Latest news with #SocialDeterminantsofHealth
Time Business News
22-05-2025
- Health
- Time Business News
CMS 2025 Proposed Rule: Key Changes in Value-Based Care and Specialty Services
The CMS 2025 Proposed Rule represents a substantial change in healthcare delivery and pricing across the board. To accelerate the transition to value-based care, the new rule focuses on three main areas: primary care transformation, specialty model optimization, and mental health integration. There is more to the 'CMS 2025 Proposed Rule' than merely a new regulation. The revisions are mandatory and represent a significant change in the government agenda's direction. They are structural. It has important ramifications for everyone working in primary, specialized, or mental health care delivery. Although value-based care has long been considered primary care, the 2025 Proposed Rule gives the change a boost. CMS plans to shift investment toward frameworks supported by evidence and phase out underperforming models. Important Takeaways: Low-revenue ACOs receive more upfront money under this new approach. To address personnel expansion and Social Determinants of Health (SDoH), it permits flexible expenditure. Designed to assist smaller or underfunded ACOs in competing in a high-risk environment. Prioritizes population-based, future payments above conventional fee-for-service. Provides regular payments to increase providers' financial certainty. The regulation upholds equality as a concept of remuneration. Reimbursements and standards will take high-need populations into account. Value-based care initiatives have traditionally focused on primary care. By promoting experts into key strategic roles, the CMS 2025 Proposed Rule alters that. Specialty Area New Initiative Key Features Oncology Enhancements to the Enhancing Oncology Model (EOM) Stricter reporting, longer performance periods, and stronger cost-accountability. End-Stage Renal Disease Comprehensive Kidney Care Contracting (CKCC) Expanded options for nephrologists to manage patient outcomes. Behavioral Health Expansion of Integrated Care Models Primary-specialty integration with increased Medicaid alignment Medicare and Medicaid should better coordinate, according to the plan, especially in the area of mental health. It acknowledges that fragmentation results in subpar outcomes as well as the loss of possible compensation. The CMS 2025 Proposed Rule seeks to standardize the structure of telehealth while maintaining the post-pandemic flexibility around it. Increased Use Cases for Telehealth: There is still a priority for behavioral and mental health consultations. The new billing codes now promote virtual follow-ups with primary care providers. CMS intends to update the risk score calculation process to prevent overcoding. More people are paying attention to 'coding intensity.' CMS wants to enhance the way that ACO benchmarks consider patient complexity. Integrating behavioral health with physical treatment is now an operational policy rather than a philosophical one. Important Features Introduced: New crisis intervention billing codes. Incentives for behavioral health experts to work together in primary care settings. For time spent arranging mental health care, CMS is proposing monetary reimbursement. These are not superficial changes. They demonstrate CMS's understanding of the importance of mental health in managing chronic illnesses. CMS wants to eliminate superfluous reporting and promote more concise, insightful measurements. Expectations for Changes: MSSP has fewer quality measures than before. Improved compatibility with Medicaid Core Set and MA Star Ratings. Emphasis on longitudinal tracking and patient-reported outcomes. Businesses will have to automate data collection or risk fines for underperformance or non-reporting. CMS encourages APMs to assume genuine risk. The 2025 regulation strengthens definitions and plugs gaps that make models seem value-based without actually having any drawbacks. Features of the APM Redefinition: More precise criteria for what constitutes 'advanced.' More robust downside risk levels. A preference for models that are accountable for both cost and quality. This raises the bar. Passive participation is no longer viable. Indirectly, CMS is indicating a greater demand for technology-enabled infrastructure. The following are some implications: Exchanging data in real time amongst care teams. Using predictive analytics to inform actions and stratify risk. Reporting systems that eliminate human labor by obtaining data straight from EHRs. All organizations, whether they are major multispecialty groups or small FQHCs, need to reevaluate their readiness to change. The purpose of the CMS 2025 Proposed Rule is not to encourage philosophical shifts. It necessitates financial and operational changes that will affect risk management, personnel, contracting, and reimbursement. Now is the moment to fill any holes in your infrastructure that may be preventing real-time data interchange, risk adjustment, care coordination, and quality tracking. Organizations require more than fragmented solutions due to shifts in care delivery standards, payment mechanisms, and benchmarks. Persivia CareSpace® provides a single platform that can do: Overseeing value-based agreements for several payer sources. Anticipatory notifications and real-time data for patients at high risk. Combining processes for general, specialist, and behavioral care. Combining SDoH, quality, and population health metrics into a single dashboard. Platforms such as CareSpace® offer not just visibility but also control over value-based performance in a rapidly aligning and accountable healthcare environment. TIME BUSINESS NEWS
Business Insider
23-04-2025
- Health
- Business Insider
Leading through change: How purpose-driven project management can bridge equity gaps in public health
By Caroline Obeahon, April 23, 2025 In the complex world of public health, transition is inevitable, whether through shifting policies, evolving community needs, or the expiration of emergency declarations. As a project manager deeply embedded in this space, I've learned that leadership during these transitions requires more than technical skill. It demands clarity of purpose, cultural responsiveness, and an unwavering commitment to equity. My transition into the public health sector from the oil and gas energy industry wasn't just a career shift; it was a personal mission ignited by life-changing experiences within my own family. Navigating the healthcare system during a crisis revealed the daily disparities that too many underserved communities face. That realization became a catalyst: I knew I had to be part of the solution. Today, I lead public health initiatives focused on Medicaid populations, community outreach, and Social Determinants of Health (SDoH). I've witnessed firsthand how project management, when grounded in purpose and inclusion, can drive transformational outcomes. Leading Through Uncertainty: The COVID-19 Public Health Emergency (PHE) One of the most defining chapters of my public health journey began with the unwinding of the COVID-19 PHE. The expiration of federal protections meant that millions risked losing Medicaid coverage. My role was to lead response efforts that supported continuity of care, especially for vulnerable populations. We partnered with state and federal agencies, compliance officers, and community health organizations to coordinate outreach and realignment efforts. We implemented multilingual, multichannel engagement strategies, ensuring every member had clear, timely information about their eligibility and options. But the work was not just about compliance. It was about compassion. Effective leadership in transitions like these hinges on empathy. I spent time listening to frontline staff and impacted members. Their voices shaped the policies we developed and the systems we implemented. Our strategies weren't built in silos; they were community-informed and equity-centered. The SDoH Imperative: Moving Beyond the Clinic If the PHE response taught us anything, it's that health doesn't begin in the hospital; it begins in the home, at the dinner table, in the classroom, and at work. That's why I've led initiatives that address the root causes of health disparities through SDoH programming. Our efforts included launching lunch-and-learn sessions for members and staff, building community partner networks, and designing value-added services (VAS) focused on housing, nutrition, education, economic support, and social inclusion. Each VAS initiative was tailored to address one or more of the five key pillars of SDoH — making it easier for families to access resources that have a direct impact on their health and well-being. For example, we launched transportation assistance services to ensure members could attend prenatal appointments, partnered with food banks to deliver nutritious meals to families experiencing food insecurity and community-based organizations that provide health and wellness services to the underserved. We also offered digital literacy workshops, recognizing that access to online health portals and telemedicine is a growing determinant of care. Each initiative was data-informed and outcomes-driven. In project management, we often ask: What does success look like? In public health, that question must be reframed: Who defines success? For me, it's the community. If a family gains housing stability because of a resource we connected them with, that's impact. If a child doesn't miss school because their family received the preventive care they needed, that's equity in action. The Role of Project Managers in Advancing Health Equity Public health needs project managers who do more than manage, it needs leaders who advocate. We must lead with integrity, clarity, and a vision for systems that serve everyone. That means designing projects that reflect real life, not just regulations. It means bringing together cross-functional teams who reflect the communities they serve. And it means using every project milestone as an opportunity to challenge inequity. In my work, I constantly remind teams: metrics represent people. That human-centered approach has helped me build trust across departments and with the public. It's how we turn technical implementation into transformational change. Lessons in Leadership During Transitions Center the Mission – When change comes fast, purpose becomes your compass. Stay anchored in the "why." Design With, Not For – Engage community voices early and often. Co-creation builds programs that work. Communicate Relentlessly – In uncertain times, clear and consistent messaging builds trust. Challenge the Status Quo – Systems weren't built for everyone. Use your position to advocate for equity-focused change. Measure What Matters – Go beyond compliance. Track outcomes that reflect lived experience. A Call to Action As public health systems continue to evolve and adapt to future challenges, we have an opportunity and an obligation to lead differently. Let's build systems that heal, policies that include, and programs that empower. Whether you're a policymaker, a frontline health worker, or a fellow project manager, your leadership matters. Lead with humility. Lead with strategy. But above all, lead with purpose. Because when we bring heart to the headwork, we don't just manage change, we create it. — Caroline Obeahon is a public health project manager with over 16 years of cross-sector experience. She specializes in community health engagement, Medicaid transitions, and Social Determinants of Health (SDoH) programs. --
Yahoo
28-03-2025
- Business
- Yahoo
United Way of NNY announced impact grant to Watertown YMCA
WATERTOWN, N.Y. (WWTI) – The United Way of Northern New York has announced a $25,000 Impact Grant to help the Watertown Family YMCA. The grant is in support of its Gateway Financial Assistance Program. According to the United Way, the 'funding helps to ensure that all children, families, and individuals, regardless of their ability to pay, have access to essential programs that help to improve quality of life.' Downtown Watertown YMCA celebrating one-year anniversary Watertown Family YMCA's Gateway Financial Assistance program provides critical support that allows families to thrive by enabling access to affordable childcare, youth programs, and health and wellness activities. By the end of the 2025 grant period, over 250 working families will remain employed, confident that their children are safe and cared for. Additionally, more than 1,100 individuals will engage in YMCA programs, improving their Social Determinants of Health Index and contributing to a stronger, healthier community. The Watertown Family YMCA is immensely grateful for the Community Impact grant from United Way. This grant will significantly enhance our scholarship program that allows us to ensure that all families in our community, regardless of financial circumstances, have access to vital programs and services that promote healthy living, youth development, and social responsibility. By investing in our youth and families, we strengthen our community and fulfill our mission of fostering a supportive environment for all. Shawna Cutuli, Watertown Family YMCA CEO This year, United Way of NNY will direct more than $315,000 toward local initiatives that promote health and wellness, support child and youth success, and strengthen economic stability, including $225,000 in Community Impact grants. Staying true to the United Way model, funding decisions are guided by community input: dedicated volunteers from across the North Country thoughtfully review and evaluate each application to determine where the need is greatest, setting the gold standard in grant-making. These vital programs are made possible thanks to the generosity of donors who believe in creating opportunity, empowering families, and building a stronger, more resilient region. To learn how you can be part of this positive change, contact United Way at (315) 788-5631. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
