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.

Population Health & SDoH

Survey: SDoH tops list of most difficult information to share through HIEs

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.

Population Health & SDoH

Data collection key to efforts that address social determinants of health

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.

Population Health & SDoH

Medicare Advantage plans can offer additional telehealth benefits in 2020

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.

Population Health & SDoH

UnitedHealthcare, American Medical Association push for 23 new ICD-10 codes to address social determinants of health

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.

Population Health & SDoH

The 2020 Final Call Letter and Rate Announcement is out: 5 things you need to know

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:

Population Health & SDoH

RISE Nashville highlights: Inspiring keynotes, engaging sessions, and networking opportunities galore

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.

Population Health & SDoH

Social determinants of health: 5 takeaways from the 2nd annual RISE Symposium

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:

Population Health & SDoH

5 health plan predictions for 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.

Population Health & SDoH

A potential game changer: CMS takes aim at the social determinants of health, may pay for housing, other social services

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?

Population Health & SDoH

3 topics that generated the most buzz at RISE West 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.