News

“Conscious entrepreneurship” is at the heart of being an entrepreneur. As entrepreneurs, we must be conscious of the world around us and the impact of our actions. For example, at Carrot Health, we are acutely aware there is power — and potential consequences — in using data modeling. For example, Optum (UnitedHealth Group) used models based on historical medical spend to identify future risk. The models were biased against populations with limited access to a doctor (i.e., lower spend), such as BIPOC communities. As an unintended consequence, the models tended to recommend more services to white members than BIPOC members. Failing to understand the bias in your data can result in critical mistakes and, in this case, perpetuate systemic racism.

The Centers for Medicare and Medicaid Services (CMS) in recent months predicted both lower premiums and richer benefits for Medicare Advantage (MA) plans in 2021. Specifically, CMS anticipated a decrease in average premiums of more than 34% from 2017 levels while plan choice, benefits, and enrollment increased—making the average monthly premium the lowest in 14 years.

But while CMS accurately depicted the indisputable trend of moving toward lower costs and higher value in MA offerings, it did not tell the whole story. To do that, we consolidated and reported on all Medicare Advantage and Prescription Drug Plan (PDP) benefit data nationwide released by CMS. This provides a much clearer picture on how these trends impact individual members vs. across member populations.

As part of its goal to reduce administrative burdens on physicians, the Centers for Medicare and Medicaid Services (CMS) has introduced a final rule for Evaluation and Management (E&M) coding changes that go into effect in January 2021. Extensive revisions to the guidelines aim to minimize the amount of time physicians spend on documenting visits—prioritizing the documentation of information pertinent to patient care, creating resource-based reimbursement, and achieving less need for audits.

The move reflects a positive step forward in terms of patient care and administrative burden, yet documentation readiness hinges on a clear understanding of how the changes impact current practices. Rather than focusing on a checklist of conditions for reimbursement, documentation must prioritize a holistic view of patient care to align with the framework supporting E&M codes going forward.

Physicians Practise»

The COVID-19 pandemic has impacted global public health response in unprecedented ways, underscoring both shortfalls and the need for innovative solutions. For micro-communities like university and workplace settings, this reality is especially true.

When most college campuses reopened in fall of 2020, administrators spent the semester fluidly adjusting plans as dynamics around the virus changed. Now, as the U.S. turns the corner into 2021 and campus leaders reflect on the effectiveness of strategies, one area that consistently rises to the top of priorities is the need for good data—highly granular insights that inform optimal decision making within the confines of a college campus

California, once a model of COVID-19 mitigation earlier in the pandemic, has seen its cases steadily rise throughout the summer, culminating in an ongoing crisis.

The state is now seeing case positivity rates of nearly 13 percent, with Los Angeles County seeing as many as 1 in 5 people test positive for the novel coronavirus.

Along with this comes reports of hospitals filling to capacity.

The scene is a severe version of a trend playing out across the country, as COVID-19 deaths nationwide have reached more than 367,000.

Walt Meyer is afraid of getting sick when he travels. Too many people aren't taking COVID-19 seriously, he says.

He'd travel again this year if he could be sure that his fellow passengers were virus-free.

"If they could require everyone to arrive an hour early, get tested, then wait for test results before boarding a flight or entering a resort, it would eliminate some of the risks," says Meyer, an author and professional speaker from San Diego.

His fears are justified, say experts. COVID-19 will be the number-one travel concern of 2021, particularly during the first half of the year. But there are other concerns. The question is: What should travelers be afraid of?

Healthcare organizations are facing a perfect storm of financial challenges. US hospitals and health systems entered 2020 with razor-thin operational margins that were exacerbated by substantial and ongoing losses related to COVID-19.

Amid a dramatic drop in healthcare spending during the first quarter of 2020, financial executives found themselves with limited means for countering ongoing pandemic-related impacts, touching everything from supply chain costs to lost billing opportunities and compliance issues. Notably, the industry acknowledges that federal incentives related to the COVID-19 pandemic will not provide enough relief to surmount the far-reaching financial impact.

Research from Arizona and beyond suggests the coronavirus that causes COVID-19 can spread erratically, making some infected people “superspreaders” and others dead ends for transmission. This can create clusters or COVID-19 micro-hotspots – neighborhoods, schools, towns or other small geographic areas where the virus runs rampant – even while communities next door remain relatively unscathed. These concentrated outbreaks aren’t included in the Arizona Department of Health Service’s COVID-19 data dashboard, which breaks down cases by county.

Dr. Peter Plantes, an internal medicine specialist, works with hc1, a health care data analysis company that recently launched a COVID-19 dashboard explaining the dynamics of the pandemic in new detail.

AZ Big Media»

PHOENIX – Research from Arizona and beyond suggests the coronavirus that causes COVID-19 can spread erratically, making some infected people “superspreaders” and others dead ends for transmission.

This can create clusters or “micro-hotspots” – neighborhoods, schools, towns or other small geographic areas where the virus runs rampant – even while communities next door remain relatively unscathed. These concentrated outbreaks aren’t included in the Arizona Department of Health Service’s COVID-19 data dashboard, which breaks down cases by county.

Cronkite News/Arizona PBS»

MINNEAPOLIS – November 23, 2020 – A groundbreaking analysis by Carrot Health of claims data compiled by the Colorado Hospital Association (CHA) determined that a high Carrot Social Risk Grouper® (SRG) score correlates strongly with higher rates of emergency department (ED) super-utilization. The analysis, which combined data from CHA’s On Demand Hospital Information Network (ODHIN) with consumer behavior data from the Carrot MarketView® platform, also found that food insecurity and other underlying social factors were driving ED utilization and readmissions.

Razor-thin operational margins coupled with substantial and ongoing losses related to COVID-19 are culminating in a perfect storm of bottom-line issues for U.S. hospitals and health systems. A study commissioned by the American Hospital Association (AHA) found that the median hospital margin overall was just 3.5% pre-pandemic, and projected margins will stay in the red for at least half of the nation’s hospitals for the remainder of 2020.

Holiday travel is downright dangerous this year. Earlier this week, the CDC warned Americans to stay home this Thanksgiving. All across the country, people are scrapping their itineraries and making a U-turn.

And for good reason. Some holiday travel errors could land you in the hospital — or worse.

New COVID-19 cases shattering records, as my FORBES colleague Suzanne Kelleher recently noted. Many health experts are warning against all nonessential travel. But if you go — and I'm not saying you should — there are other errors you have to avoid. Because some holiday travel mistakes could kill you.

Forbes»

The fundamental problem with healthcare can be summed up in one sentence: We expect healthcare services that cater to our individual needs, yet the health care system operates under a one-size-fits-all, trial-and-error model. It is a model that results in missed diagnoses, protracted illnesses, and even premature death and wastes $765 billion annually.

The financial toll of this outmoded approach pales in comparison to the human toll. More than 128,000 people in the U.S. die each year from taking medications as prescribed—four times the number of people killed by prescription painkillers and heroin combined, as reported by the Centers for Disease Control and Prevention.

As the healthcare delivery system continues on its journey from a fee-for-service to value-based care reimbursement model, the realization of moving from a traditional “sick care” system that has driven the healthcare industry to date to one that provides more affordable, personalized and preventive care, will be critical to achieving success in this movement.

Many industry leaders believe that the tools needed to reimagine and change how to treat illness, and to establish healthy behaviors in patients by focusing on personal details—such as their unique biology, traits, and environmental factors—are already in place, and the next steps needed to shift the paradigm will be around culture, mindset and operational transformation.

The healthcare industry continues to see an uptick in oversight of federal healthcare payments. In late 2019, HHS’s Office of the Inspector General (OIG) reported that Medicare made $54.4 million in improper payments to acute care hospitals due to incorrectly coded claims. It also recommended that CMS direct its contractors to recover the lost money.

Enter 2020 and the introduction of COVID-19 incentive payments, and today’s C-Suite can expect a continuation of this trajectory in terms of increased scrutiny. In fact, the OIG recently announced its audit plans related to hospital payments covering COVID-19 discharges under the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

Healthcare Business Today»