The California Consumer Privacy Act (CCPA or Act) is upon us and no matter how far along your organization is in its readiness efforts, action and persistence are required to stay on top of this comprehensive and dynamic new law. Use the building blocks to discover where your readiness efforts should focus.
 

They looked at how long it took late-expanding states (those that expanded eligibility after the initial implementation of ACA reforms in January 2014) to start enrollment. Though the length of time from state authorization (legislation or executive order) to enrollment varied considerably across states, once a state secured federal approval, some states began implementation very quickly.  Maine’s governor signed an executive order to implement Medicaid expansion on January 3, 2019 (her first day in office), and enrollment began just a week later. The governor of Indiana and the federal government agreed to an alternate Medicaid expansion plan on January 27, 2015, and enrollment began on February 1, 2015. Alaska’s governor used executive authority to expand Medicaid eligibility, announcing it on July 16, 2015; the expansion was implemented a month and a half later on September 1. Though these fast turnarounds were not typical of late expansion states, they demonstrate an ability to implement these programs expeditiously. 

This report attempts to offer guidance to state Medicaid programs and other stakeholders on the lessons learned by states that have sought to develop innovative behavioral health VBP initiatives. Section III summarizes the recent experiences of three states whose Medicaid programs have experimented with different types of behavioral health VBP models: Vermont, New York, and Tennessee.

The descriptions and assessments of these models are based on interviews with key stakeholders in each state and a broad review of publicly available materials. Section IV synthesizes key lessons learned from these states, including their challenges, successes, failures, and adjustments. Finally, Section V includes a discussion of California-specific considerations. This includes an overview of the existing Medi-Cal behavioral health system, with a focus on managed care structures and existing payment methodologies for behavioral health services. The conclusion synthesizes key lessons for Medi-Cal based on the analysis of other states’ efforts

Healthcare providers are increasingly investing in and deploying telehealth capabilities that will extend services to patients in rural areas, deliver higher-quality care to individuals with complex conditions, and reduce costs associated with unnecessary emergency department (ED) visits, transfers and admissions, among other benefits.

Telehealth programs require institutions to make upfront investments in technology, program design and staffing. While payers are increasingly expanding coverage for telehealth services, receiving reimbursement across all payers at a level commensurate with costs continues to be a challenge. To that end, providers are eager to think beyond reimbursement and understand the potential comprehensive return on investment (ROI) of various telehealth programs.

The ROI of telehealth programs can vary dramatically based on the size, nature, clinical capacity and payment model of the organization. For instance, academic medical centers (AMCs) typically have a highly specialized workforce that treats high-acuity patients across a wide range of clinical domains. In contrast, many community hospitals are smaller, have a more generalized workforce and may not provide comprehensive services at all hours of the day. Similarly, an integrated healthcare delivery system that operates on a value-based versus a fee-for-service basis may be more interested in the cost-saving potential of telehealth programs. The characteristic differences of these institutions make their ROI considerations around various telehealth investments fundamentally different, as summarized in Table 1.

Since the decision to invest in telehealth is highly dependent on institutional objectives and the estimated financial impact of the telehealth program, this brief has been developed with the following aims:

• To propose a framework for calculating the ROI of a given telehealth program;
• To demonstrate how this framework can be applied to two distinct telehealth case studies; and
• To illustrate the financial impact of these specific telehealth programs.

Hospital and health system executives are developing and implementing new tactics to meet the healthcare industry’s core strategic need: a higher value of care at lower cost. This objective has been aided by advanced technological solutions in medical-grade remote patient monitoring (RPM) and consumer-grade devices and apps that track a wide variety of factors including biometric indicators, activity, sleep, moods, and emergency response. As a result, patient-generated health data (PGHD) has increased the potential to change the practice of medicine from an episodic model to one based on a continuum of care – marked by the availability of realtime data that can be managed to create actionable intelligence about the patient. However, the U.S. healthcare system is facing a variety of challenges that make it difficult for patients and providers to benefit from the increased flow of PGHD.
 

An infographic that gives important data points regarding medication adherence, and focuses on Virginia residents produced by eHI's member SHEIC.

An infographic that gives important data points regarding medication adherence, and focuses on Maryland residents produced by eHI's member SHEIC.

Without the cost of employee health benefits expected to rise 5.5% in 2018, cost containment is a top priority for health plan sponsors. However, simply shifting costs to employees through higher deductible and copays may not be a viable  option since affordability of medical coverage is a growing concern. One way to reduce expenses without further shifting costs to plan participants is to use patient health data to design extremely targeted-high-value medical benefit programs.  

What was the first “connect the dots” picture you’ve ever drawn? Can you remember the amazement at seeing seemingly random points spread across a sheet of paper coming together to form a complete big picture? Connect the dots pictures are an important experience for young children. And understanding that putting together small pieces of data to gain a better view of the ‘big picture’ is an important life lesson.   

it is not just children that benefit from ‘connecting the dots’. Managers in the health and human service field are surrounded by data and data points. But, the connection between these data points to form the ‘big picture’ that is needed for the best outcomes is often not revealed.  

For consumers with a behavioral health condition, the ‘big picture’ is often quite complex. Most of these individuals have a range of different clinical needs, developmental challenges, and environmental constraints. it is up to the clinical professional to recognize the resulting complexity (a.k.a. “connect the dots”) across a fragmented health care continuum. 

Radiology departments face the same challenges as the rest of the healthcare market; they must transition to an environment driven by outcomes and value. Yet, this challenge is compounded for imaging departments, since they’re often perceived as a cost center instead of a profit center. One factor that hampers their ability to change, is that their tools—mainly the PACS—were designed to help them read more studies faster. And while maintaining a high reading volume remains important, it’s now accompanied by additional priorities including quality metrics, improved outcomes, patient satisfaction, and reduced costs.  To achieve these goals, radiologists need to streamline their workflows through advanced, modern tools. 

This paper describes both best practices and examples of ways in which workflow can deliver tangible value in these four areas.