Recent advancements in healthcare, such as telemedicine, automation, and clinical studies, have propelled the industry forward, unleashing new possibilities for fostering better patient outcomes. While many are lucky enough to reap the rewards of new research and technology, critical communities are being left behind.
The Medicaid population, who typically benefits from progress last, still grapples with harmful biases within the healthcare system that pose extreme barriers to care. A new
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Medicaid | Medicaid Patients | Medicaid Reform | Regulation, Policy, Analysis, Insights - HIT Consultant
CalAIM: How to Support CBOs in Medicaid Transformation
California’s bold new CalAIM Medicaid transformation program is restructuring what partnership for health looks like across the state. With a goal of better-integrating healthcare and social services for our most vulnerable residents, many eyes are turning toward local community-based organizations (CBOs) as a critical component of that evolution and investment in health equity. However, traditional health privacy, security infrastructure, and regulatory requirements, like HIPAA and HITRUST,
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The Future of Medicaid: 4 Considerations for MES Modernization
More than 75 million people access comprehensive and cost-effective care through Medicaid, including low-income families, older adults, and individuals with disabilities or chronic conditions.
Given the program’s importance in addressing the health needs of vulnerable populations, optimizing the experiences of Medicaid members and providers is critical. How they interact with the program can impact many outcomes, from member access and care utilization to provider participation and
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Navigating the Final CMS Medicaid Managed Care Rule (CMS-2439-F)
On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) released the final rule, Medicaid Program; Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality. The rule aims to promote consistency and transparency, with an increased focus on improving access, driving quality, and advancing equity for Medicaid beneficiaries. CMS has been moving in this direction for several years, and states managed care organizations, and providers have
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Cityblock, Sunshine Health Partner to Deliver Care to Florida Medicaid Members in Central Florida
What You Should Know:
- Cityblock, a value-based healthcare provider specializing in Medicaid, announced a new partnership with Sunshine Health, a Florida managed care plan. This collaboration aims to provide high-quality primary care and care coordination services to Medicaid beneficiaries with complex needs in Central Florida.
- The partnership expands Centene Corporation's, Sunshine Health's parent company, existing relationship with Cityblock. Cityblock has already established
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Pair Team Secures $9M to Connect Underserved Communities to Care
What You Should Know:
Pair Team, a virtual and community-based primary care solution connecting Medicaid's highest-risk patients to high-quality care, today announced it has raised $9 million in Series A funding. The financing was led by NEXT VENTURES, with participation from PTX Capital, Kapor Capital, Kleiner Perkins, Y Combinator, and several notable healthcare angel investors including Jay Desai.The funding will be used to help Pair Team accelerate its
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Waymark Secures $42M to Expand Community-Based Care for Medicaid Patients
What You Should Know:
- Waymark, a San Francisco, CA-based Medicaid provider enablement company raises $42M in new financing to scale technology-enabled, community-based care for primary care providers and their patients enrolled in Medicaid programs. The round was led by Lux Capital and CVS Health Ventures joins as a new investor.
- Existing investors Andreessen Horowitz (a16z) and New Enterprise Associates (NEA) also participated in the round. The investment consists of $22M in
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Innovation Key to Tackling Medicaid Redetermination Challenge
As a result of the Families First Coronavirus Response Act (FFCRA), Medicaid programs were required to keep citizens continuously enrolled through the COVID-19 public health emergency (PHE). These continuous enrollments ended on March 31, 2023, resulting in what many call the unwinding of Medicaid.
In June, the Kaiser Family Foundation (KFF) estimated that between 8 million and 24 million people will lose Medicaid coverage during the unwinding of the continuous enrollment provision. The
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Why Accurate Data is a Lifeline to Care in the Medicaid Redetermination Cycle
During the pandemic, Medicaid enrollment grew by nearly 30% to cover more than 93 million Americans, due in large part to COVID-19 provisions that included continuous Medicaid enrollment. With the unwinding of these pandemic emergency orders, annual cycles of Medicaid redetermination have returned. As a result, states have removed close to 4 million Americans from Medicaid to date. The ongoing redetermination process is likely to expand health inequities across the nation, including in
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TytoCare Report Reveals Providers’ Key to Virtual Care Adoption
What You Should Know:
A new report released by TytoCare, a virtual care company enabling accessible, high-quality primary care from home, revealed insights into how health plans and organizations can drive virtual care engagement.While key elements that patients value in virtual care offerings include cost and time savings, and the ability to reduce Emergency Department (ED) or urgent care visits, people want to see doctors they trust or and are more likely to adopt virtual care when
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