Bright Spots in Healthcare

Eric Glazer

Each episode, I interview innovators in the healthcare industry to extract the strategies, tactics, tools, and/or routines they utilize to generate extraordinary, positive outcomes. We highlight and breakdown these bright spots so you can apply them at your organization. "See a bright spot .... and clone it!" read less

Novel Approaches to Care Coordination: The Key to Profitable Risk Models
Jan 20 2023
Novel Approaches to Care Coordination: The Key to Profitable Risk Models
The residual impact of the COVID-19 pandemic is a change in the way care is delivered in the U.S.  With a growing demand for post-acute care, coupled with staffing challenges, providers face challenges and opportunities in care transition and coordination along the continuum of care. Hear our panel of experts discuss innovative and novel approaches to care coordination. Topics include: real-time transparency, streamlining and improving communication, and Interoperability between partner organizations   Panelists: Cynthia Deculus, Chief Population Health Officer and Vice President, Population Health, Cedars Sinai; Margie Zeglen, MBA, RHIA, Vice President, Population Health, Carle Health; Jessica Hohman, MD, MSc, MSc, President and Medical Director, Cleveland Clinic Medicare Accountable Care Organization; Lissy Hu, M.D., MBA, President, Connected Networks, CarePort, powered by WellSky Bios: https://www.sharedpurposeconnect.com/events/novel-approaches-to-care-coordination-the-key-to-profitable-risk-models/   This episode is sponsored by CarePort, powered by WellSky CarePort is the leading care coordination network of 2,000 hospitals and 130,000 post-acute and community providers. The end-to-end platform bridges acute and post-acute EHRs, providing visibility into the patient journey for providers, physicians, payers and risk-bearing entities.    With CarePort, healthcare professionals can efficiently and effectively coordinate patient care with visibility and intelligence to manage patients as they move through the continuum. Visit website at: www.careporthealth.com
ACO REACH: Advancing Equity and Optimizing Performance
Jan 13 2023
ACO REACH: Advancing Equity and Optimizing Performance
CMS replaced the Global and Professional Direct Contracting (GPDC) Model with the redesigned ACO Realizing Equity, Access, and Community Health (REACH) Model in 2023. ACO REACH is the first accountable care model to directly address health equity and access to care, with a specific directive to meet the needs of patients from marginalized and underserved communities.    Whether you are participating in ACO REACH, the model provides vital insights into the future of value-based care and care collaboration. This panel will discuss the incentives and requirements laid out by the new ACO REACH model and how organizations can develop action plans to identify differences or disparities in their members' health status.   Panelists: Gary Jacobs, Executive Director, Center for Government Relations and Public Policy, VillageMD; Kate Casaday, MPH, Director of Market Operations, CareMount Health Solutions; Ashley Perry, MPH, Chief Solutions Officer, Socially Determined   Bios: https://www.sharedpurposeconnect.com/events/aco-reach-advancing-equity-and-optimizing-performance/   This episode is sponsored by Socially Determined Socially Determined is leading the transformation of healthcare delivery and payment through social risk analytics and solutions. Our SocialScapeⓇ SaaS platform, data and industry-leading expertise empower health systems, plans and other risk-bearing organizations to manage risk better, improve outcomes and advance equity at scale. Recently named by Fierce Healthcare as one of the 15 most promising healthcare companies, Socially Determined is headquartered in Washington, DC. Visit the website at www.sociallydetermined.com.
The Key to Your Health Equity Strategy
Dec 21 2022
The Key to Your Health Equity Strategy
Dr. Errol L. Pierre, Senior Vice President, State Programs at Healthfirst, joins Eric to discuss how health plans, providers and other organizations can create a culture of health equity. He notes the challenges of obtaining the data necessary to understand where to start. Errol advises organizations to gain the patient's or member's trust to get the information. He also touches on setting ROI expectations for health equity programs, defining terms to normalize the discussion of health disparities within the organization and the business imperative of diversity.  Errol shares his identity-defining moments and experience as an executive of color in the healthcare industry. He talks about his new book,  The Way Up: Climbing the Corporate Mountain as a Professional of Color,  which profiles Errol’s career journey from working in a beauty salon warehouse to being a health insurance executive. The book also offers guidance from prominent executives of color and delivers a pragmatic and actionable guide to help underrepresented individuals from all ethnic backgrounds uncover their passion for achieving their professional goals and elevating their careers.   About Errol   Dr. Errol L. Pierre is a business executive, healthcare strategist, public speaker, professor, and author. He currently serves as a senior executive of Healthfirst, the largest nonprofit health plan in New York. He is also the former Chief Operating Officer of Empire BlueCross BlueShield, the largest for-profit health plan in New York.   Errol graduated from Fordham University with a bachelor’s degree in Business Administration. He later obtained a master’s degree in Health Policy and Financial Management from New York University. He completed his Doctorate in Business Administration from the Zicklin School of Business at Baruch College, focusing on Health Economics. He is a professor at Baruch College, Columbia University, and New York University, teaching Health Economics and Health Transformation and serves on several boards, including the Arthur Ashe Institute for Urban Health and MediNova.
2023 Strategy Session: Member Redetermination, CAHPS, and Social Needs
Dec 16 2022
2023 Strategy Session: Member Redetermination, CAHPS, and Social Needs
As we turn the page from 2022, health plans are facing new challenges impacting member experience, retention, and, most importantly, their member’s health. This panel will offer insights on the priorities to focus on as we enter 2023. Topics include: the new reality health plans and members will face once the PHE ends and how getting ahead will avoid significant membership losses; CMS’ increased weight on CAHPS surveys will lead to more focus on member satisfaction; New Social Need Screening and Intervention (SNS-E) requirement means that plans will need to get more serious about members’ social needs by 2025 Panel: Mikal Sutton, Managing Director, Medicaid Policy, Blue Cross Blue Shield Association; Mildred Menos, Director of Member Advocacy and Community Outreach Transformation, Horizon Blue Cross Blue Shield of New Jersey; Steve Wigginton, CEO, Icario Link to bios: https://www.sharedpurposeconnect.com/events/2023-strategy-session-member-redetermination-cahps-and-social-needs/ This Bright Spots in Healthcare episode is sponsored by Icario Icario is a health action platform that unites pioneering technology, data science, and behavioral insights to connect everyone to better health. Icario develops personalized healthcare experiences that move people to better health with every action while reducing member abrasion through extrinsic and intrinsic motivations. Learn more at icariohealth.com.
Proactively Managing Risk via Innovations in Last Mile Care
Dec 2 2022
Proactively Managing Risk via Innovations in Last Mile Care
Health leaders from Network Health, Health Net, Priority Health, and Health.io discuss how top health plans improve risk assessment and quality measures through innovations and at-home testing.    Topics include: Strategies for deploying novel solutions to drive member engagement and reduce costs for members, especially among traditionally unengaged populationsWhy removing barriers to testing with at-home solutions is a boon to health equityHow accurate staging improves health outcomes for members with chronic conditionsWorking with provider networks for better management of members’ health   Panelists: Pooja Mittal, MD, Vice President, Chief Health Equity Officer, Health Net, Inc.; Megan Schmidt, Sr. Vice President, Employer Solutions, Priority Health; Mushir Hassan, MD, Chief Medical Officer, Network Health; Jonah Mink, MD, Medical Director, Healthy.io   This episode is sponsored by Healthy.io Healthy.io is the global leader in turning the smartphone camera into a clinical-grade medical device for an at-home urinalysis and digital wound management.    Their at-home kidney test, Minuteful Kidney, aids in the early detection of chronic kidney disease and helps close gaps in access and care for over 500,000 patients worldwide. It is the first and only smartphone-powered home kidney test to receive FDA clearance and the first digital health test to obtain FDA clearance across all smartphone devices.    Healthy IO is partnered with some of the nation's leading health plans and the National Health Service in the United Kingdom b/c of the test’s ease of use, high completion rates, and huge potential savings.   They are the first company to convert your smartphone into a clinical-grade medical device to allow patients to take the test – and receive results – in the comfort of their homes.
Co-Designing Social Care: Payers and Providers
Oct 21 2022
Co-Designing Social Care: Payers and Providers
The delivery of social care services in connection with healthcare requires new systems to organize the relationships and activities of healthcare payers, providers, community-based organizations (CBOs), and community members.    This panel will discuss integrating social care into healthcare delivery and the need for the organized delivery of social care services, including care coordination, through a multi-stakeholder health and social care ecosystem, as part of a whole-person approach to health.   Ji Im, MPH, Senior Director for Community and Population Health, CommonSpirit Sherry Novick, Community Health Lead, Social Health Practice, Kaiser Permanente June Simmons, MSW, CEO, Partners in Care Foundation Tim McNeil, COO & Founder, Freedmen’s Health   This episode is sponsored by the Partnership to Align Social Care Personal and community health outcomes significantly depend on our social, economic, and community conditions. Meeting our communities' social care and health care needs requires strengthening our systems of care and aligning health and social care. The Partnership to Align Social Care aims to achieve precisely this goal. We are a national collaborative that brings together healthcare and community leaders to co-design systems of care that will better meet the health and social care needs of individuals and communities. Learn more and join our efforts by visiting our website, www.partnership2asc.org.
How One Value-Based Care Company Became Profitable!
Oct 7 2022
How One Value-Based Care Company Became Profitable!
Landmark Health CEO Chris Johnson joins Eric to share his vision for the aging health system of tomorrow and his organization’s mission to help seniors age in place by extending primary and urgent care into the homes of patients with challenging illnesses. Finally, Chris talks about the shift to value-based care and how providers can navigate the new landscape by leveraging technology to create and execute the most effective care plan for each individual.   Launched in 2014, Landmark currently is in 25 states with around 300,000 patients. By the end of next year, the integrated health provider will be in about 40 states with just over half a million patients. A fully mobile medical group, Landmark brings medical care into the homes of seniors and chronically ill patients. These home-based visits are conducted by doctors, advanced practitioners, and care team members to supplement the care patients receive from their primary care providers and specialists – at no additional cost.    Chris joined Landmark in 2017 as Vice President and General Manager, responsible for launching the New England market. Most recently, Chris has served as Landmark’s Head of Corporate Development, responsible for the company’s growth strategy, strategic partnerships, mergers and acquisitions, and public policy. In this position, Chris was integral in spearheading Landmark’s merger with Optum and leading the company’s integration into Optum’s Home and Community platform. He was named one of Aging Media Network’s 2022 Vision Series Leaders.   Before Landmark, Chris was a Principal at Innosight, a healthcare-focused growth strategy consultancy and Co-founder of Predilytics, a healthcare analytics business. Chris holds a Bachelor of Arts in economics from Harvard College. He also received his M.B.A. from Harvard Business School.   This Bright Spots in Healthcare episode is sponsored by Icario Icario is a health action platform that unites pioneering technology, data science, and behavioral insights to connect everyone to better health. Icario develops personalized healthcare experiences that move people to better health with every action while reducing member abrasion through extrinsic and intrinsic motivations. Learn more at icariohealth.com.
Payer and Provider Strategies for Last Mile Care
Sep 9 2022
Payer and Provider Strategies for Last Mile Care
Healthcare leaders from Avera, Blue Shield of California, Renown Health and the Partners in Care Foundation discuss solving the last mile In healthcare, the link between the consumer and where care is delivered. When consumers can’t pass through the last mile connection to the healthcare delivery system, they never even get an opportunity to engage with healthcare up close. Our panel will share success stories and best practices for improving access, creating a new business model and engaging consumers in their care. Panelists:  Mitchell Fong, Vice President of Virtual Care, Renown Health Daniel Rivas, Senior Manager, Community Health, Blue Shield of California Rhonda Weiring, Vice President, Clinical Innovation, Avera @Home Dianne Davis, Vice President, Community Wellness, Partners in Care Foundation   Bios: https://www.sharedpurposeconnect.com/events/novel-approaches-to-last-mile-care/   This episode of Bright Spots in Healthcare is sponsored by Partners in Care Foundation. The Partners in Care Foundation aligns social care and health care to address the “Social Determinants of Health” that routinely affect diverse, under-served, and vulnerable populations. PICF serves as a bridge between medical care and what individuals can accomplish on their own at home, achieving greater equity of conditions and effectiveness of care. Partners’ evidence-based programs and services have been demonstrated to improve quality of life, help participants avoid suffering, and reduce costly hospital readmissions, Emergency Department visits, and nursing home placements.   For over two decades, the Partners in Care Foundation has been innovating and improving SDOH solutions and driving life-changing, life-saving alignment between social care and health care for those we serve. Please visit https://www.picf.org for more information.
How to Conquer the Transition of Care Journey
Aug 31 2022
How to Conquer the Transition of Care Journey
Dina CEO Ashish V. Shah joins Eric to discuss the advantages and challenges in transitioning care from the hospital to the home. He shares what it takes to replicate the facility-based experience outside of the hospital and deliver measurable quality improvements cost-effectively. Ashish provides a step-by-step blueprint for creating an exceptional transition-to-home care model you can replicate at your own organization.    Our GuestAshish V. Shah is CEO of Dina  Ashish leads the Dina (Dena) team on its mission to power the healthcare industry’s transition to virtual and in-home care. He founded the company in 2015 and remains passionate about empowering care teams with the tools they need to help people age. A recognized thought leader, Shah previously served as CTO at Medicity, the market leader for vendor-neutral Health Information Exchange solutions (acquired by Aetna in 2011).    This episode is sponsored by Dina Dina powers the future of home-based care with its care-at-home platform and network that can activate and coordinate multiple home-based service providers, engage patients directly, and unlock timely home-based insights that increase healthy days at home. Dina works with many leading health systems, ACOs and health plans to extend their reach into the home to help people live their best lives.   The platform creates a virtual experience for the entire healthcare team so they can communicate with each other--and help patients and families stay connected--even though they may not physically be under the same roof. Dina helps professional, and family caregivers capture rich data from the home, using artificial intelligence to recommend evidence-based, non-medical interventions.
Why You Shouldn't Settle for Partial Duals
Aug 25 2022
Why You Shouldn't Settle for Partial Duals
Josh Weisbrod from Network Health and Keslie Crichton and Sean Libby from BeneLynk join Eric to discuss opportunities and challenges in identifying and converting members to full dual status, including specific examples and an outlined roadmap into this additional revenue stream. After listening to this episode, you will understand: Why identifying members as “full or partial” mattersHow much revenue you may be leaving on the tableWhat components need to be in place to convert members Our Guests Josh Weisbrod, Vice President, Risk Adjustment, Network Health Josh has over 20 years of healthcare, health insurance, healthcare analytics and human service experience working with local and national companies and state and federal agencies, specializing in health plan operations and data analytics. Sean Libby, President and Co-founder, Benelynk Sean has worked at the intersection of managed care and government benefit programs for the past 19 years. Before BeneLynk, Sean served as the President of Freedom Disability and Alpha Disability, one of the nation’s largest Social Security Disability and Veterans Advocacy companies. Before that, Sean served as Vice President, Sales for SSC Disability, providing government program benefit services for Managed Care Organizations. Keslie Crichton, Chief Revenue Officer, BeneLynk Keslie has over 25 years of comprehensive managed care and healthcare technology experience. Before BeneLynk She spent 13 years as Vice President of Sales at Change Healthcare and its predecessor companies Altegra Health and Social Service Coordinators, helping plans improve risk-adjusted revenue and quality performance scores through dual enrollment and retention, as well as health education campaigns. Acronym Glossary MSP - Medicare Savings ProgramsABD- Age Blind and DisabledMAPP - Medicaid Purchase PlanSSI - Supplemental Security IncomeQMB - Qualified Medicare BeneficiarySLMB - Specified Low-Income Medicare BeneficiaryQI-1 - Qualifying IndividualSNAP - Supplemental Nutrition Assistance ProgramLIS - Low-Income SubsidySSA - Social Security AdministrationCMS - Center for Medicare and Medicaid ServicesMAO - Medicaid Add OnMA - Medicare AdvantageHCC - Hierarchical Condition CategoryFPL - Federal Poverty LevelMAGI - Modified Adjusted Gross IncomePMPM - Per Member Per MonthHRA - Health Risk AssessmentD-SNPs - Dual Eligible Special Needs Plans We are pleased to provide you with this copy of the white Hi Sherry,   Are you leaving revenue on the table? Find out by listening to our new episode, Why You Shouldn’t Settle for Partial Duals, now live on Apple, Google, Spotify, Amazon Music or your favorite podcast app, and YouTube.   Josh Weisbrod, Vice President, Risk Adjustment, Network Health, Keslie Crichton, Chief Revenue Officer, BeneLynk and Sean Libby, President and Co-founder, BeneLynk, join me for an insightful discussion on the opportunities and challenges in identifying and converting members from partial dual to full dual status. Hear specific success stories and walk away with an outlined roadmap for capitalizing on this additional revenue stream.    In addition, we are pleased to provide this whitepaper, Are You Getting Partial Dual Premiums for Partial Dual & Full Dual Risk?, from our partner BeneLynk. I hope you find it valuable.  BeneLynk sponsors this Episode of Bright Spots in Healthcare. BeneLynk is arguably the most innovative Dual Advocacy organization in the country. Benelynk’s mission is to improve people’s lives and positively impact social determinants of health barriers by granting their healthcare partners the necessary information while providing healthcare consumers with the advocacy they deserve. They use innovative technology that enables their people to have a dynamic conversation that flows organically to meet social determinants of health challenges and, as such, can build stronger human connections. This carefully planned combination generates exceptional results. Visit their website at www.benelynk.com
Reducing Chronic Condition Readmissions
Jul 22 2022
Reducing Chronic Condition Readmissions
Preventable hospital readmissions cost the healthcare system approximately $25 billion annually, and it is estimated that one of every five Medicare patients is readmitted to the hospital within 30 days of discharge. Our panel of experts shares insights and best practices on lowering readmission rates for patients with chronic health conditions through proven prevention and discharge programs and follow-up plans. Panelists: Troy Garland, MBA, RN, Vice President, Clinical and Quality Operations, Equality HealthSarah Keenan, RN, BSN, MSIHM, Chief Clinical Officer/President, Integrated Care, Bluestone Physician ServicesMichelle Nelson, Director, Health Improvement, United Regional Health Center​Ashish V. Shah, CEO, Dina​   This episode is sponsored by Dina Dina powers the future of home-based care with its care-at-home platform and network that can activate and coordinate multiple home-based service providers, engage patients directly, and unlock timely home-based insights that increase healthy days at home. Dina works with many leading health systems, ACOs and health plans to extend their reach into the home to help people live their best lives.   The platform creates a virtual experience for the entire healthcare team so they can communicate with each other--and help patients and families stay connected--even though they may not physically be under the same roof. Dina helps professional and family caregivers capture rich data from home, using artificial intelligence to recommend evidence-based, non-medical interventions. Visit their website at dinacare.com
How Digital Technologies are Advancing Health Equity
Jul 1 2022
How Digital Technologies are Advancing Health Equity
Digital technology can give organizations more data, giving them more visibility not only into patients’ clinical profiles but also population health profiles and socioeconomic profiles.  Our panel of experts will discuss how health plans can effectively tap the potential of digital technologies to improve care delivery, outcomes and equity for traditionally underserved populations. Learn strategies and best practices you can implement in your own organization! Panelists: Paula Gutierrez, Director, Health Equity, Director of Health Equity for CVS Kidney Care, a CVS Health Company Seun O. Ross, Executive Director, Health Equity, Independence Blue CrossPaula LeClair, US General Manager, Healthy.io   Panelist bios: https://www.sharedpurposeconnect.com/events/health-equity-how-digital-technologies-are-reshaping-healthcare/   This episode is sponsored by Healthy.io Healthy.io is the global leader in turning the smartphone camera into a clinical-grade medical device for at-home urinalysis and digital wound management  Their smartphone-powered home kidney test (pause) aids in the early detection of chronic kidney disease and helps close gaps in access and care for over 500,000 patients worldwide. Beyond being recently featured by CNBC, Fast Company and the Financial Times, Healthy IO is partnered with some of the nation's leading health plans and the National Health Service in the United Kingdom b/c of the test’s ease of use, high completion rates, and the huge potential savings. They are the first company to convert your smartphone into a clinical-grade medical device to enable at-home testing with instant results.
Elevate Risk Adjustment by Activating Providing Participation
Jun 24 2022
Elevate Risk Adjustment by Activating Providing Participation
Risk adjustment is much more than a regulatory requirement for Medicare Advantage plans –  it can improve the quality of care by providing an accurate picture of each member’s health status and ensuring each member receives the right interventions and treatment.    Providers play an important role in risk adjustment, too. An engaged partnership between health plans and providers is vital to ensure beneficiaries receive valuable benefits.    Our panel of experts from Blue Cross Blue Shield of Illinois, CommuniCare Health Centers, Priority Health, SelectHealth and Vatica Health will share successful strategies and best practices for payers and providers to work in partnership to close gaps in care, achieve better clinical and financial performance, and support value-based care. Hear both payer and provider perspectives on building a successful relationship.   Confirmed Panelists: Jeslie Jacob, Divisional Vice President, Provider Analytics, Reporting & Connectivity, Blue Cross and Blue Shield of Illinois. Rebecca Welling, Associate Vice President, Risk Adjustment & Coding, SelectHealth Lisa Wigfield, RN, BSN, CCM, CRC, CDEO, Clinical Advisor, Risk Management, Priority Health Janie Reddy, DNP, FNP-BC, Director of Family Medicine, CommuniCare Health Centers Hassan Rifaat, MD, CEO, Vatica Health Bios: https://www.sharedpurposeconnect.com/events/elevating-risk-adjustment-by-activating-physician-participation/   This episode is sponsored by Vatica Health Founded in 2011, Vatica Health is the leading provider-centric risk adjustment and quality of care solution for health plans and health systems. By pairing expert clinical teams with cutting-edge, HITRUST-certified technology at the point of care, Vatica increases patient engagement and wellness, improves coding accuracy and completeness, facilitates the identification and closure of gaps in care, and enhances communication and collaboration between providers and health plans. The company’s unique solution helps providers, health plans, and patients achieve better outcomes together. Vatica Health is trusted by many of the leading health plans and thousands of providers nationwide. Vatica Health is a portfolio company of Great Hill Partners. For more information, visit www.vaticahealth.com/.