Welcome to Daily Dose HQ

  1. Healthcare - Millions, Billions, Trillions
    Healthcare - Millions, Billions, Trillions
    To give you an idea of the magnitude of the healthcare industry, let's look at some numbers. BIG NUMBERS. These are not perfectly researched but are near enough to give you an idea of the staggering number of beneficiaries and amounts of money spent on healthcare for these beneficiaries. The US general population for 2016 is just over 322 million people. (US News) There are over 70 million beneficiaries enrolled in Medicaid. With nearly 80% (or 56 million) enrolled in a managed care plan. (Medicaid.gov) There are over 55 million beneficiaries enrolled in Medicare. With nearly 31% (or 17 million) enrolled in a managed care plan. (CMS.gov) Healthcare costs in 2014 for Medicaid beneficiaries - 495 billion dollars (kff.com) Healthcare cost in 2014 for Medicare Beneficiaries - 618 billion dollars (kff.com) Healthcare costs in 2014 for private insurance companies - 991 billion dollars (kff.com) In December 2015 it was estimated that total healthcare costs in the US were in excess of 3.o trillion dollars or an estimated $9523/yr for every person in the US. (kff.com) Mind-numbing numbers for sure. So can you see what BIG BUSINESS this is? Look at it from a business standpoint. THREE TRILLION DOLLARS. No wonder managed care organizations are wooing beneficiaries away from their traditional Medicare and Medicaid. As I stated in my last post -- a managed care organization can not offer less than the State plans but can add more services or cost savings for a beneficiary. I will not be going into the differences between managed care plans -- I will be focusing on the healthcare careers associated with this THREE TRILLION DOLLAR INDUSTRY. More to come --- Jane Jackson, RN
  2. Managed Care - What is it??
    Managed Care - What is it??
    To quote Wikipedia -- Managed Care -- The term managed care or managed healthcare is used in the United States to describe a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care (managed care techniques), for organizations that use those techniques or provide them as services to other organizations (managed care organization or MCO) or to describe systems of financing and delivering healthcare to enrollees organized around managed care techniques and concepts (managed care delivery systems). Managed Care is a healthcare delivery system with goals to manage medical costs, streamline healthcare utilization and maintain expected quality standards. A managed care organization contracts with Medicare and Medicaid to provide for the delivery of health benefits and additional services and in return receive a set per member per month (PMPM) payment also called capitation. By contracting with MCOs (also called Medicare or Medicaid Advantage Plans) to deliver Medicare and Medicaid health care services to their beneficiaries, states expect to reduce costs and better manage utilization of health services. Improvement in health plan performance, health care quality and outcomes are key objectives of managed care. Medicare and Medicaid Advantage plans (or MCO as they are often called) are required to offer a benefit package at least equal to the benefits offered by Medicare and Medicaid. More about Managed Care and how it should interest you..... coming up. Jane Jackson, RN
  3. Daily Dose HQ - Intro - First blog post
    Daily Dose HQ - Intro - First blog post
    HEDIS, RAPS, CPT, AMRR, HCC, ICD-10, HOS, CAHPS, CPC, MCO, NCQA, CDIP, EMR, HCPCS, CRC, HIPAA, HRA, PHI, IPA, ACO, MRA, PCMH, CPHQ -- look like an alphabet gone wrong?? Wonder what all these mean? What they may mean to you? Join us for a deep dive into these AND MORE to answer your questions on Healthcare quality and related careers, managed care plans, managed care quality reporting requirements, related and required skill-sets, current employment opportunities, HEDIS chart reviews and abstraction skills, Medicare Risk Adjustment and Hierarchical Condition Categories, workplace skills --whether on-site with a provider, in an office or... for the lucky few... working from home, medical coding related to healthcare quality reporting..... the list goes on and on.... all explored and explained. New articles daily by proven professionals written in an informative useful format. WELCOME to your Daily Dose of Healthcare Quality. Jane Jackson, RN
  4. Managed Care - Alphabet Soup
    Managed Care - Alphabet Soup
    Common Acronyms - All to be explained in future posts. HEDIS - Health Effectiveness Data Information Set RAPS - Risk Adjustment Processing System CPT - Current Procedural Terminology AMRR - Annual Medical Record Review HCC - Hierarchical Condition Coding ICD - International Classification of Diseases HOS - Health Outcomes Survey CAHPS - Consumer Assessment of Healthcare Providers and Systems CPC - Certified Professional Coder MCO Managed Care Organization NCQA - National Committee for Quality Assurance CDIP - Certified Documentation Improvement Practitioner EMR - Electronic Medical Records HCPCS - Healthcare Common Procedure Coding System CRC - Certified Risk Coder HIPAA - Health Insurance Portability and Accountability Act HRA - Health Risk Assessment PHI - Protected Health Information IPA - Independent Physicians Association ACO - Accountable Care Organization MRA - Medicare Risk Adjustment PCMH - Patient Centered Medical Home CPHQ - Certified Professional in Healthcare Quality So that is what they mean. All of these will be discussed and explained. First up is a discussion of Managed Care in general. Starts tomorrow. Please feel free to ask questions for topics not covered yet as it will take a while to get posts completed to cover all these topics and the others I have planned. Jane Jackson, RN