By Susan Baker, Executive Vice President and General Manager, Integrated Health Solutions Stress is a normal part of life, but when it becomes chronic stress can hurt your physical and mental health. Whether you’re working from home, in an office setting, or in the field, stress is proven to play a huge role in employee burnout, absenteeism, and other related workplace issues.
By Susan Baker, Executive Vice President and General Manager, Integrated Health Solutions Stress and burnout are the most common struggles for employees and a driving force of the current U.S. workplace mental health crisis. In recent years, burnout has emerged as one of the primary concerns among employees across various industries.
By Susan Baker, Executive Vice President and General Manager, Integrated Health Solutions
By Verlon Johnson, Chief Government & Corporate Affairs Officer Key Takeaways from the National Association of Medicaid Directors (NAMD) 2023 Fall Conference The NAMD Fall 2023 Conference brought together state agencies, Centers for Medicare & Medicaid Services (CMS) representatives, and industry leaders for insightful discussions on the future of Medicaid. This year’s conference focused on four different themes: PHE unwinding, long-term care, maternal health, and youth health. Additional conference insights and main discussion topics from some of the NAMD sessions include the following:
By Susan Baker, Executive Vice President and General Manager, Integrated Health Solutions What We Know About the Latest Proposed Changes In the past two years momentum behind the need to update the Prior Authorization (PA) process has been growing at both the federal and state levels. From the Centers for Medicare & Medicaid Services (CMS) proposing new rules to the HHS Office of the Inspector General (OIG) raising concerns about access to care through a fair and equitable process for Medicaid beneficiaries, it's clear that changes to the PA process will be required for Medicaid prior authorizations in the foreseeable future. As planning begins for the implementation of the proposed CMS rules in January 2026, our Acentra Health experts are considering updates to four key areas: The latest CMS proposed rule is slated to go into effect on January 1, 2026, and applies to Medicaid managed care plans, the majority of Medicaid fee-for-service plans , Children’s Health Insurance Program (CHIP) managed care and fee-for-service arrangements, Medicare Advantage (MA) plans, and Qualified Health Plans (QHP) on the federally facilitated health insurance marketplace (i.e., healthcare.gov). The new ruling focuses on improving automation of the PA process , increasing access to data , and enhancing the beneficiary and provider experiences. States may add additional requirements on top of the new CMS rules. In addition, the HHS OIG’s July 2023 report detailed variations in the Medicaid MCO prior authorization process. A significant number of states surveyed in OIG’s review reported they had limited oversight of the prior authorization process including initial decisions, appeals, and reconsiderations. The OIG is urging CMS to provide additional guidance to benefit states and to ensure Medicaid beneficiaries have equitable and timely access to all appropriate care. Leveraging Key Focus Areas for a Smoother Transition With changes inevitably on the horizon for Medicaid Prior Autho
By Susan Baker, Executive Vice President and General Manager, Integrated Health Solutions Insights from the first four months of redetermination are showing impacts to the Medicaid population. According to the latest Medicaid renewal data captured in the KFF Medicaid Enrollment and Unwinding Tracker, over 3.7 million Americans across 41 states have lost their coverage.1 The challenges expected from the redetermination process around completion of paperwork are yielding almost 3 out of 4 individuals reportedly dropped due to incomplete paperwork or missing required documentation.
By Susan Baker, Executive Vice President and General Manager, Integrated Health Solutions April 1st is upon us and states are starting the redeterminations process for Medicaid, which has been referred to as one of the “biggest administrative burdens” states have faced to date from the pandemic. From now through the end of the year, the impacts to Medicaid beneficiaries as well as internal state operations, providers, and stakeholders will come to the forefront. The early months will bring to light challenges and broader impacts than perhaps the most thoughtful and deliberate state plans could have anticipated.
This article originally appeared in the February 11, 2022 issue of Forbes India.
