How Can We Help You?
Our focus is investigation, identification, insights, incubation, and implementation of innovative ideas that advance equitable, value-based care. For example, we’ve collaborated with clients to 1) Build new VBC-related product and service capabilities, 2) Corporate Strategy and Development, M&A, and Private Equity Funding, 3) Launch existing product in a new industry segment, and 4) Executive Leadership of Value-based Care Organizations.
About TripleAim Strategy Advisors
TripleAim Strategy Advisors is a management consulting firm, which collaborates with clients to improve performance and outcomes in the transition to equitable, value-based care.
We bring 25 years of health plan operations experience and 18+ years of providing insights and creating solutions focused on advancing equitable, value-based care.
Meet our Principal Advisor, Don Gerdts
Don Gerdts specializes in the identification, investigation, insights, ideation, incubation and implementation of innovative ideas that advance the transition to value-based care.
Mapping Medicare Health Disparities by Population
CMS has created and maintains a new tool for mapping Medicare health disparities by population (MMD).
The MMD interactive tool contains health outcome measures for disease prevalence, costs, hospitalization for 60 specific chronic conditions, emergency department utilization, readmission rates, mortality, preventable hospitalizations, and preventive services.
Z Codes Can Help to Predict Health and Financial Risk for Value-Based Care
ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) contains over 70 Z codes (Diagnosis codes that start with Z) that capture SDoH. These Z codes identify problems related to education and literacy, employment, occupational hazards, housing and economic circumstances, and health care access. There are also Z codes related to the patient’s social environment and problems related to upbringing, one’s primary support group, and many psycho-social circumstances such as imprisonment and exposure to disasters.
SDOH data can be collected by any member of a patient’s health care team during any encounter. This includes providers, nurses, community health workers, and self-reporting individuals. This SDoH data are documented in the patient’s encounter record in the list of presented diagnoses. Providers and staff are then able to submit the appropriate SDoH Z code(s) into the claims billing and encounter reporting system, which begins the institutionalization of SDoH data for future use.
A New Public Health Emergency in Medicaid?
The Families First Coronavirus Response Act specifies that Medicaid beneficiaries must re-determine their eligibility once the federal public health emergency is declared to have ended.
While all people who lose their Medicaid coverage qualify to enroll in the federal ACA marketplace for 2023 coverage, HHS estimates that five to ten million people will lose eligibility or choose to forego coverage.
Medicare Advantage Plan Revenue Take Hits Over Lower Quality Ratings
CVS Health and Centene have reported projected 2024 earnings reductions of 5% due to year-over-year declines quality bonus payments from the Medicare Advantage Star Rating program. The declines were caused primarily by the expiry of the one-time changes to the rating system due to the COVID pandemic, which results in a sharp reduction in Centene and CVS members in plans with a 4+ Star-rating for 2023.
The downward shift in MA Star Ratings will present revenue headwinds and operational hurdles for Medicare Advantage health plans in 2024, as additional changes in the Medicare Advantage Star Ratings are implemented.
ACHP Health Plans Outperform Other Medicare Advantage Plans in CMS Star Ratings
Alliance of Community Health Plans (ACHP) member companies offering Medicare Advantage plans score better than other MA plans in CMS Star Ratings, both on critical health measures and overall satisfaction. More than 33% of all beneficiaries nationwide in 5-Star plans are enrolled with an ACHP member plan while ACHP members represent approximately 10% of total Medicare Advantage enrollees. Why? When payers and providers work together, they’re able to focus on consumers’ needs—ensuring better health outcomes and an overall better care experience.
From SDoH Policy to Action – AmeriHealth Caritas Creates Social Determinants of Life® Strategy
Social determinants of health can contribute to health disparities and inequities when there are challenges with regard to the accessibility and availability of nutritious food, safe housing, reliable transportation, and quality health care. AmeriHealth Caritas is referring to SDoH as the Social Determinants of Life® (SDOL) and developing an entire strategy around addressing SDOL. AmeriHealth Caritas are implementing their SDOL strategy through screening for key social determinants of health and be creating a new company focused on addressing those needs.
NCQA Publishes 2023 HEDIS® Quality Measures Update
The 14 updates to HEDIS Quality Measures for MY 2023 include new measures that target access, prevention, utilization, and disease management. Other changes target improving health equity through screening, intervention, expanded race and ethnicity data segmentation, and more inclusive measure language. The 2023 update to the HEDIS Quality Measures also advances digital measure transformation.
Let’s discuss how to advance equitable, value-based care!
We believe that the best way to determine if there we should explore collaboration is a confidential, exploratory conversation, so contact us today!
Phone: (442) 443-6439
email: hello@3aimstrategy.com
Bright Health Group to focus on Fully Aligned Care Model
The tech-enabled health plan that was a darling of Wall Street less than a year ago during its IPO is shedding all individual and family-based plans and focusing on Medicare Advantage business in CA and FL where it has an integrated model through its Neuehealth subsidiary.
Medicare Advantage improves Value-based Care compared to FFS Medicare
Medicare Advantage significantly outperformed FFS Medicare on each of the 16 clinical quality measures and four of the six patient experience measures. Now that total Medicare eligibility is approximately 60 million beneficiaries and enrollment in Medicare Advantage plans approaches 50% of all Medicare beneficiaries, these findings demonstrate the success of the Medicare Advantage increasing value-based care by increasing quality of the care delivered.