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Ms. Johnstone has lived in Nevada since 1999 and recently began her own consulting firm in Las Vegas, offering health benefit, managed care and project management consultative services. Ms. Johnstone serves on the Silver State Health Insurance Exchange Board as an appointee of Governor Sandoval. She worked as the Executive Director for the Health Services Coalition January 2010 to January 2013. The Coalition is a non-profit organization representing 23 self-funded employer and labor trust health plans covering 280,000 lives in southern Nevada. Immediately prior to joining the Coalition, she was Executive Officer for the Public Employees' Benefits Program (PEBP), the State of Nevada's health benefits program covering 72,000 lives. PEBP benefits eligibility included state and local government employees, early retirees and Medicare retirees along with their dependents. While with the State, Ms. Johnstone also worked as a program analyst in the Legislative Counsel Bureau (LCB) Fiscal Division. From 1996 to 2001 Ms. Johnstone served as a senior principal for American Management Systems (AMS) providing human resource, payroll application and functional consulting for various state and municipal agencies including the State of Nevada. Ms. Johnstone began her career working 13 years in various financial and budgetary leadership positions with the County of Fresno and three years at the Fresno Unified School District as fiscal services director. She also served as the Health Services Agency financial officer for the County of Fresno where she was responsible for a $265 million budget that included 2,774 agency employees.Ms. Johnstone received a Bachelors of Science degree from University of California, Davis and a Masters of Business Administration from California State University, Fresno. She is also a Certified Employee Benefits Specialist (CEBS) by the International Foundation of Employee Benefit Plans and Wharton Business School.

Who knows us best?

Providers and Patients

Why concerned family members matter.

We talk a lot about patient and family engagement at HealthInsight. I'm sure it is on the mind of most health care professionals at some level. But building this into our day-to-day muscle memory of how we respond in situations is still pretty rare. I would like to tell a story of a dear friend of mine who recently dealt with the lack of patient and family engagement and all it is intended to prevent.

This is a 75-year-old man, overweight, not in horrible shape but who has long suffered from breathing problems (frequent bronchitis, sleep apnea, etc.). He has desperately needed a knee replacement for as long as I've known him but was very reluctant to take such a drastic step. Finally, he knew he didn't have any choice and made the decision to proceed. He researched local surgeons and settled on one with full confidence that he had picked the best in the area.

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Health Care Payment Change Highway

Southwest Road

HealthInsight understands that the payment environment for health care providers is more complex than ever as the Centers for Medicare & Medicaid (CMS) continues to implement new payment policies transitioning the system to value-based approaches. The adoption of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will impact the payment structure for the health care community in many ways. MACRA eliminates the Sustainable Growth Rate (SGR) formula and creates a new reimbursement model focused on paying providers for value and better care. CMS has created the Quality Payment Program (QPP) to execute MACRA. Most clinicians in outpatient practices will participate in the Merit-Based Incentive Payment System (MIPS) initially, and eventually more will move into the qualifying Advanced Alternative Payment Models (APMs) arm, although most current APMs will not be qualifying. Implementation rules are still being finalized, but the initial payment adjustments scheduled to be made in 2019 would be based on clinicians' performance beginning in January 2017.

The MIPS combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-Based Payment Modifier) and the Medicare Electronic Health Record (EHR) meaningful use incentive program into a single program. Eligible practitioners will be measured on quality, resource use, clinical practice improvement activities and meaningful use of certified EHR technology, now called Advancing Care Information. Most clinicians in accountable care organizations (ACOs) and the Medicare Shared Savings Program (MSSP) will not be considered Advanced APMs. Only a few existing APMs will qualify, such as the higher tracks of the MSSP that have significant shared risk, some bundled payment arrangements and enhanced versions of patient-centered medical homes. The law also created programs to offer support to physician offices so they can prepare and adapt successfully, with a focus on quality.

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Patient and Family Engagement Council – One Year Later

Group Session

It's been just over a year since I wrote a blog about how HealthInsight Nevada was taking on establishing our own Patient and Family Engagement Council (PFAC). Because we are so proud of our progress, I wanted to provide an update. The hard part was getting started. Now, even though we are only five months into having actual PFAC meetings, it is starting to feel like a sustainable effort.

After much helpful advice from Joan Gallegos and Juliana Preston, our HealthInsight colleagues in Utah, we began our venture. First, we established a core group of staff to represent HealthInsight Nevada. Then we spent a few months going through the Patient and Family Centered Care Partners Gateways Program presented by Libby Hoy. For those that don't know about this, it is a course of five webinar sessions working with a small number of organizations (there were three in our cohort) with Libby's curriculum, homework assignments and feedback. It really provided focus for our group and forced some decisions to be made early.

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HealthInsight Works to Reach Common Goals, Improve Community Engagement

Paper cutout people joining hands around the world

HealthInsight's goals often focus on improving efficiency—being able to do more while using less. This is a goal we share with many of the communities we serve, and we have found that sharing resources in order to foster the development of mutually beneficial program activities is the most efficient way to achieve our shared goals. A couple of great examples have occurred recently in Nevada. One is an internal example—the CDC 1305 sub-grant from the state of Nevada. The other is an external example—the Nevada provider community picking up on a statewide initiative to address drug-resistant infections and the use of antibiotics. Much of the information I am sharing here has been taken directly from material written by staff involved with each of these efforts, and the progress toward real community engagement and reaching common goals across programs is truly exciting.

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Patient Engagement - Finding the Silver Bullet

Seniors

We've all been a patient, sometimes during a planned encounter, sometimes not. Regardless of our background or training, the setting can be intimidating or overwhelming when it involves our own health.

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Uncertainty Remains During Open Enrollment Extension in Nevada

iStock 000005589395Large Health insurance exchanges (“marketplaces”) reached a major milestone on March 31, 2014—the end of the first open enrollment period. However, most exchanges, including the federal Healthcare.gov and Nevada’s Nevada Health Link, decided to offer special enrollment periods to allow more time for individuals who had technical difficulties completing their enrollment. In Nevada, this will be a full 60-day special enrollment period for as many as 300,000 people, but its success is very dependent on whether the system is working better than it has to this point. The website vendor, Xerox, continues to make assurances that most of the severe technical problems have been resolved. We will see; and the citizens of Nevada will be subjects in that experiment. None of us want to see more Nevadans believing that they’ve done everything necessary to ensure their insurance coverage, only to find out that the insurance carriers don’t recognize the coverage.
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Insurance Exchanges – First Impressions

keyboardThe "go-live" date for health insurance exchanges ("marketplaces") across the country is less than a month old. Regardless of what we all thought of the Affordable Care Act, commonly known as "Obamacare", its most significant feature, the exchange, is now here. States represented by HealthInsight each took a different approach to implementing their exchange: New Mexico has a state-run exchange using the Federal government's technology platform for at least the first year; Nevada chose to implement a fully state-run exchange; and Utah continued with its state-run small business exchange and will follow the federally facilitated exchange model for individual coverage. Who knows how many studies will be conducted on all of these different models – and that is just three western states!

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