I’m a longtime fan of “wholistic” healthcare and case management processes, with a “W” as opposed to an “H” for holistic. This approach addresses whole-person care of physical health, behavioral health, and psychosocial circumstances, taking care not to leave any holes in care; it’s an approach that’s even more vital for today’s populations. This approach is also in sync with value-based reimbursement methods.
Due to COVID-19’s rising numbers, especially amid communities and populations most vulnerable to racial and socioeconomic disparities, the Centers for Medicare & Medicaid Services (CMS) is again emphasizing the power of value-based reimbursement. Considering that national health expenditures for 2020 are expected to more than double to over $7 trillion, courtesy of the pandemic, the industry will be even more fixated on high-cost populations and defined strategies to rein in future costs.
COVID-19 outcomes were released by CMS last week. Health disparities and the social determinants of health (SDoH) were front and center in the data. Based on Medicare claims for beneficiaries from Jan. 1 through May 16 of 2020, the data revealed spending of $1.9 billion in fee-for-service payments for 81,227 COVID-19 hospitalizations. Other notable statistics included:
Asian beneficiaries had 187 per 100,000.
CMS is echoing what industry providers, practitioners, and payors have been saying for the past several years: clinicians must have access to a payment structure that accounts for “wholistic” healthcare, addressing pathophysiology, psychopathology, and psychosocial risk factors to improve quality of life for beneficiaries and the financial health of health organizations.
Today’s Monitor Mondays survey digs deep into the impact of this latest data on the reimbursement for health systems and organizations. You can view the survey results here.
One of the greatest challenges facing case management today is not a lack of clinical expertise; it is a lack of time. Case managers are
H.R. 1 doesn’t directly rewrite ICD-10 or CPT, but it does change the environment in which you’re coding. The impact is mostly indirect – through
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