LUMINA Podcasts

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As healthcare providers engage in payer contract negotiations, understanding their contractual reimbursement rates compared to the market has never been more crucial. In this episode of Value-Based Care Insights, we sit down with Damon Morse, an expert in payer rate analyses, to discuss the challenges healthcare providers face with payer contract negotiations, and the strategies required to level discussions. Gain insights into how thorough analysis and strategic positioning can ensure fair reimbursement for provider organizations and support organizational growth.

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Medicare Advantage has been the subject of significant attention lately among provider organizations due to its distinctive demands that influence traditional practice operations norms. In this episode of Value-Based Care Insights, we sit down with Sarah Hartley, an expert in health information management, to discuss some of the hurdles with new Medicare Advantage contracts, along with the efforts needed to align providers and patients. Gain insights into the administrative challenges, diverse strategies for effective patient data management, and the essential cultural shift required to promote collaboration between provider organizations and payers.

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Forty-five years after a Chicago hospital pioneered an integrated network strategy, the healthcare landscape has undergone a significant shift towards prioritizing preventative care. In this episode of Value-Based Care Insights, Jeffry Peters, an expert on medical group strategy, along with Michael Antoniades, President of the University of Chicago Medicine, explore the groundbreaking challenges and strategies that revolutionized healthcare delivery, and how they are still being tackled today. Gain insights on the evolving focus towards preventative care, the measures used to evaluate healthcare delivery, and the pivotal role of primary care in bolstering the entire healthcare ecosystem.

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Within the healthcare industry, effective organizational culture requires building trust, nurturing collaboration, and positioning leaders to drive strategic and impactful change. In this episode of Value-Based Care Insights, we sit down with Dr. Eric Velazquez, Professor of Medicine at Yale, alongside Doug McKinley, a clinical psychologist and leadership coach. Together, they explore the challenges and opportunities of strengthening the workplace culture in order to improve organizational effectiveness, financial performance, and overall patient care. Gain insights on the importance of vision alignment, a healthy culture, team collaboration, and the delicate balance between “steering the ship” and delegating responsibility.

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Behavioral health is pivotal for overall patient well-being, yet healthcare providers are just beginning to recognize the significance of lifestyle factors and social determinants in delivering this sort of whole-person patient-centric care. In this episode of Value-Based Care Insights, host Dan Marino sits down with Dr. Matthew Burg, a clinical health psychologist at Yale, to explore how social determinants and behavioral medicine are addressing the clinical needs of patients. Gain insights into the challenges and opportunities involved in integrating behavioral health into patient care, in prioritizing quality outcomes over services, and in recognizing the importance of preventative measures to establish a more comprehensive patient-centric care delivery system.  

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Improving patient outcomes requires a close look at the latest innovations in healthcare. In this episode of Value-Based Care Insights, we sit down with Dr. Jason Spangler, CEO of the Innovation and Value Initiative, a non-profit organization focused on advancing the science of determining the merit of various clinical innovations. Dr. Spangler sheds light on health technology assessments (HTAs), their history, and how they help leaders decide which new technologies or devices provide interventional benefits to patients that includes clinical outcomes and cost analysis. Listen to gain insights into how HTAs consider clinical outcomes, the incorporation of health equity, and how social determinants provide a broader understanding of the benefits that shape healthcare decisions. 

• A health technology assessment (HTA) is a comprehensive analysis that evaluates the cost-effectiveness and clinical and societal impact of new healthcare technologies and innovations.  
• HTAs have to take into consideration many different kinds of value, from traditional quantitative clinical outcomes to more nuanced preventative measures and patients’ personal values.
• Technology plays a significant role in shaping the efficiency and cost dynamics of population health, with various assessments offering healthcare leaders deeper insights into where the benefits lie.  

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With the recent push for healthcare reform, state governments started to issue crucial legislation to redesign the Medicaid program. In this episode of Value-Based Care Insights, we explore the new terms and conditions of New York’s 1115 demonstration waivers. With Vanessa Guzman, CEO of SmartRise Health, we share insights into the $6 billion initiative focusing on health equity, workforce investments, and the general support of Medicaid programs. Discover how the New York program sets a precedent for other states, addresses DEI initiatives, and strategically allocates funds to improve the care delivery infrastructure and overall patient outcomes.  

• The waivers allocate $6 billion for health equity reform emphasizing workforce investments to create a “Healthcare Equity Regional Organization” to enhance resources and accountability, particularly in underserved areas.  
• This legislation strategically allocates funds to tackle social determinants of health, emphasizing a holistic approach for immediate impact and long-term sustainability.  
• As one of the first states to enact such legislation, New York has demonstrated a commitment to social reimbursement to address diverse healthcare needs and reshape policies nationwide. 

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