Groupers are key to developing alternative payment models, but not all groupers are alike

By Andrei Gonzales, M.D., assistant vice president, Value-Based Care Strategy, Change Healthcare

Dr. Gonzales is responsible for product management of HealthQx®, Change Healthcare’s value-based payments analytics platform.

Episode Resources

1. Andrei Gonzales, M.D., bio
2. Groupers Comparison Grid
3. Change Healthcare Industry Insights
4. COVID-19 Updates and Resources
5. COVID-19 Updates Newsletter
6. Change Healthcare Insights Newsletter

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• Suggest or become a guest
• Contact Change Healthcare

Pandemic-Driven Medicaid and ACA Expansion
Impacts and Considerations for Payers

By Jimmy Liu and Dan O’Brien

Jimmy Liu is vice president of Risk Analytics at Change Healthcare. Dan O’Brien is director for Risk Adjustment Strategy at Change Healthcare.

Understanding the full impact of the COVID-19 pandemic on the healthcare industry is not yet possible, but a few outcomes are evident. Medicaid and Affordable Care Act (ACA) enrollment rates are surging alongside the unemployment rate. In addition, postponed procedures and delayed routine services—as well as pent-up demand for elective procedures—will soon drive increased utilization.

This report details expected changes in the composition of national Medicaid and ACA member populations, and explores the potential financial consequences of the pandemic on payers. We address the timing of the Medicaid/ACA expansion and provide five immediate, actionable strategies to help payers mitigate challenges caused by the pandemic.

Episode Resources

1. Jimmy Liu's bio
2. Dan O’Brien's bio
3. Pandemic-Driven Medicaid and ACA Expansion
4. Risk Adjustment Analytics
5. Change Healthcare Industry Insights
6. COVID-19 Updates and Resources
7. COVID-19 Updates Newsletter
8. Change Healthcare Insights Newsletter

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• SUBSCRIBE to the podcast using any podcatcher or RSS reader
• Suggest or become a guest
• Contact Change Healthcare

CommonWell Health Alliance Executive Director Paul Wilder joins hosts Deanne Kasim and Arien Malec to discuss how healthcare IT interoperability can drive innovation that mitigates compliance risks and, equally if not more important, improves capabilities and the consumer experience to minimize the need for further regulation.

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• Follow Arien Malec, SVP of R&D at Change Healthcare
• Follow Deanne Kasim, VP of health policy at Change Healthcare
• Follow Paul L. Wilder, executive director at CommonWell Health Alliance
• commonwellalliance.org/
• changehealthcare.com/about/innovation/interoperability
• changehealthcare.com/government-affairs

CAQH’s chief policy and research officer,April Todd, joins host Andrew Johnson to discuss areas around prior authorization that remain the most challenging, the benefits of transitioning to an automated workflow, and efforts underway to speed the adoption of electronic prior authorization.

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• Follow April Todd, chief policy and research officer at CAQH
• Follow Andrew Johnson, vice president of growth and innovation at Change Healthcare
• caqh.org/
• caqh.org/caqh-core
• changehealthcare.com/clinical-decision-support/interqual-connect