Shilpa Medicare Ltd.

The Centers for Medicare & Medicaid Services has set a goal to have all people enrolled in traditional Medicare treated through accountable care arrangements with their provider by 2030. Signify Health is expanding its collaboration with Ardent Health Services into accountable care beginning in 2023. Ardent, which provides healthcare services across 200 sites of care in six states, previously worked with Signify to manage bundled payment programs, but Signify's acquisition of Caravan Health enables it to assist companies with accountable care organization programs as well. Tim Gronniger, chief of value-based care solutions at Signify, told Fierce Healthcare the company has been proactively reaching out to existing clients to see whether ACO models are of interest. The Centers for Medicare & Medicaid Services has set a goal to have all people enrolled in traditional Medicare treated through accountable care arrangements with their provider by 2030, so starting now puts providers ahead of the curve, Gronniger said. "The alignment there was really tight, and it was really where they wanted to go," he said of Ardent. Through the partnership, Ardent's network of providers in New Mexico, Texas, Oklahoma and Kansas with work alongside independent providers in a collaborative ACO model, with the goals of better managing risk and achieving scale. Ardent has seen success to date in its value-based care models, including a 26% decrease in its 90-day readmission rate and improved clinical outcomes, said CEO Marty Bonick in the announcement. "We are excited to expand our partnership with Signify Health to bring our patients proven preventive and care management services that will help drive better health and improve the overall experience for both patients and care teams," Bonick said. Gronniger said making value-based care models like ACOs work means giving patients a "bear hug" and taking a holistic view of their needs. It begins with thinking about primary care differently, engaging more with preventive services and improving chronic care management. He said Ardent's existing model, including its relationship with specialists and others in the care continuum, puts it in a strong position to succeed in accountable care. "The model and the organization is well suited to a multiyear investment in improving patient health and improving patient outcomes," he said.

TUSCALOOSA, Ala. and BOSTON, Dec. 13, 2022 /PRNewswire/ -- The University of Alabama's University Medical Center is partnering with Ceras Health to offer an innovative digital health monitoring program to patients 65 and older and those with limited health-care access. Through its partnership with the Boston-based Ceras Health, UMC will provide state-of-the-art health services and better care to vulnerable Alabama patients. Continue Reading University of Alabama's University Medical Center is partnering with Ceras Health to offer digital health monitoring. Tweet this The University of Alabama’s University Medical Center Using leading-edge patient digital devices, which monitor vital signs and other health factors to provide access to patient health data in real-time, UMC will help patients manage diabetes, high blood pressure and other chronic conditions. UMC physicians will also be able to monitor patients transitioning from hospital to home and more closely oversee their recovery. "University Medical Center has a long tradition of working to improve health in Alabama communities," said Dr. Richard Friend, dean of UA's College of Community Health Sciences, which operates UMC. "Our work with Ceras Health will bring the company's Digital Transitions of Care solutions to improve patient connections with their care teams upon leaving the hospital, or after being seen at one of our six UMC outpatient clinics, so that our patients can receive optimal care when needed and where they are most comfortable – at home. We hope this work is a first step to creating collaborations that innovate primary care delivery across the Southeast." The cost of providing in-patient and out-patient care for the country's older adults is expected to grow significantly during the next decade due to a growing elderly population and increasing health-care costs. Spending on Medicare, the federal health insurance program for people age 65 and older, is projected to increase from $768 billion in 2022 to nearly $1.6 trillion in 2032. In Alabama, approximately one million residents are enrolled in Medicare, about 21% of the population. Alabama is also a largely rural state, where access to health care is limited in many communities. More than 80% of the state is classified as rural (54 of 67 counties), and seven counties have no public-access hospitals, complicating access to care and care delivery for nearly half of Alabama's residents. Leveraging digital health to extend the reach of care teams for older patients and those with limited access to care creates a significant opportunity for better health outcomes, particularly in critical areas for vulnerable patients such as after-hospital discharge and chronic condition monitoring, Friend said. "Through University Medical Center, The University of Alabama is the first in the region to bring Digital Transitions of Care to improve the patient experience, especially for Medicare and rural populations," said Udaya Devineni, chief executive officer of Ceras Health. "Our partnership with The University of Alabama will help bring impactful, personalized care to patients with chronic diseases and after hospital discharge, without having to travel far. This contributes to enhanced health equity, outcomes and experience while reducing the cost of care." UMC and Ceras will continue to explore and expand their partnership to incorporate other areas of mutual interest, including various research and development projects, and academic courses and program offerings, Friend said. About University Medical Center University Medical Center is the largest multi-specialty medical practice in West Alabama with six locations offering health-care services in family medicine, internal medicine, pediatrics, obstetrics and gynecology, geriatrics, psychiatry, neurology, sports medicine, hospitalist medicine and surgery. UMC is operated by The University of Alabama College of Community Health Sciences, which also operates clinical components of, or relating to, Capstone Hospitalist Group, the UA Student Health Center and Pharmacy, Brewer-Porch Children's Center, the UA Tuscaloosa Family Medicine Residency and its 48 residents, approximately 65 medical students of the UAB Heersink School of Medicine, post-residency fellowships in obstetrics, pediatrics, geriatrics, behavioral health, emergency medicine, hospital medicine and sports medicine, as well as community-based clinical work under contract or in affiliation with a variety of partners and collaborators. The College's mission is to improve and promote the health of individuals and communities in rural Alabama and the Southeast region through leadership in medical and health-related education, primary care and population health; the provision of high quality, accessible health-care services; and research and scholarship. For more information, visit and . About The University of Alabama The University of Alabama, part of The University of Alabama System, is the state's flagship University. UA works to shape a better world through its teaching, research and service. With a global reputation for excellence, UA provides an inclusive, forward-thinking environment and nearly 200 degree programs on a beautiful, student-centered campus. A leader in cutting-edge research, UA advances discovery, creative inquiry and knowledge through more than 30 research centers. As the state's largest higher education institution, UA drives economic growth in Alabama and beyond. For more information, visit and . About Ceras Health Ceras Health is a pioneering digital health solutions provider, utilizing 24/7 clinical expertise and remote monitoring, advanced AI and analytics, connected health devices, and a personalized behavioral change and gamification platform to help and empower patients through their Digital Transitions of Care solutions. Ceras partners with health systems, providers and payers to deliver solutions to vulnerable populations to improve their health outcomes and care experience through digital care with a human touch. To learn more about Ceras Health, visit or email [email protected]. Media Contact Leslie Zganjar, MPA Director of External Relations The University of Alabama College of Community Health Sciences University Medical Center [email protected] SOURCE Ceras Health, Inc.

The audits, the most recent ones the agency has completed, sought to validate payments to Medicare Advantage health plans for 2011 through 2013. (cacaroot/Getty Images) In April 2016, government auditors asked a Blue Cross Medicare Advantage health plan in Minnesota to turn over medical records of patients treated by a podiatry practice whose owner had been indicted for fraud. Medicare had paid the Blue Cross plan more than $20,000 to cover the care of 11 patients seen by Aggeus Healthcare, a chain of podiatry clinics, in 2011. Blue Cross said it couldn’t locate any records to justify the payments because Aggeus shut down in the wake of the indictment, which included charges of falsifying patient medical files. So Blue Cross asked the Centers for Medicare & Medicaid Services (CMS) for a “hardship” exemption to a strict requirement that health plans retain these files in the event of an audit. CMS granted the request, and auditors removed the 11 patients from a random sample of 201 Blue Cross plan members whose records were reviewed. A review of 90 government audits, released exclusively to KHN in response to a Freedom of Information Act lawsuit, reveals that health insurers that issue Medicare Advantage plans have repeatedly tried to sidestep regulations requiring them to document medical conditions the government paid them to treat. The audits, the most recent ones the agency has completed, sought to validate payments to Medicare Advantage health plans for 2011 through 2013. As KHN reported late last month, auditors uncovered millions of dollars in improper payments—citing overcharges of more than $1,000 per patient a year on average—by nearly two dozen health plans. The hardship requests, together with other documents obtained by KHN through the lawsuit, shed light on the secretive audit process that Medicare relies on to hold accountable the increasingly popular Medicare Advantage health plans—which are an alternative to original Medicare and primarily run by major insurance companies. Reacting to the audit findings, Sen. Chuck Grassley, R-Iowa, called for “aggressive oversight” to recoup overcharges. “CMS must aggressively use every tool at its disposal to ensure that it’s efficiently identifying Medicare Advantage fraud and working with the Justice Department to prosecute and recover improper payments,” Grassley said in a written statement to KHN. Medicare reimburses Medicare Advantage plans using a complex formula called a risk score that computes higher rates for sicker patients and lower ones for healthier people. But federal officials rarely demand documentation to verify that patients have these conditions, or that they are as serious as claimed. Only about 5% of Medicare Advantage plans are audited yearly. When auditors came calling, the previously hidden CMS records show, they often found little or no support for diagnoses submitted by the Advantage plans, such as chronic obstructive pulmonary disease, diabetes, or vascular disease. Though auditors look at the records of a relatively small sample of patients, they can extrapolate the error rate to the broad population of patients in the Medicare Advantage health plan and calculate millions of dollars in overpayments. Overall, CMS auditors flagged diagnostic billing codes—which show what patients were treated for—as invalid more than 8,600 times. The audits covered records for 18,090 patients over the three-year period. In many cases, auditors found that the medical credentials of the healthcare provider who made the diagnosis were unclear, the records provided were unacceptable, or the record lacked a signature as required. Other files bore the wrong patient’s name or were missing altogether. The rates of billing codes rejected by auditors varied widely across the 90 audits. The rate of invalid codes topped 80% at Touchstone Health, a defunct New York HMO, according to CMS records. The company also was shown to have the highest average annual overcharges—$5,888 per patient billed to the government. By contrast, seven health plans had fewer than 10% of their codes flagged. Registering excuses   One Medicare Advantage health plan submitted 57 hardship requests, more than any other insurer, though CMS approved only six. In three cases, the health plans said the records were destroyed in floods. Another cited a warehouse fire, and two said the records couldn’t be turned over because a doctor had been convicted for his role in illegally distributing millions of oxycodone pills through his network of pain clinics. Other Medicare Advantage health plans argued they had no luck retrieving medical records from doctors who had moved, retired, died—and in some cases been arrested or lost their licenses for misconduct. CMS found most excuses wanting, telling health plans they granted exceptions only in “truly extraordinary circumstances.” CMS said it receives about 100 of these requests for each year it audits and approves about 20% of them. The Medicare Advantage plan issued by Minnesota Blue Cross won its appeal after it relied on Aggeus Healthcare for diagnoses of vascular disease for 11 of its patients who got podiatry care. Dr. Yev Gray, a Chicago podiatrist who owned the Aggeus chain that operated in more than a dozen states, was indicted on federal fraud charges in Missouri in October 2015. The indictment accused him of creating an electronic medical record that fraudulently added billing codes for treatment of medical conditions patients didn’t necessarily have, including vascular disease. Gray pleaded guilty in May 2017 to charges of conspiracy to defraud the United States and making false statements related to health care matters. He was sentenced to 90 months in prison. Blue Cross said it “terminated” its network agreements with Aggeus about two weeks after learning of the indictment. Jim McManus, director of public relations for Blue Cross and Blue Shield of Minnesota, had no comment on the case but said the insurer “is committed to investigating credible cases of fraud, waste, and abuse.” Dara Corrigan, a CMS deputy administrator, said that as a “general matter,” its Medicare Advantage audits “are not designed to detect fraud, nor are they intended to identify all improper diagnosis submissions.” Protecting taxpayers   The costs to taxpayers from improper payments have mushroomed over the past decade as more seniors pick Medicare Advantage (PDF) plans. CMS has estimated the total overpayments to health plans for the 2011-13 audits at $650 million, yet how much it will eventually claw back remains unclear. Payment errors continue to be a drain on the government program. CMS has estimated net overpayments to Medicare Advantage plans triggered by unconfirmed medical diagnoses at $11.4 billion for 2022. “This isn’t a partisan issue,” said Sen. Sherrod Brown, D-Ohio. “I’ve requested a plan from CMS as to how they plan to recoup these taxpayer-funded overpayments and prevent future overbilling.” Leslie Gordon, an acting director of health care for the Government Accountability Office, said CMS needs to speed up the audit and appeals process to get quicker results. “That is money that should be recovered,” Gordon told KHN. As Medicare Advantage faces mounting criticism from government watchdogs and in Congress, the industry has tried to rally seniors to its side while disputing audit findings and research that asserts the program costs taxpayers more than it should. AHIP, an insurance industry trade group, criticized KHN’s reporting on the newly released audits as “misleading,” while the pro-industry group Better Medicare Alliance said the audits were “in some cases, more than a decade old.” Jeff De Los Reyes, a senior vice president at GHG Advisors health care consulting group, said he believes the health plans have improved their documentation in recent years. But, he said, “coding is never 100% perfect and there will be errors despite the best of intentions.” Rep. Katie Porter, a Democrat from Southern California and a critic of Medicare Advantage, countered: “When big insurance bills taxpayers for care it never intends to deliver, it is stealing our tax dollars.” KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.