The healthcare landscape is evolving rapidly, presenting primary care practices with various challenges. In fact, CMS’ Making Care Primary (MCP) model is launching on July 1, 2024, requiring practices to thoroughly understand its patient population, financial drivers and care outcomes.  The Making Care Primary model , lasting 10+ years, aims to:  improve care management and care coordination; equip primary care clinicians with tools to form partnerships with health care specialists; and leverage community-based connections to address patients’ health needs and their health-related social needs (HRSNs), such as housing and nutrition.  CMS is working with State Medicaid Agencies in eight states to engage in full care transformation across payers, with plans to engage private payers in the coming months.  The CMS MCP Model will provide a pathway for primary care clinicians with varying levels of experience in value-based care to gradually adopt prospective, population-...

Health equity isn’t a one-size approach  The COVID-19 pandemic highlighted the crucial connection between Social Determinants of Health (SDOH) and patient outcomes. Addressing medical and behavioral health needs requires a comprehensive understanding of a patient’s social context.   Effective interventions and care plans must meet patients "where they are," and one-size-fits-all approaches fail to address diverse vulnerabilities and needs.  For healthcare organizations looking to begin or enhance their equity initiatives, the National Committee for Quality Assurance's (NCQA's) Health Equity Accreditation (HEA) is an excellent starting point. HEA is a comprehensive framework that aligns with many other recognized programs, such as those from the Joint Commission and CMS, providing a holistic approach to advancing health equity. It aims to improve the quality of care and patient experience within the United States.  3 Reasons why NCQA HEA is the perfect starting ...

Key IPPS updates you need to know about  On April 10, Centers for Medicare & Medicaid Services (CMS) released the federal fiscal year (FFY)   2025 Medicare Inpatient Prospective Payment System proposed rule . This rule proposes significant changes and updates to Medicare fee-for-service (FFS) payments and policies.  Understanding these changes is crucial for healthcare professionals, state hospital associations and multi-state health systems. This blog aims to break down the key points and implications of this proposed rule to help you stay informed and prepared.  Overview of the proposed rule  The proposed rule includes regular updates to wage indexes and the market basket. Below are some policies being proposed.  1. Data utilization for standard calculations  CMS plans to use FFY 2023 Medicare Provider Analysis and Review (MedPAR) claims data and FFY 2022 Hospital Cost Reporting Information System (HCRIS) data for standard calculations. Using Med...

Sourcing impartial data is an essential step in conducting a Health Equity Impact Assessment. In this short FAQ, DataGen’s Melissa Bauer, principal healthcare informatics analyst, explains:   impartial data in relation to health equity assessment and advancement;   why impartial data are needed; and   how impartial data help hospitals, ambulatory surgery centers and other providers evaluate how healthcare proposals may or may not impact underserved communities.   FAQ 1: What are impartial data?   Third-party data sources and independent entities are to provide impartial data. These data provide an accurate understanding of the potential effects of healthcare initiatives while helping to ensure that supporting data points and, ultimately, decisions are not biased toward the provider. An example of impartial data would include the underserved/marginal population rates for the service area of contracting providers.    FAQ 2: Why i...

Many healthcare organizations overlook the importance of mandatory data submissions to New York’s Statewide Planning and Research Cooperative System (SPARCS) when acquiring a new facility. Accurate, up-to-date SPARCS data can give the organizations the most operational horsepower throughout the acquisition process. Accurate SPARCS data ensures compliance, provides guidance and prevents costly delays in expansion plans.  This blog will cover two common SPARCS compliance scenarios* and how they impact facility acquisition. We’ll also highlight how using a data submission platform, like DataGen’s SPARCS submission tool, UDS (UIS Data System™ ), can aid the process.   Scenario 1: Large hospital system acquires a rural facility  Overview  A larger hospital system has acquired a new rural facility. The rural facility has one SPARCS coordinator who handles claims in its healthcare information management department. The rural facility is behind on its SPARCS data submis...

The Surveys on Patient Safety Culture™ (SOPS®) take your hospital’s pulse. The results help answer questions like:  Are staff focused on patient safety?  What are our safety results and where can we improve?  How do we take our scores and use them to transform patient outcomes?  How do we build staff confidence?  How do we stress the importance of patient safety?  When used strategically, the required SOPS® survey data can reveal important insights — that go beyond maintaining The Joint Commission accreditation. The Agency for Healthcare Research and Quality offers data collection as a part of the SOPS® survey. Though you’re spending the resources and time to complete this requirement, this effort alone doesn’t improve patient safety. You need to know which safety initiatives to target, followed by the outcomes and impact. A deep dive into the data can deliver that.  In this blog, we'll examine five important factors that impact patient safety da...

The National Committee for Quality Assurance defines a patient-centered medical home (PCMH) as “a model of care that puts patients at the forefront.” The PCMH highlights the importance of care coordination and provides pathways to ensure that the medical neighborhood is tangible to the patients served.   The tenants of the medical home ask care teams to treat patients for their medical, behavioral and address their social and economic needs to achieve desired outcomes. As one of the 6 concept areas of the PCMH, it is imperative to implement policies, workflows and partnerships that will promote relationships outside of the primary care setting.   Medical homes are not just care settings but care connectors. Read on to learn:  how to sustain the medical home through effective care coordination;  why practices shouldn’t exclude community-based organizations; and  the key technical components for an effective, sustainable PCMH care coordination model.  Su...