Asante’s Post

💨 Whether we’re feeling the wind in our faces or at our backs, the healthcare system still needs value-based care. The fundamental brokenness will not repair itself. Physicians need real incentives to provide the best care at the lowest cost. But they can’t do it alone. So the organizations that can revolutionize medical management will differentiate themselves. That’s what I shared with a panel of fellow VBC leaders on Friday. Wellvana is starting to see the revolution come to life. Last year, the complex patients who were assigned a nurse from our team ended up with 🏥 14% fewer ED visits 🛏️ 23% fewer inpatient admissions 📉 $3,900 average reduced medical spend We really can reduce costs by offering more service, not less. Right now, that’s mostly because patients can avoid unnecessary trips to the hospital. But we’re just scratching the surface on the savings potential. Highlights from my panel partners: Anna Haghgooie of Valtruis: To really hit the tipping point for VBC, legacy players still have to change behavior. Nathan Goldstein of Duo Health: Belt tightening in value-based care isn’t all bad. It forces everyone to refocus on fundamentals. Paul Martino of VillageMD: CMS cannot afford for Medicare Advantage to fail. Dan Liljenquist of Intermountain Health: It’s not too soon to think beyond Medicare. Commercially-insured patients need value-based care too. It’s always nice to get in a big ballroom and inspire and challenge each other with our insights and visions. Thanks to Kate McDonald and McDermott Will & Emery for giving us the excuse to get together.   #valuebasedcare #healthcare

Gain our expert insights into how the recently released 2025 Medicare Inpatient Prospective Payment proposed rules will impact GME funding here:

It’s critical that we continue to advocate for hospital-at-home services. Not only does it drive down the cost of healthcare, it allows patients to receive care in the comfort of their home. Let’s keep the conversation going! Check out and share the article below to help spread the word.

The latest issue of the North Carolina Medical Journal includes an article co-written by CCNC executives Lydia Newman, Stan Taylor, Denise Levis-Hewson and Dr. Tom Wroth. The article, entitled “Is Primary Care Adapting to Medicaid Managed Care in North Carolina? Implications for Expansion and Future Managed Care Transitions,” details the need to strengthen the state’s primary care infrastructure by such initiatives as building upon the value-based care incentives in the Advanced Medical Home model, strengthening payor data, aligning quality measures, and easing administrative burdens for primary care practices. Read it here: https://bit.ly/4cDWxkd

So what does it take to meet a 5-star quality metric set by Centers for Medicare & Medicaid Services for nursing homes across the nation? The CMS Quality rating system gives nursing homes a rating between 1 and 5 stars, those with 5 stars (like us 👍🏼) are considered to have ‘much above average’ quality. There is also the ‘Overall’ rating for each nursing home, which includes three domains: health inspections, staffing and quality measures — in which 4 of 5 of our nursing homes also have ⭐️⭐️⭐️⭐️⭐️. Only the Top 10% of the country’s nursing homes earn a 5-Star Overall Rating. Choosing the right nursing home for your loved one is among the most difficult decisions you will ever need to make in life. Aside from the metrics evaluated by CMS, there are other characteristics that are just as important and you will need to rely on your own instincts: trust, integrity, transparency, compassion, kindness, familial connection, and assurance that your Mom, Dad, Abuelita (Grandma), among others, are treated with the respect and dignity they deserve. If you’re thinking about long-term care or short term rehab options, call 646-694-6680 for admissions or visit the links in our press release to learn more.

Gain Germane Solutions' insights into how the recently released 2025 Medicare Inpatient Prospective Payment proposed rules will impact GME funding here:

"You're just better with these patients" I heard when, as the only person of color in the group of physicians I always go the patients with high social needs, non-English speaking, on #Medicaid. I worked there only part-time so what happened to those patients' care the days I was not on service? Also, by "good with them" they meant I did not just shout English louder but I spent the time to get an interpreter. I did not merely mutter, "What is wrong with their culture" but I non-judgementally observed barriers and methodically worked through them one by one on behalf of the family. Yes, many times I did the work of a #socialworker, but that is part of whole-person care that includes #SDoH. As someone who knows "to err is human" and I know I can err, I double and triple check data. I am not that doctor who signs discharge orders then leaves while taking calls by pager. I don't leave until I have personally viewed all the data and then, with all the needed information and screenings complete, sign orders. I have seen it happen once before where a parent pushed to be discharged prior to completion of care and a colleague agreed, only for there to be a tragedy after discharge. Later, the doctor was told, "You're the doctor. It was your job to make the right decision." I too was named in that case, then dropped from it. It made me vow I was never, ever, ever going to miss anything no matter if people felt I was being overly cautious. If it were your child, wouldn't you want the doctor to be careful and right, not causal or sloppy? What was the No-good-deed-goes-unpunished "thank you" for all that? I was perceived "slower" and "less efficient" and not as fast at bed turnover. It gives you "bad" metrics if the goal is "operational efficiency" for hospital and system KPIs. The system metrics and ways of labeling “good” vs “bad” doctors, measured in how few minutes are spent per patient, disincentivizes good care, especially for socially complex patients. Yes, some patients do require more time to sort out all the factors that affect health outcomes. Many times those are the patients on lower paying insurance types, like Medicaid. That is not a reason to give suboptimal care. Should doctors be arranging transportation or food access? Ideally, no, these societal problems would not even exist. Then, we could allow medicine to be about science rather than social issues. Until that ideal state becomes reality, doctors will be spending a lot of hours on non-scientific aspects of whole person care.

White physicians shun Medicaid patients New study shows that Black and Latino physicians are bearing a disproportionate burden caring for patients most in need, with these physicians far likelier to accept Medicaid than their white peers. Linking unique data on physician race and ethnicity against 2016 Medicaid claims from more than 13,000 doctors, they found Black MDs had a 60% increase in the likelihood of accepting a significant number of Medicaid patients. Those who were Latino had a 40% increased likelihood. Not surprising as we know that Black and Latino physicians are more likely to work in underserved areas than white physicians. However, government need to increase reimbursement rates and improve administrative efficiency to support these physicians as well. Link: https://lnkd.in/efKfsuzZ

The findings of this study are not surprising but still deeply unsettling. The fact that Black and Latino physicians are shouldering the disproportionate burden of caring for Medicaid patients isn't some accident or isolated phenomenon. This is yet another example of how capitalist structures reinforce racial and class inequities. While Medicaid is supposed to provide healthcare to those in need, we see that white physicians, in positions of privilege, can afford to turn these patients away, choosing instead to chase the profits of private insurance. This commodification of healthcare only serves the capitalist class, leaving the most vulnerable—both patients and physicians—trapped in a system that exploits their labor and denies them adequate resources. The suggestion that the solution is simply to increase reimbursement rates or streamline administrative processes is woefully insufficient. We need to question why healthcare, something so essential, is even tied to profit in the first place. Until we dismantle the for-profit system that treats healthcare like a luxury for the wealthy and a burden for the underserved, these inequities will persist. As usual, capitalism ensures that Black and Latino communities bear the brunt of its failures.

There is so much to further unpack here on the healthcare equity side. So I will just highlight what attacks on Medicaid would accomplish in combination with these findings. The net result would be a systemic reduction in available healthcare services and likelihood of service to many already poorly served communities. Observe a further hardening of access to care being closely linked to class and race. #healthequity #medicaid