Member experience game changer CMS has upped the ante for member experience measures for 2023 Star ratings. Take action now to ensure you are ahead of the game.
GOES VIRTUAL
nยบ9 - Fall 2020
The 2020 election’s impact on health care: Part 1 of a video interview with John McDonough of the Harvard T.H. Chan School of Public Health RISE’s take: The trouble with telehealth for coordinated care plans CCIIO clarifies what telehealth claims are valid for risk adjustment RISE West Keynote Dr. Marc Milstein on the importance of a good night’s sleep to manage stress and protect your mental health CMS releases report on 2019 ACA risk adjustment transfers RISE West 2020 to shine a spotlight on SDoH cross-sector community paramedic program New CMS data shows the impact of COVID-19 on Medicare beneficiaries Regulatory roundup: Cigna accused of MA fraud; Trump emergency order expands access to telehealth COVID-19 update: HHS extends public health emergency, takes over hospital data reporting as cases surge
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A win for Trump administration: Appeals court upholds expansion of short-term health plans Another problem on the health horizon: Medicare is running out of money Regulatory Roundup: CDC no longer to collect COVID-19 data; CMS releases stats on telehealth use during outbreak 5 findings on the state of Medicare Advantage in 2020: Trends in enrollment growth, health care quality, and consumer attitudes Telehealth study: Technology disparities correlate with health disparities NQF’s new goal: Improve health and patient outcomes by 2030 Supreme Court landmark ruling protects LGBTQ work rights, days after HHS rolls back transgender health care protections CMS issues HHS-RADV proposed rule: 4 things you need to know CMS finalizes changes to telehealth, ESRD, supplemental benefits, and Star ratings for Medicare Advantage
See our entire collection of Insights & Articles
MEMBER EXPERIENCE
GAME CHANGER Changes to member experience measures require MA plans and providers to act now With the world turned upside down due to COVID-19, it is understandable if you missed the news that the Centers for Medicare & Medicaid Services (CMS) has once again increased the weight of member experience measures. But the news requires your attention now because the new weights of these measures are game changers. CMS had already increased the relative weight of these measures from 1.5 to 2 for the 2021 Star ratings. And recently CMS issued a final rule dramatically increasing the weight of member experience measures. For the 2023 Star ratings (which are based on 2021 measurement year), CMS will increase the weight from 2 to 4. This change greatly increases the importance of the member experience measures as they will make up a significant portion of your plan’s overall score. The member experience measures are collected through the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys (except flu measure), disenrollment, appeals, call center, and complaint measures. The strategies and tactics needed for success are different for each organization, but before you strategize, you must know where to start. Getting started can sometimes be a daunting task in and of itself. So… where do you begin?
It starts with leadership Approaching the business in the usual way, “the way we’ve always done it,” is no longer enough to get you to the next level, or even to keep you where you are. You must nurture strong leaders at all levels of your organization (both at the health plan and provider groups). That means identifying effective and compelling communicators who can convey your vision, persuade staff, doctors, and other members of the team to embrace change and eagerly take part in reshaping how care is delivered. Where to look? You will need senior leaders (i.e. at least one executive sponsor in the C-suite) to set the tone and establish the policies and organizational structure to support your efforts. Look for mid-level managers and directors to serve as important members of the interdisciplinary teams that are essential to effectuate cross-functional cooperation. Identifying the QI leaders who will work together within and outside your organization and investing in change management training for these “influencers” is an important key to success.
Ready, set… GO! Meet your organization where it is at by knowing where you are standing before you set off. Conduct an honest and critical self-assessment of your existing organizational culture and structure to understand the impact of weaknesses on your efforts to improve the member experience. Ask these questions of the organization:
“the way we’ve always done it,” is no longer enough to get you to the next level Click to see other articles
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• Do we develop and support QI leaders at all levels of the enterprise? • Do we know, granularly, where each member experience measure is won and lost? Where are the touchpoints that move the needle one way or the other in the areas that require improvement? • Do we invest in training for all staff on key satisfaction improvement models and skills? • How much do we pay attention to member satisfaction? How do we know if we are doing a good job? What are our internal key performance indicators? Can our leaders and staff articulate what our scores are or how we are doing or what needs to improve? • Do we adequately recognize and reward success within and outside the organization? How, specifically, do we do that? • Do we “make it easy” to do the right thing? Once you know these answers, you can plan your way forward by addressing any of the above areas where you miss the mark.
Set the course As you begin, integrating the goals of improving the member experience into your current business ecosystem is vital. You can start by connecting your QI goals to your foundational principles (your vision, mission, and values). Take it to the next level by incorporating the goals into your strategic business plan. Think about how you might make that actionable in multiple ways that best serve your organization. For example, you might establish communication methods across your enterprise; use regular measurement and monitoring by management to stay focused on the goals; ensure that you allocate sufficient personnel and financial resources to the QI efforts; set up data collection infrastructure within all member facing departments and touchpoints to gather improvement information; look for and remove obstacles (i.e. outdated policies, resource constraints (money/people), company politics, bad attitudes, etc.); address staff concerns when legitimate. In short, set up an “ecosystem” for member experience improvement across the enterprise. This may require a total transformation in how you currently operate, which is why starting with leadership is so important.
Launch Once you have established a solid foundation, it is time to ACT. Take a disciplined approach to the following next steps in your journey:
• • • • • •
Analyze your member experience data to understand past and current performance Select your improvement goals and strategy Set up your project as a “continuous improvement” activity (Plan, Do, Study, Act) Choose your tactics and interventions and IMPLEMENT Measure performance and adjust your plan, as necessary Celebrate successes early and often
If you have been tasked with championing these measures at your organization, get very good at articulating a compelling case for improving the member experience. In the face of multiple priorities and limited resources, getting your entire organization to come along for the ride can be challenging. Meet your different constituencies where they are at, using evidence to link improvements in member experience to clinical outcomes or business outcomes. Each of the steps above takes a concerted effort. Do not make the mistake of suffering from analysis paralysis. Get started as soon as possible, and do not let the perfect be the enemy of the good. Take the first step and get help if you need it. This is too important to wait another day.
Ana Handshuh, CHC
RISE Executive Advisory Board Member Principal CAT5 Strategies
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Quality & Revenue Newsletter
GOES VIRTUAL Sneak a peek at this year’s agenda and speakers KEYNOTES THAT WILL INSPIRE YOU
Former Navy SEAL Brent Gleeson kicks
Marc
and
Stephen Klasko, M.D., MBA, president
off the main conference on Thursday,
researcher on health and happiness, will
Milstein,
and CEO, Thomas Jefferson University
Sept. 10 with a keynote presentation
open the second day of the conference
and Jefferson Health, will close out
on how to lead during times of crisis.
with an address focused on how to
the conference on Friday, Sept. 11
Gleeson, an expert on leadership, culture,
optimize your brain so you can sleep
with a presentation on how COVID-19
and engagement, will compare stories
better,
your
will change the health care delivery
from the battlefield, lessons learned,
memory, and protect your mental health.
landscape. He’ll provide tips for payers
and how to apply those lessons during
Dr. Milstein will help attendees tap into
and providers to navigate the changes
times of crisis, like the current COVID-19
the latest breakthroughs in science to
in the industry and prepare for the
pandemic.
live a healthier, happier life.
future and will also offer tactical ways
manage
Ph.D.,
stress,
scientist
boost
to redefine roles within the health care system to provide “best in class patient care.”
Click to see other articles
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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.
General sessions on today’s most pressing concerns Worried about the outcome of the 2020 election and its effect on Medicare, Medicare Advantage, Medicaid, and the Affordable Care Act? Former politician John E. McDonough, DrPh, MPA, professor of public health practice, Harvard T.H. Chan School of Public Health, will give his predictions and potential scenarios for health plans. McDonough, former member of the Massachusetts House of Representatives, and former senior advisor on national health reform for the U.S. Senate Committee on Health, will discuss the effect of COVID-19 on health care policy, the long-term view of the health care infrastructure and health care policy, and pandemic preparedness. An all-star payer panel will provide a perspective on the shortened calendar year, including what the pandemic means for 2021 risk and quality scores and how the lack of documentation (because of COVID-related seclusions) could adversely impact risk adjustment next year. Panelists will include Mark Dodge, AVP of Stars, risk, and quality, Bright Health Plan, Tom Lutzow, president and CEO, Independent Care Health Plan, and Jason McDaniel, vice president of risk adjustment and quality, Healthcare Partners Nevada.
social determinants of health (SDoH). You’ll learn how the Rockford, Ill. fire department did so through a partnership with health care stakeholders to improve patient outcomes in the community. Chief Derek Bergsten, chief fire officer and chief EMS officer for the Rockford Fire Department, will discuss what led to the success of his partnership with MCOs and hospital systems to optimize emergency medical services in the community. Get insights into what members really think about Medicare and Medicare Advantage (MA) products during a panel discussion with Medicare and MA customers. Engagys Managing Director Kathleen Ellmore will moderate the discussion to learn more about their experience, satisfaction, pros and cons of products, the effects of COVID-19 on their experience, and how they responded to their health plans’ efforts to retain them this year. Join the RISE Risk Adjustment Policy Committee for a roundtable discussion on the regulatory state of the industry. Panelists will offer their perspectives on real-world implications of telehealth guidance, pending Star ratings changes, and advice on how to stay compliant in an uncertain environment. Speakers include Sean Creighton, vice president of federal policy, Humana; Larry Bishoff, president, Laurence Bishoff & Associates; Dave Meyer, vice president, risk adjustment and quality, Cigna; J. Gabriel McGlamery, J.D., senior health care policy consultant; and Howard Weiss, associate vice president, policy, EmblemHealth.
Concurrent track sessions on main conference days
UPDATE: NCQA Q&A session added to Each day of the main conference will RISE West 2020 feature several hours of concurrent sessions in two tracks. Interested in two It is possible to create a successful sessions taking place at the same time? cross-sector collaboration to address No worries. Our virtual sessions will be
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Panelists will offer their perspectives on real-world implications of telehealth guidance, pending Star ratings changes, and advice on how to stay compliant in an uncertain environment”
available to you for 90 days after the live event so you can watch presentations you missed and re-watch ones you want to hear again.
Plan, and Colleen Gianatasio, director of ambulatory clinical documentation quality improvement, Mount Sinai Health System, will lead the six-hour workshop.
Sessions in the risk adjustment and quality track will include navigating the new post-pandemic world of risk adjustment and quality; provider/payer collaboration; how COVID-19 is affecting your quality engagement scores; and a case study that spotlights a successful partnership between a payer and their primary care providers.
New this year is a workshop on member engagement. The three-hour workshop will focus on tools to keep up with changing quality guidelines for health plans, including the change of CAHPs survey scores, CAHPS improvement strategies, telehealth member experience, Click here to learn more about RISE West and strategies to tackle the second wave 2020 and to register for the pre-conference of COVID-19. Speakers include Shannon workshops and main conference. Decker, M.Ed., MBA, Ph.D., vice president, clinical performance, Brown & Toland Physicians; and Dominic Henriques, vice president of performance improvement and Johanna Martinez, director of quality improvement, both from Prominence Health Plan.
A track on innovations and responses to COVID-19 will include presentations on risk adjustment in the new era of telehealth as well as telehealth coding guidance in RADV audits. COVID-19 has also exposed health disparities in the United States. Anna Wetherbee, MBA, principal, technology innovation and integration, Blue Shield of CA, will present a case study during one of the track sessions on the second day on how to tap into SDoH data to advance health equity efforts. She’ll describe how her plan is leveraging novel sources of data to advance SDoH efforts, provide insights into the operational challenges, success and outcomes, of a pilot project that focused on a longitudinal patient record, and share the results from pilot projects.
Our risk adjustment professional advance workshop is an update to RISE’s 101 workshop and is designed for those who have a managerial role in risk adjustment, from running the department to the day-to-day duties, with a primary focus on risk adjustment for the Medicare Advantage line of business. Laura Sheriff, R.N., MSN, CPC, CRC, national director, risk adjustment, Molina Healthcare, Inc., and Susan Waterman, RHIT,CCS, CPC ,CRC, director of risk adjustment, Scott and White Health Plan, will serve as instructors of the three-hour class.
Take advantage of pre-conference workshops on Wednesday
Bonus session and network opportunities
Back by popular demand! Our in-depth workshop on HCC Coding 201 will provide managers with best practices for an end-to-end method of aligning chart documentation, HCC code chapter, and audit readiness at both the provider and health plan levels. Donna Malone, CPC, CRC, senior manager of enterprise risk adjustment, HCC coding and quality assurance for Tufts Health
Give your mind a rest and join us Friday morning for our bonus “virtual yoga and meditation session” before the opening keynote. Yoga veteran Kim Larkin will guide attendees through breathing exercises, meditation, and gentle yoga to get your morning off to a great start. We may be virtual, but that doesn’t mean you won’t have a chance to meet
with other attendees, exhibitors, and our sponsors. Networking breaks will take place in between select sessions and we’ve also scheduled enhanced networking time in the exhibit hall on both days of the main conference so you can mix and mingle with solution providers and peers to learn the latest and greatest advancements in risk adjustment and quality program improvement.
Our virtual sessions will be available to you for 90 days after the live event so you can watch presentations you missed and re-watch ones you want to hear again” Click to see other articles
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Regulatory updates, strategies to improve Star ratings, risk adjustment, payer/provider collaboration Did you miss last month’s RISE National 2020 virtual conference? Here are highlights from a few of the sessions.
OIG’s work on vulnerabilities with Medicare Advantage Megan Tinker, senior advisor for legal affairs, and San Le and Jacqualine Reid, both social science research analysts at the Office of Inspector General, gave an excellent presentation, providing attendees with the findings of recent evaluations and investigations aimed to ensure that beneficiaries of the Medicare Advantage (MA) program get the services they need and funds aren’t being diverted through fraud, waste, and abuse. Essentially the OIG aims to root bad actors out of the system and ensure that the services provided lead to healthier people, lower costs, better care, and a
more economic and efficient system. That mission permeates everything the OIG does, including how it identifies risks and where it spends its limited resources. OIG research focuses on three main buckets: quality (such as denials or appeals); federal money (fraud and RADV); and data (security, adequacy, and compliance). The presentation addressed OIG reports and recommendations on:
• MA appeal outcomes (MAOs overturned 75 percent of their own denials and 1 percent of denials were appeals during 2014-2016) • Behavioral health provider
shortages in New Mexico’s Medicaid Managed Care (75 of 218 enrollees had unsupported diagnoses codes due to ineffective policies and procedures to detect and correct noncompliance) • Data security vulnerabilities (which found disparate treatment at the state and MCOs as well as an increased risk to Medicaid patient data) • Office of Evaluation and Inspections (OEI) work related to MA encounter data: • Chart reviews almost always added rather than deleted Click to see other articles
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...digitization of health care has established a foundation and electronic-based environment, but the progression toward interoperability has been slow diagnoses for risk adjustment • Increased estimated risk-adjusted payments from chart reviews far exceeded decreased payment • Estimated payments from unlinked chart reviews totaled $2.7 billion–they weren’t linked to service records and many contained default procedure codes) NCQA updates We heard the latest plans from the National Committee for Quality Assurance regarding quality reporting and telehealth during and after COVID-19. Paul Cotton, director of federal affairs for NCQA, said the pandemic has led the organization to move all activities virtual, including its health plan accreditation surveys. It has canceled Quality Compass and the release of 2020 plan ratings and Cotton said it will base the 2020 Health Plan Report Card on existing status or performance on 2020 standards. In addition, Medicare Advantage plans will not be required to report HEDIS data for measurement year 2019, and NCQA will not collect data for CAHPS. Meanwhile, the NCQA has plans to soon start a new interactive community for digital quality measurement and on Monday launched a taskforce on telehealth policy to identify the best ways to integrate telehealth into traditional care once we get past the COVID-19 10
Quality & Revenue Newsletter
public health crisis. The task force includes representatives from HHS, CMS, clinicians, consumers, telehealth firms, and health systems but also seeks public comments. Cotton said the task force plans to release its consensus recommendations by September.
The future of interoperability Panelists shared challenges, improvements, and opportunities for continued expansion. The digitization of health care has established a foundation and electronic-based environment, but the progression toward interoperability has been slow due to several barriers, noted Chad Brooker, associate principal, policy, Avalere Health. Attendees were asked for direct feedback through an in-session polling question regarding the biggest payer/provider data sharing challenges. The leading barrier identified, according to 35 percent of responses, was a lack of data and measure standardization. The remaining challenges included:
• Integrity, quality, and timeliness of data shared (27 percent) • A lack of trust between payers and providers (20 percent) • A lack of technical interoperability (12 percent) • None of the above (4 percent) • Key information such as prior authorization requirements, benefits, eligibility not available (2 percent)
Payer, provider, vendor collaboration A session on how to improve risk and quality highlighted a successful collaboration between M Health Fairview, UCare, and Optum to improve quality and coding accuracy. Panelists shared the key components to their partnership that propelled improvement and growth for both payers and providers, including a tactical working group with representation from coding, medical records, population health, and quality and primary care to execute the strategy; accountability oversight assigned to Population Health Governance Committee; weekly status updates and meetings; and the development of an ongoing strategic approach. In the session, provider/payer collaboration in a virtual world, presenters discussed the new realities in chart retrieval and lessons learned so far in telehealth. Panelists emphasized the importance of true collaboration between payers and providers for efficient access to charts, provider education, and telehealth. “Payers and providers weren’t natural friends,” said Rich Bitting, vice president, actuarial informatics, Jefferson Health. “But when you find the common ground where you can improve the patient experience, improve the member experience, and create a win all around, those are the scenarios that make the most sense.”
...Not everything has to be a fire drill. Give people a realistic time to respond Shelley Collins, R.N., director of clinical quality improvement, Blue Cross and Blue Shield of Nebraska (BCBSNE) and Erica Krieger, vice president, quality, Advantasure, discussed the benefits of vendor/client partnerships for Star rating success. Their partnership began in October 2015 shortly after BCBSNE began to search for a MA partner to help prepare for the 2017 AEP. The insurer wanted to enter the MA market but knew its penetration would be low and it had limited inhouse capabilities. Advantasure offered consultative support, experience, multifaceted turnkey solutions, and a partnership based on upside and downside risk.
to 1,500 in 2019, and has since doubled that membership to 3,000. Collins and Krieger said the partnership works well because the two organizations set clear expectations from the start, made sure communication is constant and transparent, collaborated by leveraging the strengths of each team, and engaged team members by working toward a common goal. The biggest piece may be intangible and involves relationship building, according to Krieger. Spending time together to better understand each other’s perspective. She also said respect is an important factor and giving people a realistic and reasonable amount of time to work through problems. “Not everything has to be a fire drill. Give BCBSNE is a small plan but has seen people a realistic time to respond.� incremental growth since its 2017 launch and expansion of its service area. It began with 500 members, increased
The future of telehealth The first day wrapped up with a panel discussion on telehealth and how it has revolutionized the health care delivery system. Discussion points included challenges for member communication and engagement and the latest guidance from the Centers for Medicare & Medicaid Services (CMS) for telehealth. Dave Meyer, vice president, risk adjustment, quality for Cigna, kicked off the discussion, noting that telehealth has been the bright spot in what otherwise has been a miserable year. Sean Creighton, vice president, federal policy for Humana, predicted that telehealth is here to stay, but it remains to be seen as to whether CMS will allow telehealth for Medicare risk adjustment.
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Life Stories
RISE National 2020: Keynotes inspire with life stories that show the power of resilience, courage, and kindness under the worst of circumstances 12
Quality & Revenue Newsletter
Phenomenal keynote speakers took the virtual stage over two days at the annual event, RISE National 2020, and offered stories of hope and perseverance during the darkest of times.
IN A WORLD OF ETHICAL DILEMMAS, JOHN QUIÑONES LIGHTS THE WAY TO THE MORAL HIGH GROUND Weeks after speaking at RISE’s National Summit on Social Determinants of Health, Emmy Award winning journalist John Quiñones returned as the keynote speaker for RISE National 2020 but with a different message for the audience. As the creator and host of the long-running, hidden camera show, What Would You Do?, Quiñones has become the face of doing the right thing when confronted with moral and ethical dilemmas. The new season of the television program premiered this week and provides a look at how ordinary people react when they witness any kind of injustice, including bullying, racism, and attacks on the LGBTQ community. Do they step in or walk away? Although the scenarios were filmed prior to the COVID-19 pandemic, Quiñones says they are timelier than ever. He asked the attendees: if you could prevent the spread of a deadly disease, if you could simply wear a mask, would you do it? What would you do if you came face-to-face with racism or police brutality? Would you join the protestors or criticize them? The dilemmas offer a true test of a person’s character, he said, because it shows what people do when they don’t know everyone is watching. “It’s the power of the camera when used in the right way,” he said. Quiñones has made a career out of shining a light on injustice and providing a voice to those who don’t have a voice. One of the first assignments he ever covered as a news reporter in Chicago was on illegal immigration. He convinced the news director to let him go undercover
and pose as a Mexican citizen trying to get into the United States. Quiñones recalled giving a smuggler $300 for a fake birth certificate and Social Security card to float on an inner tube to get to Chicago. Once there he got a job at a restaurant that had hired undocumented Mexican workers but never paid them. The owner told them that if they complained,
What would you do if you came face-to-face with racism or police brutality? Would you join the protestors or criticize them?” he would have them deported. During the day Quiñones bussed tables and did the dishes, at night he interviewed the undocumented workers in Spanish about their lives and they explained to him they were being kept as virtual slaves in the basement for weeks and weeks without pay. The next day Quiñones, wearing business attire, brought along a camera crew and confronted the restaurant owner. The day after the segment aired on CBS television, the U.S. government
moved in, shut down the restaurant, forced management to pay the workers the money they were owned and issued the workers temporary visas. “I knew I was destined to tell the story and perhaps tell it better than anyone else,” said Quiñones, who described journalism as the candle in the darkness. The journalist is the person who can illuminate the darkest corners of society like corruption and civil rights violations. “When journalism is done right, these are the stories we should be telling,” he said.
FROM CONVICTED FELON TO CELEBRITY CHEF: JEFF HENDERSON’S LIFE OF REDEMPTION Jeff Henderson, star of Flip My Food with Chef Jeff and the author of “If You Can See It, You Can Be It” shared his compelling life story of redemption through resilience. As a young boy raised in poverty in South Los Angeles, Henderson developed a vision for the future at an early age: one with a large house on the hill, white picket fence, and an abundant fruit bowl on the kitchen table. “I always had this thought in my mind that one day I’m going to be in a position to help change the narrative in my family,” he said. “So as a young child, I always had the concept that if you can see it, you can be it.” But hardships throughout his childhood didn’t make his dream an easy one to attain. Henderson watched his single mother, who worked several jobs, struggle to keep food on the table. The people in Henderson’s community who had money, nice cars, and beautiful apartments were the drug dealers, and Henderson wanted the same success for his family. He started to go to school less and work alongside drug dealers more, mastering how to manage a crew of people and run a business on the streets. But he didn’t see the negative impact it had on his Click to see other articles
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community. By the time he was 20-years old, Henderson was a millionaire but, he said, it was “at the expense of people who looked like me.” In 1988, Henderson was indicted by the federal government and sent to prison. It was the darkest moment of his life, he said. “I knew mental toughness was going to be the key to me surviving prison.” Isolated from the life he knew, he read books, joined the Toastmasters program, and met people from around the world. “As a young black boy who didn’t travel and had limited knowledge of how the world works, for the first time in my life, in prison, I begin to understand diversity and how it’s so important in daily business and our lives,” he said. “How important it is to understand our values and cultures of others, which allows us to work in harmony at home and in our lives.” Henderson discovered his natural talent for cooking when he was hired to the prison food service staff. He was eventually promoted to “chief inmate cook” and even developed an underground catering business to further his motivation. After almost a decade, Henderson was released from prison, and with the same vision he had since he was a child, he aimed to build the life he always dreamed of. With resilience, never-ending hope, and a clear vision of the future, Henderson got his first job as a chef. He continued to grow his career and became the first African American named “Chef de Cuisine” at Caesars Palace and the first African American executive chef at the Bellagio. He later became a star on his own television shows and a best-selling author. Henderson credits his transformation to his faith, mental toughness, and hope, all of which he urged others to cling to amid such uncertain times. “No matter what we face in these trying times, we are a 14
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resilient country. We are a resilient people. We are a strong American culture,” he said. “Now’s the time not to divide but to unite under one dream: That American dream. It doesn’t matter the color of your skin, the socioeconomic background we come from. Our freedoms in this country are so valued and should be so cherished that we don’t do anything to divide us.”
THE LIFE-THREATENING ACCIDENT THAT INSPIRES ALLISON MASSARI TO SAY ‘YES’ TO LIFE EVERYDAY In a keynote address that brought attendees to tears, Allison Massari, an executive coach and artist, shared the gripping events of the treacherous automobile accident 22 years ago that left 50 percent of her body covered in second-and third-degree burns. In what Massari thought were her final moments, engulfed in flames and consumed by excruciating pain, it was the anguish of loneliness that she felt the deepest, she said. “What this tells me is just how much we human beings need each other. We need each other. I had never known this depth of truth until I lived that fire.”
moment, she said. “Without question, her kindness made it easier. I was calm. The fact that she took those extra few seconds to show that genuine caring made this torturous experience bearable.” Once Massari was released, she faced years of grueling recovery and rehabilitation. After significant healing, she still struggled with the ability to raise her right arm due to scar tissue, so she reached out to physical therapists across the country hoping that one of them could help. But they all gave the same response: there was nothing they could do. But Massari wasn’t willing to take no for an answer and continued her search. Finally, a physical therapist in Colorado shared her optimism. With unwavering dedication to her health, Massari moved to Colorado to further her healing journey. She made progress every day until her arm healed completely.
It was the compassion and kindness from that physical therapist, her nurses, doctors, family, and friends that brought Massari to true healing, she said. “The world of medicine, the science and technology of it, takes people so far, and still there is a vital need for the human connection. From your presence,” she She spent 40 days in the burn unit and said. “Compassion heals the places that endured two major skin graft surgeries. medicine cannot touch.” Each day was filled with torment that was inescapable, said Massari. But it Massari is now the founder of a camp for was the compassion from her caretakers teenagers with severe burn injuries, The and family that brought her to health Roger Pepper Adventure Camp for Teen and happiness. Massari recalled a Burn Survivors, named after the man who moment shortly after she was rushed to pulled her from the burning vehicle that the hospital when the nurse explained perilous night. to Massari that her scalp was removed off the top of head and would need to “We can trust this process of life,” she be stapled down to her skull. It was the said. “Everything we go through; it has a compassion of the nurse and a kind hand job it can do on our being. Seek to find on Massari’s shoulder that gave her the the good. Search with ferocity and have strength to endure such an unimaginable unbending belief.”
Seek to find the good. Search with ferocity and have unbending belief
PROVIDER/PAYER COLLABORATION IMPERATIVE FOR IMPROVED PATIENT CARE Leading experts in the Medicare Break down the barriers between Advantage and Affordable Care Act providers and health plans. market continue to call for collaboration There are a variety of ways in which a between providers and payers. Take an health plan can collaborate with provider inside-look at their tips to bridge the gap. partners to limit unnecessary work and Provider/payer collaboration was a burdensome practices as well as develop consistent theme throughout last month’s a more efficient workflow, explained Alan virtual conference, RISE National 2020. Whittington, director of risk adjustment During the two-day mega-conference, programs and portfolio management, industry leaders shared insights and best Highmark, Inc. practices for providers and payers to remove existing barriers, improve risk and quality, and work together in a virtual world. Here are three of the biggest takeaways.
Highmark partnered with Arcadia, a health care data and software company, to streamline electronic solutions in place of outdated and burdensome paper processes to simplify access to important
information, reduce administrative burdens, and provide curated support. To gain involvement from providers, Highmark collected and shared extensive data to offer a comprehensive view of the new program, including program capabilities, existing gaps the system can solve, and user group feedback, explained Whittington. “The data told the story so well for us that there wasn’t a whole lot of convincing that needed to happen.” Highmark transitioned its provider partners to the new technology when the provider felt comfortable, which also allowed the health plan’s support team to Click to see other articles
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deliver thorough provider education, which Fairview. The model included: is key to the process, said Whittington. The implemented process realigned communication between providers and health plans and provided a clear and searchable user interface, realtime updates and responses, simplified reporting for what’s been done and remains left to do, and monthly reporting for physicians, practice, and the entity to compare performance.
Develop engagement programs to drive quality and risk outcomes
has allowed the health plan to continue to receive the same kind of records while • A structured working group with maintaining everyone’s health and safety.
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representatives from coding, medical records, population health, quality, and primary care Accountability oversight assigned to Population Health Governance Committee Reprioritization of resources to support providers Regular reporting from Optum IT for data driving and data transparency Weekly status updates with the care system core team and Optum team An end-of-year-gap analysis to develop a sustainable approach through 2020
• Alignment between payers and care providers can improve risk and quality, as well as member outcomes, said Jeff Dumcum, senior vice president, clinical • performance and compliance, Optum, who led a panel discussion to highlight a successful partnership aimed to improve The updated workflow allowed Optum, quality and coding accuracy at Optum, UCare, and M Health Fairview to provide UCare, and M Health Fairview. their best care while being as accurate as possible. Preliminary results from the The payers and providers attributed collaboration demonstrated a 30 percent the collaborative success to four key improvement rate year-over-year. components: leadership alignment and agreement in partnership, reimbursement Leverage technology as much as realignment from fee-for-service to value- possible to collaborate in a virtual based payment, a thorough operating world, said Marilee Klock, director coding model, and integrated data systems operations, Geisinger Health Plan. Chart for a more complete approach to risk access and retrieval has been a challenge adjustment. due to the COVID-19 pandemic since
Buy-in from the providers is critical to forge these kinds of collaborative relationships, said Rich Bitting, vice president, actuarial informatics, Jefferson Health, who joined Klock for the presentation. “The first thing you have to do is win the heart of providers as far as why this is important,” he said. Communicate a clear value proposition for the patient, provider, and payer to underscore the benefit in collaboration for all parties. Provider education is an essential component to the partnership, as well. Bitting recommends training programs, tutorial videos, and data-driven feedback to guide providers through the process and make it as seamless as possible. Education has been particularly important since the expansion of telehealth amid the COVID-19 pandemic to ensure providers and health plans fully utilize telehealth and optimize performance. From the provider perspective, noted Bitting, the pandemic is an opportunity to demonstrate the equal, if not better, level of care possible through telehealth.
Because it is new to many providers, accurate auditing, documenting, and coding for telehealth is critical, noted most individuals are working remotely, The operating model played a critical Klock. explained Klock. But established, trusting role in strategy execution, said Jessica relationships with providers and the use of Cunningham, R.N., BSN, PHN, director technology resources such as data feeds population health strategy, M Health
Leverage technology as much as possible to collaborate in a virtual world” 16
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