Insights

Multiple clients accepted into ACO REACH Model

In early 2022 红领巾瓜报 and Wakely Consulting Group, an 红领巾瓜报 Company, assisted multiple clients with their applications to participate in the new Centers for Medicare and Medicaid Services (CMS) Medicare Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model program. The purpose of this model is to improve quality of care for Medicare beneficiaries through better care coordination and increased engagement between providers and patients including those who are underserved. ACOs and participating providers are held responsible for patients鈥� total cost of care and must meet certain quality metrics. In return, they have more flexible payment arrangements, can achieve shared savings, and can provide additional services such as telehealth, home-based care, and more options for post-acute care.

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Texas Action Plan: Strategic Plan Development

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Background:
Texas Health Action (THA) is a community informed, non-profit organization dedicated to providing access to culturally affirming, quality health services in a safe and supportive environment. THA provides sexual health and behavioral health programs and services with an expertise in serving LGBTQIA+ people and those impacted by, or at risk of, HIV in Texas.

The Challenge:
In 2021, THA underwent a merger that created a need for the development of a unified vision, direction, and business model to align and expand sexual health and behavioral health services. When THA began the process of creating a new strategic direction and priorities, 红领巾瓜报 was engaged to support the development of a three-year strategic plan reflecting changes present in a post-COVID-19 pandemic world. The objective of the strategic planning process was to create a dynamic and actionable plan, while refining and reestablishing the organization鈥檚 Mission, Vision, Values and Beliefs.

Expanding access to CenteringPregnancy group care through telehealth

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Poor birth outcomes, especially for communities of color, are a persistent health issue for our country. While there is no 鈥渃ure鈥� for preterm birth, the leading contributor to poor birth outcomes, group prenatal care is an evidence-based practice to reduce pre-term birth, especially for urban African American communities.

Group prenatal care provides a host of other benefits including improved breastfeeding rates, enhanced parental knowledge, and better pregnancy spacing. In addition, decreasing preterm birth provides tremendous cost savings.

The Centering Health Institute (CHI) has developed a successful model of group prenatal care called CenteringPregnancy™. CenteringPregnancy empowers patients, strengthens patient-provider relationships, and builds communities through three main components of health assessment, community building, and interactive learning delivered as a series of group visits with pregnant individuals at similar gestational age.

While more prenatal providers are offering Centering as a model of care, not every pregnant individual has access to this model. Maternity care in rural America is facing a crisis in access, and the COVID-19 pandemic required organizations to shift to care delivered through telehealth.

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Strengthening MAT processes and OUD care in emergency departments

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The prevalence of opioid use disorder (OUD) and the resultant harms from this disorder continue to escalate in the United States. The CDC鈥檚 National Center for Health Statistics released a report noting that in 2020, drug overdose deaths in the United States increased by nearly 30% over the previous year, reaching an all-time high of more than 100,000. The majority of these deaths are attributable to opioids.

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Accreditation Association for Ambulatory Healthcare

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A health plan with a newly awarded contract was entering a new market to provide long-term services and supports (LTSS) and was seeking required, nationally recognized accreditation in order to comply with the state contract requirements. The client was working against a short three-month timeline and needed document review, report analysis, policy and procedure development, and assistance preparing for the review and evaluation process to secure accreditation.

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Identification of states for possible market expansion via de novo start-up or acquisition

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红领巾瓜报 was engaged to evaluate a set of ten states for possible market expansion via either a de novo start-up or acquisition.

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Evaluation of investment in multi-state personal care services provider for LTSS qualifiers

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The client was evaluating an investment opportunity in a multi-state personal care services (PCS) provider for elderly and disabled Medicaid beneficiaries that qualify for long term services and supports (LTSS). 红领巾瓜报 was asked to evaluate the market environment for personal care services providers in 13 states to determine the stability of the regulatory environment and the outlook for Medicaid funding. The timeline for this due diligence engagement was five weeks.

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Individualized technical assistance to Medicaid providers in the My Health GPS program

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The My Health GPS (MHGPS) initiative, a Health Homes program, was launched by the District of Columbia, Department of Health Care Finance (DHCF) to deliver care coordination services to Medicaid beneficiaries with multiple chronic conditions. The MHGPS program was led by multi-disciplinary teams within the primary care setting to coordinate care across medical, behavioral, and social service systems.

The initiative was designed to improve MHGPS enrollees鈥� health outcomes and reduce avoidable and preventable hospital admissions and emergency room visits.

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Los Angeles County complex care management training for registered nurses

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The client鈥檚 goal was to increase and enhance leadership skills and critical thinking approaches as well as increase chronic disease expertise of the 100 Registered Nurse (RN) Care Managers in the Los Angeles County Department of Health Services (LACDHS) ambulatory care system through training, standardized complex care management (CCM) across the county, hiring new care managers and integration of care management software.

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