Telehealth Utilization Increasing Medicaid Provider Reimbursement

March 17, 2022  by  Allzone MS   179

Telehealth Utilization Increasing Medicaid Provider Reimbursement

Not only has Medicaid ensured care access for enrollees during the pandemic, but its coverage of telehealth services has proved a boon to Medicaid providers in California.

Increased use of telehealth services by Medicaid beneficiaries in California is leading to positive financial outcomes for providers in the state.

CLOSEDLOOP.AI TOPS EPIC, CERNER FOR AI PLATFORM SATISFACTION

Upon reviewing how artificial intelligence impacted healthcare stakeholders in 2022, researchers from KLAS revealed a relatively high customer satisfaction rate, particularly among customers of ClosedLoop.ai.

All ClosedLoop.ai customers said that they would buy its AI platform again, as compared with 91 percent of Epic and 84 percent Cerner customers who said the same. Further, it achieved an overall performance score of 96.5 in December 2021, up from 91.7 in December 2020. It also helped customers achieve positive outcomes such as improved medication adherence and recognizing at-risk patients.

KLAS reported that Epic came up short of the market average across all metrics, including culture, relationships, operations, product, value, and loyalty. Cerner reported even lower performance scores compared to ClosedLoop.ai and Epic, with an overall score of 78.2 in December 2021. READ MORE

INCREASED TELEHEALTH BOOSTS MEDICAID PROVIDER REVENUE IN CA

Sixty percent of Medicaid providers in California said that telehealth provided financial stability for their organization, a new report shows.

The report was released by Health Net, a payer supporting members on Medi-Cal, California’s Medicaid program. In 2020, Health Net awarded 138 Medi-Cal providers about $13.4 million in grants to implement and expand telehealth services. The grant period was from May 2020 to April 2021, after which the grantees submitted information about how they used their funds. The new report is a summary of the reports submitted by 98 Medi-Cal providers.

Overall, telehealth use among Medi-Cal patients increased from 2 percent of all doctor visits prior to the pandemic to 45 percent at the end of 2020, representing a 20-fold increase.

STAFFING SHORTAGES ADDED TO GROWING LIST OF PATIENT SAFETY RISKS

Staffing shortages and the impact COVID-19 had on the medical workforce’s mental health are the leading patient safety risks for 2022, joining familiar roadblocks like health inequities and access to care on the ECRI Institute’s patient safety risk list.

“Shortages in the healthcare workforce and mental health challenges were broadly known and well-documented for years,” Marcus Schabacker, MD, PhD, president and CEO of ECRI, stated. “Both physicians and nurses were at risk of burnout, emotional exhaustion, and depression prior to 2020, but the pandemic made both issues significantly worse.”

According to the ECRI Institute, these staffing shortages have resulted in long wait times and even denial of healthcare. Organizations that do not have enough healthcare professionals on staff sometimes have to turn away patients experiencing medical issues.

Medical industry leaders and government officials alike should prioritize these leading patient safety risks, Schabacker added, lest they become the “new normal” in healthcare. READ MORE

MODERNA UNVEILS PUBLIC HEALTH STRATEGY FOR MRNA VACCINES

Moderna recently announced its global public health strategy through four initiatives to advance mRNA vaccines for infectious diseases.

In the first strategy, Moderna will expand its global public health portfolio to 15 vaccine programs targeting priority pathogens that threaten global health. The company will advance these vaccines into clinical studies by 2025.

Second, Moderna will launch its mRNA Access program to offer researchers the use of Moderna’s mRNA technology to explore new vaccines against emerging or neglected infectious diseases.

In the third strategy, Moderna will expand its patent pledge to never enforce COVID-19 patients in the Gavi COVAX AMC for 92 low-and middle-income countries. And finally, Moderna’s fourth strategy will focus on a Memorandum of Understanding with the Government of the Republic of Kenya to establish Kenya as the location for its mRNA manufacturing facility.

Overall, will prioritize development efforts against pathogens identified as persistent global health threats, including HIV, tuberculosis (TB), malaria, neglected tropical diseases, and the priority pathogens of the World Health Organization (WHO) and the Epidemic Preparedness Innovations (CEPI). READ MORE

SUTTER HEALTH CLEARED OF ANTIRUST, ANTICOMPETITION ALLEGATIONS

A federal jury has sided with Sutter Health in an antitrust class-action lawsuit in which plaintiffs claimed that the health system drove up insurance premiums through anticompetitive tactics, Reuters reported.

After less than 10 hours of deliberation across two days, a nine-member jury in the US District Court for the Northern District of California rejected the claims and sided with Sutter Health.

Plaintiffs first filed the lawsuit, Sidibe v. Sutter Health, in 2012. The case stated that Sutter Health violated antitrust and unfair competition laws, leading certain individuals and employers in Northern California to pay unfairly high premiums for health insurance from Aetna, Anthem Blue Cross, Blue Shield of California, Health Net, and United Healthcare between 2011 and 2020. The plaintiffs — four patients and two companies representing three million individuals and small businesses — alleged that Sutter Health’s actions resulted in $411 million of damages.

The lawsuit claimed that the health system used its market power to force health plans into contracts that prevented them from directing patients to non-Sutter hospitals with lower costs, resulting in higher premiums for members.

COVERAGE DETERMINATIONS TO IMPACT ACCESS TO CONTROVERSIAL ALZHEIMER’S DRUG

CMS has released a national coverage determination draft for the Alzheimer’s drug, Aduhelm or aducanumab, but coverage limitations in the draft may create access to care challenges for seniors with Alzheimer’s disease if the draft is finalized, according to an Avalere analysis.

Using these data, the Avalere researchers found that the CMS coverage with development national coverage determination draft—as it stood in March 2022—would restrict access to the Alzheimer’s drug based on its hospital outpatient department setting requirement.

Eight out of ten fee-for-service Medicare beneficiaries do not have access to an Alzheimer’s disease research center in their home counties. Less than one percent of patients who require rural healthcare have an Alzheimer’s disease research center in their counties.

The draft does not address the portion of patients with an Alzheimer’s disease diagnosis who do not have access to a hospital outpatient department. Less than one in ten Medicare fee-for-service beneficiaries who have Alzheimer’s disease or mild cognitive impairment (seven percent) do not have access to a hospital outpatient department in the same county.

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