Literature Review

UnitedHealthcare, Humana, Aetna continue to outgain peers in Medicare Advantage Home Health Care News, by Andrew Donlan; 3/6/24In 2023, Medicare Advantage (MA) plan members represented more than half of all Medicare beneficiaries for the first time. In 2024, while penetration continues, there are other trends within MA that home-based care providers should be paying attention to. ... A few of the top companies continue to gain market share. Specifically, UnitedHealth Group (NYSE: UNH), Humana Inc. (NYSE: HUM) and CVS Health (NYSE: CVS) – through Aetna – continue to outpace competitors. 

The question of palliative care sustainabilityPalliative Care News, by Holly Vossel; 3/5/24A wide variety of palliative care services have cropped up nationwide in recent years, but not all have remained viable. The forces driving some community-based palliative programs to shutter are two-pronged, related to financial and operational sustainability, according to Renee McInnes, CEO of NVNA & Hospice. Reimbursement and staffing challenges are the most significant factors. 

MA’s cost-management tools may be hurting home healthcare quality, outcomesMcKnights Long-Term Care News, by Adam Healy; 3/5/24Medicare Advantage’s use of cost-reducing tools such as copays, prior authorizations and restricted provider networks may be preventing home healthcare providers from delivering higher-quality care, according to one home healthcare leader. 

Understanding the role algorithms play in our lives and navigating palliative careListen - Life Matters, by Hilary Harper, presenter podcast; 3/4/24Every day, we interact with dozens of algorithms as we go about our lives, but many of us don't understand how they work. How do we get the the best out of these tools while keeping the potential dangers in check?Editor's Note: From palliative care experts Australia; information about algorithms and Artificial Intelligence (AI) transfers to our USA palliative care (of course, without applications to CMS systems).

The top strategies healthcare organizations can use to reduce denials MedCityNews, by Laxmi Patel; 3/5/24Here are six actionable steps healthcare organizations can take to reduce their likelihood of denials and write-offs.

Change Healthcare's temporary funding program 'not even a Band-Aid,' AHA says Becker's Health IT, by Giles Bruce; 3/4/24 The American Hospital Association called Change Healthcare's temporary funding program for providers affected by the cyberattack on the UnitedHealth Group subsidiary inadequate, while a U.S. Senate leader asked CMS to speed up payments to hospitals. Change Healthcare set up the funding assistance March 1 for providers facing cash-flow issues after losing access to its payer systems, which have been down since the Feb. 21 ransomware attack. However, AHA President and CEO Rick Pollack wrote in a March 4 letter to UnitedHealth Group that the program is "not even a Band-Aid on the payment problems you identify."

Contract CNA staffing associated with worse care quality outcomes: study McKnights Senior Living, by Kathleen Steele Gaivin; 3/1/24Nursing homes that use contract staffing to fill certified nursing assistant position vacancies are more likely to experience worse care quality than those that do not, according to the results of a study by PHI. The proportion of total CNA hours filled by contract CNAs in SNFs increased from 2% in 2017 to 11% in 2022, the study found.

Double your cybersecurity spending, CIO warns amid Change Healthcare attack Becker's Health IT, by Naomi Diaz; 2/29/24What does the Change Healthcare ransomware incident mean for healthcare organizations? Doubling your cybersecurity spending, according to one health system CIO. Will Weider, CIO and senior vice president of Wausau, WI-based Aspirus Health, shared five thoughts on LinkedIn Feb. 29 about the incident, saying, "Whatever you planned to spend to improve cybersecurity, double it." Additionally, Mr. Weider stated that in light of this incident, healthcare organizations should: ...

Why not-for-profit health systems need positive margins: Deloitte Becker's Hospital CFO, by Andrew Cass; 2/28/24Health system margins are the "lifeblood of a healthy, patient-centered, innovative health care system and community," according to a report from consulting firm Deloitte.  "Claims that profits are not important in fact undermine the ability to fund the mission, serve the community, and deliver better, equitable care," Deloitte said in the report. ... "[Systems] should consider a holistic approach that integrates margin drivers to create a balanced transformation portfolio, according to the report. Timing and sequencing are important within each driver and "a full understanding of the dollar impact and priority of each is necessary for margin improvement to be successful."

How AI will help the world's top hospital CEOs transform health careNewsweek, by Jeff Young; on 2/28/24Artificial intelligence is quickly showing the potential to revolutionize many aspects of care giving, from cancer diagnoses to clerical work. But AI also presents new risks, uncertainties and vexing ethical questions. With the release of Newsweek's ranking of the "World's Best Hospitals," executives at leading hospitals around the world told us how they are using the power of AI.

The best changes 32 healthcare leaders made this year Becker's Payer Issues, by Rylee Wilson; 2/27/24Question: What is one change you made in the last two years that had great results?Leaders in the payer space are making changes to simplify members' experiences, improve equity and level-up the way their teams work together. The 32 leaders featured in this article, part of an ongoing series, [answered this question].

Chapters Health System CEO on prioritizing value-based care initiatives in the home Home Health Care News, by Andrew Donlan; 2/26/24Andrew Molosky, the president and CEO of Chapters Health System, is keenly aware of the struggles that coincide with turning a large health care provider organization into a value-based one. The first priority in that situation, in his mind, is making sure that the entire organization is on the same page in terms of what value-based care really means, he told Home Health Care News ... “You want to get to the point where you can manage populations in the home,” Molosky said. “That becomes a parlay to reducing ER spend in a full-risk environment. It becomes earlier intervention for a hospice or home health episode. 

C-suites, clinicians are burning out at both endsBecker's Hospital Review, by Alexis Kayser; 2/22/24C-suite leaders and clinicians often feel they are on opposite sides of an ever-expanding chasm. But they actually have a lot in common, according to Bruce Cummings and Paul DeChant, MD — a former executive and a former practicing physician, respectively, and perhaps an unlikely pair. Executives and physicians are both knowledge workers. Both are trained to spot and solve problems. Both crave the autonomy to fix those problems — but often, neither feels they truly have it. Both are far strides from the bright-eyed, difference-driven graduates they once were. Both are exhausted, and neither really knows how to talk about it.