Angela Bower

Nothing to see here...well, just a few conflicts to be aware of: ▶ Quality of Care: Prioritizing cost savings could lead to the underuse of necessary services, affecting the quality of care provided. ▶ Provider Choice: Patients may be directed to owned clinics, limiting their choices and access to possibly better or more specialized providers. ▶ Cost Control: There might be less motivation to negotiate the best rates with various providers, potentially leading to higher costs at owned facilities. ▶ Billing Practices: Increased risk of upcoding or inflated charges at owned clinics, with the monitoring party having a financial interest in such practices. ▶ Conflict in Claims Processing: As both provider and processor of claims, there's a conflict in adjudicating claims fairly, particularly in costly medical cases. ▶ Incentive Alignment: The TPA's goal to minimize health plan costs may conflict with owned clinics' goals to maximize revenue, leading to decisions that might not favor the employers or employees. ▶ Steering to Other Owned Services: There may be an incentive to direct patients to other owned services like specialty clinics, rehab centers, or labs, regardless of whether these are the most suitable options. ▶ Pharmacy Benefits Management (PBM): If the TPA or carrier also serves as the PBM, there might be conflicts in prescribing medications—favoring drugs that provide the PBM with higher returns rather than those most effective or affordable for patients. ▶ Referrals to Specific Hospitals or Health Systems: Financial interests in certain hospitals or systems could lead to referrals there instead of to facilities that might offer better or more cost-effective care. ▶ Transparency and Trust: Dual roles can reduce trust among plan members and employers, as biases in healthcare administration and decisions can be perceived or real.

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Thank you Dr Bricker, Very insightful, as usual. Primary care cannot be easily scaled because its true value lies in preventing disease and disease progression, which is typically measured at a population level. Our healthcare system's profit-driven focus often hinders progress, as seen in the U.S., where high spending does not translate to better health outcomes. Shifting towards preventive care, as exemplified by Kaiser Permanente's capitation model, for example, can incentivize healthcare systems to prioritize wellness and reduce costs by avoiding expensive treatments through data-driven preventive measures. Keeping people healthy, leads to improved margins by avoiding the need for costly procedures such as cardiovascular interventions, cancer treatments, and other invasive treatments, while maintaining health. I believe the concept of using primary care as a “loss leader” will only result in increased healthcare utilization.

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What makes a children's hospital a true unicorn in healthcare? Cincinnati Children's Hospital is a model of excellence in healthcare. This hospital stands out for its quality pediatric care and its adherence to the principles of #HighReliability Organizations (#HRO). How is this achieved? ➡ Excellence in Child Care: The hospital is recognized for its high-quality pediatric care. ➡ Constant Innovation: Investments in innovative technology and processes to improve patient outcomes. ➡ Governance Model: Effective organizational structure that promotes security and efficiency. ➡ Community Impact: Active engagement in the community to promote children's health and well-being. ➡ Adherence to HRO Principles: Cincinnati Children's commitment to the principles of HROs has resulted in significant improvements in patient safety and operational efficiency, making it a true example for healthcare to follow. Do you know how your organization can benefit from implementing HRO principles? #patientsafety #healthcare #hro #highreliability

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➡️ The FACHE credential brings continuous value to you as a healthcare leader, to your organization and to your community. Become a recognized leader among executives in healthcare management by becoming a Fellow of the American College of Healthcare Executives®. Learn more and get started here: https://bit.ly/4eve6UF

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How do you find the courage to continue innovating in your healthcare practice, even when faced with setbacks? This wisdom reminds us that in the dynamic field of healthcare, resilience is key. What strategies have you implemented to stay resilient and proactive in the face of challenges? Join us for our FREE masterclass "3 Ways on How AI Can Transform Your Business and Increase Revenue" 🗓 Date: May 14, 2024 🕒 Time: 5 - 8 PM Register: https://lnkd.in/gbAuVQZ9 #NurseEntrepreneurs #NurseCoach #NurseConsultant #HealthcareBusiness #NurseBoss #NurseCEO #Entrepreneurship #SuccessMindset #LearnFromFailure #GrowthMindset #BusinessCoaching #ConsultingBusiness #EntrepreneurLife #EmpoweredNurses #NurseLeadership

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A shocking development this morning!!! Walmart Health is shutting down all of their 51 clinics and #telehealth services throughout the country siting a challenging reimbursement environment and inability to reach profitability. Primary Care is a complex care delivery service, with multiple challenges from addressing social determinants of health, referrals and prior authorisation, to provide a comprehensive care to the underserved communities, to name a few. Big companies are realizing how hard and complex is to successfully operate primary care clinics alone in this environment without an upstream or downstream tertiary services. Maybe an acquisition of ChenMed is closer now given this news!! #HealthcareonLinkedin #PrimaryCare #ValuebasedCare Link:

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Here’s a clip from the keynote!!

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Interesting article (read the full text link in the post). Anyone familiar with this organization? The article points to unintended consequences of insurance expansion and highlights that health insurance, healthcare, and access to care are not synonyms. #healthcarereform #healthpolicy

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Medication adherence is critical to seniors’ overall health and well-being, including reducing the risk of cognitive decline. This article from our CenterWell Home Health team details how our occupational therapists partner with seniors and their caregivers with tips and tools to improve medication management and get patients back to their everyday routines. https://lnkd.in/eEKbmpsv #CenterWell #CenterWellHomeHealth  

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We are thrilled to participate in a roundtable discussion with Becker's Healthcare, sharing insights on the state of care management & value-based care with other industry leaders including Sue Powers with VirtualHealth, Natosha Anderson with Blue Cross NC, Michelle Fullerton with Blue Cross Blue Shield of Michigan and Roberta Kafora with Innovation Care Partners. We'll be covering: 1. The top three barriers to successfully implementing VBC — what they mean for the broader payer industry and the value in addressing them 2. Payers' frustrations with current care management capabilities 3. How technological alignment is concerning payers, and how these concerns might be addressed Please register to join us: https://lnkd.in/gM8idzdh

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Andra Farcas, MD, assistant professor of emergency medicine, was first author on the paper "Achieving Equity in EMS Care and Patient Outcomes Through Quality Management Systems: A Position Statement" published last month in Prehospital Emergency Care. 👏 Read the full article online to learn more about the process framework of measuring and reducing care inequities in EMS, and what is needed to drastically reduce inequities: https://lnkd.in/gxZqEtuG

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When caregivers can't access the necessary supports they need, their care recipients rely on health resources they wouldn't have otherwise used. Learn more in our first policy brief on the results of 2024 Caregiver Survey: https://lnkd.in/gsmrB6hN #caregivers #caregiversupport

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I am thrilled to participate in a roundtable discussion with Becker's Healthcare, sharing insights on the state of care management & value-based care with other industry leaders including Sue Powers with VirtualHealth, Natosha Anderson with Blue Cross NC, Michelle Fullerton with Blue Cross Blue Shield of Michigan and Roberta Kafora with Innovation Care Partners. We'll be covering: 1. The top three barriers to successfully implementing VBC — what they mean for the broader payer industry and the value in addressing them 2. Payers' frustrations with current care management capabilities 3. How technological alignment is concerning payers, and how these concerns might be addressed Please register to join us: https://lnkd.in/gmibMmix

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Kicking off #nursesweek in #chicago with BOARD OF CERTIFICATION FOR EMERGENCY NURSING (BCEN®) 🥳🥳 Excited to connect with #nurses from across the country and speak on one of my favorite topics - #socialmedia best practices for #nursing professionals!! 💻🩺📱 Let’s go!! 💛💛 #nursesonlinkedin

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Doctor Kelvin Muthami from Muthami Family Hospital shares how the Ilara Health Management Information System has helped streamline his facility operations and management. Watch his story!

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