Changes in Healthcare Means Limiting Freedom
Healthcare providers have limited freedom to run their businesses due to rate cuts, price fixing and needless regulations.
AutoGov is a typical small software company. Our customers are healthcare providers such as nursing homes, hospitals and home health companies. We are entangled in the never ending struggle balance scarce resources against the needs of our customers to ensure high service levels are maintained while offering a disruptive product.
We are free to charge whatever we choose is the optimum price for CaseVue. We spend weeks analyzing our costs against feedback we receive from our customers. If we are right, the market rewards our decisions. If we are wrong, we are punished. But, they are always our decision.
Troubling trends have emerged for our customers, however. They are increasingly hamstrung by government sponsored price fixing - eliminating a key freedom that business leaders require to be successful. For many of these providers (aka businesses) the inability to set prices as they see fit requires doors to close, further limiting capacity in this $3 trillion industry.
We watch as politicians, faceless bureaucrats and and the well meaning healthcare advocates make decisions that ultimately stifle their ability to survive. The basic laws of supply and demand are ignored.
Price fixing and monopolies are always bad in free market economies.
Businesses, including healthcare businesses will fail. Hospitals and nursing homes will close. Home health providers will struggle to recruit quality care givers. Drug companies will discontinue key research.
Our customers are watching helplessly as decisions are made and rates are set, or rather fixed, that ensure their rights and freedoms to run their businesses are reduced or eliminated.
Fair warning to all involved, this will not end well.
We all deserve the opportunity to succeed.
AutoGov Releases Updated Risk Management Software for Medicaid and Healthcare Reform
Leveraging analytics driven by more than 30 million cases, CaseVue allows healthcare providers, states and insurance companies with a comprehensive solution to managing risk in eligibility, enrollment and insurance exchanges.
CaseVue combines advanced analytics with world class data to ensure fast, accurate eligibility, enrollment and exchange decisions.
Austin, Texas (PRWEB) January 14, 2013
AutoGov Director of Technology and Analytics, Taylor Phillips; announced today a major release of his company’s flagship healthcare risk management software, CaseVue 5.0. This important version introduces improvements and tools designed to ensure that information necessary for Medicaid eligibility and enrollment is available in real time on a caseworker’s desktop.
Business office managers and caseworkers are often saddled with making decisions without the benefit of data necessary to prevent mistakes or errors. In these times of rate pressure and uncertainty in the healthcare reimbursement structure, mistakes and errors often mean money – significant write-offs and even fines. Phillips says, “CaseVue combines advanced analytics with world class data to ensure fast, accurate eligibility and enrollment decisions.” CaseVue gathers case data and fuses information from third party data providers to feed an algorithm designed facilitate decisions. A remarkably fast turnaround…this process takes less than one second.
Thanks to AutoGov’s new financial partner, Ontario, Canada based Fusebill (fusebill.com); CaseVue can now be priced to suit our client’s needs – by the score, in packages or on a monthly basis! AutoGov’s specialists can create a custom pricing structure to support any healthcare business.
The software also features new self-service sign-up, administration, training and reporting designed by Phillips and an amazing development team at Rochester, NY based Netsmartz (netsmartz.net).
CaseVue is part of a comprehensive platform used by healthcare providers and government agencies to provide decision support solutions with a base in predictive analytics. CaseVue provides users with fast, accurate decision support tools that improve both the timeliness and quality of eligibility, enrollment and exchange related decisions.
AutoGov’s CaseVue software has provided scores to healthcare providers and government organizations since its launch in 2005. AutoGov’s algorithms are informed by data mining and statistical analysis of more than 30 million Medicaid, Food Stamp and TANF cases. The company’s firm belief is that solutions for its clients must be affordable, practical, and harness technology to support day-to-day operations without major disruption or unnecessary expense.
Contact one of AutoGov’s CaseVue specialists for a demonstration at 512-439-2900 or sign your company up today at http://www.casevue.com.
AutoGov at the University of Alabama's Business Analytics Symposium
The Business Analytics Symposium is a two day event exploring the diverse landscape of analytics in business. World-renowned experts in the fields of statistics, data mining, analytics, and business attend.
In addition to many excellent presentations and discussions, guests have the opportunity to interview and get to know University of Alabama students pursuing graduate degrees in Statistics, Business Analytics, and Economics.
In addition to meeting the up and coming talent, guests have the opportunity to network with seasoned colleagues. Many of our partners will take part in an exhibition following day one of the event where you will have the opportunity to learn about how they use analytics .
Past speakers include Bill Kahn of Traveler's insurance, Lan Guan of Accenture, Kevin Busby of Capital One, Sundar Dorai-Raj of Google, Gene Grabowski of Ford, Collen McCue of Geoeye Analytics, and Tom Bohannon of SAS.
"Be brave. You have to be brave." -Gregg Phillips on small businesses going for goals and challenges.
— AutoGov (@AutoGov) February 2, 2012
55% of all denials of eligibility of Gov't healthcare benefits comes from lack of data on the applications.
— AutoGov (@AutoGov) February 2, 2012
Resources For Finding an Assisted Living Facility
The search for the perfect Assisted Living facility for your loved one can be time consuming and confusing. With so many options, it’s hard to know where to start or how to begin to narrow down the search. There are many resources on the web for you to be able to check out and do research. We have gathered 3 websites that have important information to be able to make this process easier for you.
Memberofthefamily.net - http://www.memberofthefamily.net/
This website offers a rating system of 16,000+ Medicare/Medicaid- certified nursing homes across the United States. You can also look at a national watch list they have compiled. This can help you build a list of possible facilities and know which ones you should steer clear of.
AARP- http://aarp.us/wl1QsR
AARP is a valuable and respected site for senior citizens. The link above will take you to an article on “The “Do’s” of Due Diligence” concerning choosing a nursing home. Before you start the nursing home selection process, you should know what it is you are looking for and how to find it.
Medicare.gov - http://1.usa.gov/zuWwn4
Medicare.gov has compiled a detailed check list for you to be able to take it with you on your assisted living search. It offers questions to ask, reminders of what to look for, a detailed area for recording information gathered, and a rating system.
Hopefully these websites answer any questions you may have on choosing the best assisted living facility and make the process less confusing and less time consuming.
A Life Under Medicaid
This video is a touching story of a 94 year old former nurse aid who has come to love the "family" she has found in her nursing home.
Health Reform Hits Main Street
This simple, easy to understand explanation of healthcare reform provides an opportunity to understand the basics of the new law without reading 1,000 pages of legislative lawyer language.
CaseVue: Saving Money. Saving Lives.
AutoGov recently released and installed Version 4 of our risk management software – CaseVue. This most recent iteration of CaseVue builds on five years and 17 million risk scores delivered to our clients desktops across the United States.
CaseVue 4.1 is specifically designed to improve the accuracy and timeliness of admission decisions made in nursing homes and other healthcare facilities. Often nursing home administrators are forced to make decisions on admitting a patient without the benefit of any detailed information. This decision – most often made inside of an hour – could cost the nursing home owners hundreds of thousands of dollars if not accurately assessed. While most importantly, patients could be denied service if a mistake is made resulting in more dire health related consequences, especially if the decision is delayed.
CaseVue provides healthcare providers with a reliable tool to support those difficult admission decisions. Our nursing home customers reported in a recent survey that they make 77 percent of their admission decisions within one hour. How do they make an accurate, and quick decision? By assessing the risks quickly, identifying potential issues before they occur and correcting problems in the case immediately; facility administrators can make quality decisions, fast!
Call (512-439-2900) or write us (inquiries@autogov.com) for more information on how CaseVue can improve your decisions and the lives of potential residents.
More Young People are Winding Up In Nursing Homes
This sobering trend of younger nursing home residents poses some interesting challenges. The statistics say close to 15 percent of residents are less than 65 years old. Both nursing homes and their younger residents must make difficult adjustments. From privacy to music choices to recreational choices – (Bingo versus Poker) -- homes and residents are changing the traditional nursing home environment. Financial considerations for these younger residents are also a significant issue. Age, for example may not play as significant a role in assessing financial risk and paying sources. Check out our CaseVue product for Long Term Care to learn more about what our products and services can do for you.
SARASOTA, Fla. – Adam Martin doesn't fit in here. No one else in this nursing home wears Air Jordans. No one else has stacks of music videos by 2Pac and Jay-Z. No one else is just 26.
It's no longer unusual to find a nursing home resident who is decades younger than his neighbor: About one in seven people now living in such facilities in the U.S. is under 65. But the growing phenomenon presents a host of challenges for nursing homes, while patients like Martin face staggering isolation.
"It's just a depressing place to live," Martin says. "I'm stuck here. You don't have no privacy at all. People die around you all the time. It starts to really get depressing because all you're seeing is negative, negative, negative."
The number of under-65 nursing home residents has risen about 22 percent in the past eight years to about 203,000, according to an analysis of statistics from the Centers for Medicare and Medicaid Services. That number has climbed as mental health facilities close and medical advances keep people alive after they've suffered traumatic injuries. Still, the overall percentage of nursing home residents 30 and younger is less than 1 percent.
Martin was left a quadriplegic when he was accidentally shot in the neck last year by his stepbrother. He spent weeks hospitalized before being released to a different nursing home and eventually ended up in his current residence, the Sarasota Health and Rehabilitation Center. There are other residents who are well short of retirement age, but he is the youngest.
The yellow calendar on the wall of Martin's small end-of-the-hall room advertises activities such as arts and crafts. In the small common room down the hall, a worker draws a bingo ball and intones, "I-16. I-one-six." As Martin maneuvers his motorized wheelchair through the hallway, most of those he passes have white hair and wrinkled skin.
"It's lonely here," Martin says, as a single tear drips from his right eye.
Martin exchanges muted hellos with older residents as he travels down the hall to smoke outside. His entire daily routine, from showering to eating to enjoying a cigarette, is dictated by the schedules of those on whom he relies for help.
He usually wakes up late, then waits for an aide to shower him, dress him and return him to his wheelchair. He watches TV, goes to therapy five days a week and waits most days for his friend to bring him meals.
He mostly keeps to himself, engaging in infrequent and superficial conversations with his elders.
Martin's parents are unable to care for him at home. His father is a truck driver who is constantly on the road, and his stepmother is sick with lupus. Medicaid pays his bills; it could take a lawsuit for him to get care outside a nursing home.
Advocates who help young patients find alternatives to nursing homes say people are often surprised to learn there are so many in the facilities. About 15 percent of nursing home residents are under 65.
"When I tell people I try to get kids out of nursing homes, they have no idea," says Katie Chandler, a social worker for the nonprofit Georgia Advocacy Office.
Federal law requires states to provide alternatives to institutional care when possible, though its implementation varies from place to place. Navigating the system can require a knowledgeable advocate and, sometimes, litigation.
Not all younger nursing home residents are there for good. Some nursing homes are seeing an increase in patients who come to recover there instead of in a hospital, because it is cheaper for their insurance company.
Like Martin, many younger residents have suffered a traumatic injury. Others have neuromuscular diseases such as multiple sclerosis, or have suffered a stroke.
Brent Kaderli, 26, of Baytown, Texas, became a quadriplegic after a car accident in 2006. He hopes rehabilitation will help him gain enough strength to move into an assisted living facility and eventually, to an apartment with his girlfriend.
He shares his nursing home room with an older man who suffers from dementia. It is not ideal, but because his parents' home is not modified to accommodate his wheelchair, he thinks it's the only option right now.
"Just knowing that one day I will be better, I'm still hoping and praying for that. In the meantime, I think about my family and my friends, what I used to be able to do, and I stay sad a lot," he says. "This is probably the best that I could have at this point."
The same generational tensions that exist outside nursing homes are inside them as well, and are sometimes exacerbated by the often close confines.
Older residents complain about loud music and visitors, younger residents complain about living with someone with dementia or being served creamed spinach. Many nursing homes try to house younger residents together, though in many cases their small numbers make that difficult.
For young people who find themselves newly disabled, the psychological and social needs are often even more challenging than their physical demands. That presents a challenge for nursing homes that are used to serving people near the ends of their lives.
At Bayshore Health Center in Duluth, Minn., 34 of the 160 residents are younger people, all living in private rooms in their own wing. The staff has found that subtle changes can improve their lives.
Instead of bingo night, there are poker games and outings to nightclubs. For someone who stays up late watching a movie, breakfast can be served at 10 a.m., rather than 7 a.m. Pizza is offered in place of lasagna; Mountain Dew and Coke are poured instead of coffee and tea.
Still, many younger residents sink into depression because of their physical limitations, their loneliness and their nursing home surroundings.
"For them it's a life sentence. When you're 40 years old you know you're never getting out. This is the way your life will be forever and ever. Amen," says Diane Persson, a gerontologist who has written about the boom in younger nursing home residents.
Martin fears that may be true for him. He used to look forward to joining the Army and earning a college degree in science or engineering. Now he simply looks forward to visits from his friend Paul Tuttle, who on this day brings him nachos he feeds him along with sips of water.
"If I'm not here, he's got no one his age to talk to about football or anything," Tuttle says, wiping Martin's face.
Propped in his wheelchair, Martin says: "It makes you feel old. If that's all you're around, that's what you become."
(This version corrects Katie Chandler's affiliation to Georgia Advocacy Office, not state of Georgia.)
Link to article: http://news.yahoo.com/s/ap/20110107/ap_on_re_us/us_nursing_homes_young
This sobering trend of younger nursing home residents poses some interesting challenges. The statistics say close to 15 percent of residents are less than 65 years old. Both nursing homes and their younger residents must make difficult adjustments. From privacy to music choices to recreational choices – (Bingo versus Poker) -- homes and residents are changing the traditional nursing home environment. Financial considerations for these younger residents are also a significant issue. Age, for example may not play as significant a role in assessing financial risk and paying sources. Check out our CaseVue product for Long Term Care to learn more about what our products and services can do for you.
SARASOTA, Fla. – Adam Martin doesn't fit in here. No one else in this nursing home wears Air Jordans. No one else has stacks of music videos by 2Pac and Jay-Z. No one else is just 26.
It's no longer unusual to find a nursing home resident who is decades younger than his neighbor: About one in seven people now living in such facilities in the U.S. is under 65. But the growing phenomenon presents a host of challenges for nursing homes, while patients like Martin face staggering isolation.
"It's just a depressing place to live," Martin says. "I'm stuck here. You don't have no privacy at all. People die around you all the time. It starts to really get depressing because all you're seeing is negative, negative, negative."
The number of under-65 nursing home residents has risen about 22 percent in the past eight years to about 203,000, according to an analysis of statistics from the Centers for Medicare and Medicaid Services. That number has climbed as mental health facilities close and medical advances keep people alive after they've suffered traumatic injuries. Still, the overall percentage of nursing home residents 30 and younger is less than 1 percent.
Martin was left a quadriplegic when he was accidentally shot in the neck last year by his stepbrother. He spent weeks hospitalized before being released to a different nursing home and eventually ended up in his current residence, the Sarasota Health and Rehabilitation Center. There are other residents who are well short of retirement age, but he is the youngest.
The yellow calendar on the wall of Martin's small end-of-the-hall room advertises activities such as arts and crafts. In the small common room down the hall, a worker draws a bingo ball and intones, "I-16. I-one-six." As Martin maneuvers his motorized wheelchair through the hallway, most of those he passes have white hair and wrinkled skin.
"It's lonely here," Martin says, as a single tear drips from his right eye.
Martin exchanges muted hellos with older residents as he travels down the hall to smoke outside. His entire daily routine, from showering to eating to enjoying a cigarette, is dictated by the schedules of those on whom he relies for help.
He usually wakes up late, then waits for an aide to shower him, dress him and return him to his wheelchair. He watches TV, goes to therapy five days a week and waits most days for his friend to bring him meals.
He mostly keeps to himself, engaging in infrequent and superficial conversations with his elders.
Martin's parents are unable to care for him at home. His father is a truck driver who is constantly on the road, and his stepmother is sick with lupus. Medicaid pays his bills; it could take a lawsuit for him to get care outside a nursing home.
Advocates who help young patients find alternatives to nursing homes say people are often surprised to learn there are so many in the facilities. About 15 percent of nursing home residents are under 65.
"When I tell people I try to get kids out of nursing homes, they have no idea," says Katie Chandler, a social worker for the nonprofit Georgia Advocacy Office.
Federal law requires states to provide alternatives to institutional care when possible, though its implementation varies from place to place. Navigating the system can require a knowledgeable advocate and, sometimes, litigation.
Not all younger nursing home residents are there for good. Some nursing homes are seeing an increase in patients who come to recover there instead of in a hospital, because it is cheaper for their insurance company.
Like Martin, many younger residents have suffered a traumatic injury. Others have neuromuscular diseases such as multiple sclerosis, or have suffered a stroke.
Brent Kaderli, 26, of Baytown, Texas, became a quadriplegic after a car accident in 2006. He hopes rehabilitation will help him gain enough strength to move into an assisted living facility and eventually, to an apartment with his girlfriend.
He shares his nursing home room with an older man who suffers from dementia. It is not ideal, but because his parents' home is not modified to accommodate his wheelchair, he thinks it's the only option right now.
"Just knowing that one day I will be better, I'm still hoping and praying for that. In the meantime, I think about my family and my friends, what I used to be able to do, and I stay sad a lot," he says. "This is probably the best that I could have at this point."
The same generational tensions that exist outside nursing homes are inside them as well, and are sometimes exacerbated by the often close confines.
Older residents complain about loud music and visitors, younger residents complain about living with someone with dementia or being served creamed spinach. Many nursing homes try to house younger residents together, though in many cases their small numbers make that difficult.
For young people who find themselves newly disabled, the psychological and social needs are often even more challenging than their physical demands. That presents a challenge for nursing homes that are used to serving people near the ends of their lives.
At Bayshore Health Center in Duluth, Minn., 34 of the 160 residents are younger people, all living in private rooms in their own wing. The staff has found that subtle changes can improve their lives.
Instead of bingo night, there are poker games and outings to nightclubs. For someone who stays up late watching a movie, breakfast can be served at 10 a.m., rather than 7 a.m. Pizza is offered in place of lasagna; Mountain Dew and Coke are poured instead of coffee and tea.
Still, many younger residents sink into depression because of their physical limitations, their loneliness and their nursing home surroundings.
"For them it's a life sentence. When you're 40 years old you know you're never getting out. This is the way your life will be forever and ever. Amen," says Diane Persson, a gerontologist who has written about the boom in younger nursing home residents.
Martin fears that may be true for him. He used to look forward to joining the Army and earning a college degree in science or engineering. Now he simply looks forward to visits from his friend Paul Tuttle, who on this day brings him nachos he feeds him along with sips of water.
"If I'm not here, he's got no one his age to talk to about football or anything," Tuttle says, wiping Martin's face.
Propped in his wheelchair, Martin says: "It makes you feel old. If that's all you're around, that's what you become."
(This version corrects Katie Chandler's affiliation to Georgia Advocacy Office, not state of Georgia.)
Link to article: http://news.yahoo.com/s/ap/20110107/ap_on_re_us/us_nursing_homes_young
AutoGov Unveils New Algorithm for Healthcare Exchanges
Austin, TX (PRWEB) December 22, 2010
AutoGov CEO, Rose Hayden, is announcing a new release of her company’s flagship risk management tool, CaseVue. This version introduces a new multidimensional algorithm designed to bridge the information gaps between Medicaid and healthcare exchanges.
Hayden says CaseVue will now be able to ensure the integrity of critical handoff between Medicaid and the new state healthcare exchanges being created in response to the new healthcare reform regulations.
About the new engines Hayden said, “Our experience with the “exchange” between Medicaid and CHIP suggests that the handoffs or deeming from one program to another must be handled with great care ensuring the integrity of the programs, eliminating the likelihood of dual eligibiles, and managing a quality based transaction. Administrators must be able to assure the public that the process has been handled with the precision of an analytical and statistically sound model.”
CaseVue is part of a comprehensive platform used by government agencies, healthcare providers to provide decision support solutions with a base in predictive analytics. CaseVue provides users will fast, accurate decision support tools that improve both the timeliness and quality of eligibility and exchange related decisions.
AutoGov’s 15 years of delivering consistent quality services to its government and corporate clients is borne of the knowledge and experience of its leadership team. All of AutoGov’s principals have served at the highest levels in government and as executives in the private sector. The AutoGov team, their advice, and the solutions reflect decades of practical knowledge and experience. The company’s firm belief is that solutions for its clients must be affordable, practical, and harness technology to support day to day operations without major disruption or expense.
For more information contact the company at 512-439-2900 or at autogov.com.
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http://www.prweb.com/releases/2010/12/prweb4919194.htm
The Medicaid Perspective
We launched a new blog today – The Medicaid Perspective (www.medicaidchip.com). Focusing on Medicaid and CHIP, the blog will focus on analysis, opinion, and news on the runaway spending program that may bankrupt the United States. Already thousands of people have visited the blog! Please join them in learning more about Medicaid, the politics of healthcare and healthcare reform.
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