My areas of expertise include occupational therapy, rehabilitation medicine, telehealth, and mental health. With nearly 10 years of healthcare experience, I am also qualified to write on topics such as exercise, health insurance, nutrition, orthopedics, geriatric care, pediatric therapy, neurology, and health tech.
Sensory Regulation Across the Lifespan (AOTA-approved continuing education course)
Sensory-based interventions are a common modality in pediatric occupational therapy. This is mostly because of how often sensory concerns co-occur with developmental delays and neurodevelopmental conditions such as Autism Spectrum Disorder, Attention-Deficit / Hyperactivity Disorder, and intellectual disabilities. As a result, much of the evidence surrounding sensory integration is focused on children and adolescents. However, therapists know that sensory factors can impact the well-being of patients of any age and with any condition.
Community Health Plan Losses May Impact Premiums
Experts predict community health insurance providers will lose a substantial amount of funds as the year comes to a close. The Alliance of Community Health Plans expects these insurers to miss out on hundreds of millions in reimbursement resulting from a lack of recent Medicaid rate adjustments.
Rates have remained the same
Reports show that many states used pre-pandemic data to inform their Medicaid rates. According to Nick Felici, Director of Network Development & Analytics at TOG Network S...
Health Plan Strategy is Key During Open Enrollment Period
For nearly every state, November 1st marked the start of open enrollment season. This was met with mixed responses from some since many subscribers are still adjusting to the news of upcoming Medicare changes. In September, Medicare recipients learned their premiums would be rising in the new year, but they will see some savings in prescription medications with a new out-of-pocket maximum and caps on some of the priciest drugs.
Who is impacted?
It appears that Medicare Advantage (MA) members ...
Decoding the New Mental Health Coverage Rules for Private Health Plans
Just a few weeks ago, new legislation was finalized that stands to impact subscriber benefits in the behavioral health arena. This set of regulations is closely aligned with federal legislation, namely, the Mental Health Parity and Addiction Equity Act (MHPAEA), as well as state-specific laws, such as the Mental Health Parity Act in California, which was expanded in 2021.
Many patients report encountering a range of barriers in accessing mental health care since the MHPAEA was enacted in 2008...
Caseload Vs. Workload (AOTA-approved continuing education course)
The discussion of caseload versus workload hones in on the job duties of school-based therapists, including OTs, SLPs, PTs, audiologists, assistive technology providers (ATPs), psychologists, and other related service providers. More specifically, caseload and workload have become distinct approaches to treatment in a school-based setting. There is a growing basis of evidence that the workload approach is more effective than the caseload approach for a variety of reasons.
What the Rise in Male Cancer Rates Means for Your Network
A new study led by the American Cancer Society has pointed out an alarming trend in the incidence of cancer among men. This research found that new, worldwide cancer cases in men are projected to rise by 84% between now and 2050. This evidence also states that the amount of cancer deaths in men is expected to skyrocket by 93% in the same time frame.
How much of an increase?
When compared to existing cancer cases, this amounts to 8.7 million new cancer diagnoses in men alone. There is an even ...
Motor Coordination: Midline Crossing and Bilateral Coordination (AOTA-approved continuing education course)
As an essential performance skill, motor coordination is a trending topic in occupational therapy. Individuals of any age may experience motor incoordination, either as a developmental delay or a health condition. When this presents as a deficit, motor coordination must be addressed in the occupational therapy plan of care. Motor incoordination stands to impact anyone’s occupational engagement and can impact an individual’s quality of life. In order to effectively address motor deficits of all varieties, occupational therapists should be aware of the smaller skills that fall under this heading
Presentation Matters: Telehealth Settings Impact Patient Satisfaction
Since its rise in 2020, it’s safe to say telehealth is now a fixture of many people’s medical care.
However, there is a lot of variation in telehealth visits – often more than patients get (or expect) from in-office visits. From using different platforms and messaging in patient portals to adopting specific pre-visit protocols and scheduling entirely online, many patients have come to learn what they like and dislike in virtual visits.
One telehealth feature that is often highly variable is t...
Oncologist Shortage: Is Your Network Adequacy at Risk?
The health care industry has been grappling with staffing shortages in recent years, but the field of oncology is facing a particularly critical challenge. The number of oncologists, especially in rural areas, has been dwindling, creating a ripple effect on patient care and network adequacy challenges. What are the driving forces behind the shortage?
Several factors converged to make the oncologist shortage particularly pressing:
Medical Advancements: Improved early detection and treatment op...
Cognitive Rehabilitation: Current Evidence-Based Practices (AOTA-approved continuing education course)
In the realm of evidence-based cognitive interventions, there is a lot of information that is revolutionizing cognitive rehabilitation for a range of professionals. Occupational therapists, in particular, have a vast amount of knowledge to draw from. Evolving technology continued advances in the fields of rehabilitation and neuroscience, and changing intervention practices all allow OTs to treat patients with cognitive disorders effectively.
What Payers Need to Know About the Changing Medicare Advantage Landscape
Recent data shows that Medicare Advantage (MA) spending surged in 2023. This comes along with a number of enrollment and other member-related trends that payers should also be aware of.
Rising Enrollment
January 2024 reports indicate that the number of MA enrollees is steadily rising, with subscriber numbers presently sitting at 32 million. Researchers anticipate this number will increase to 34 million before January 2025. Over 50% of individuals eligible for both Medicaid and MA (also known ...
Navigating Digital Transformation in Health Care
Health care is often recognized as a quickly changing industry, and the technology sector is quite similar. For this reason, health technology is something payers should especially keep up-to-date on.
Artificial intelligence (AI) is one of the biggest technology niches that comes along with digital challenges. So much so that researchers are trying to gauge health care leaders’ views on implementing AI and other digital solutions to assist with implementation.
McKinsey & Company conducted a s...
Medicaid Members To See Continued Coverage Through Mid-2025
Individuals who currently participate in Medicaid waiver programs are getting an additional year of benefits. CMS made this decision in an effort to boost retention for eligible Medicaid recipients. As a result, the waiver program will now end in June 2025 instead of December 2024.
Last spring, many states started the eligibility redetermination process for their Medicaid members. Since this hadn’t occurred in over three years–the last time being mid-pandemic–it was a lengthy undertaking. How...
Fundamentals for Skilled Nursing (AOTA-approved continuing education course)
With a growing aging population, geriatric care as a whole is becoming more essential to the fabric of our society. This means the United States will see an even greater number of geriatric care centers, such as assisted living facilities (ALFs), skilled nursing facilities, and long-term care facilities (LTC) established in coming years. Each of these practice settings needs qualified healthcare professionals to treat both short-term patients and long-term residents. As a result, occupational therapists (OTs) and certified occupational therapy assistants (COTAs) are in high demand in SNFs.
Essential Metrics for Your Health Plan’s Member Satisfaction
Member satisfaction has always been a strong barometer for health plan success. When looking at commercial payers, the most recent J.D. Power U.S. Commercial Member Health Plan Study found that convenience/accessibility, price, and trustworthiness were the biggest differentiators between low and high-rated health plans.
To obtain a comprehensive picture, J.D. Power reported surveying 35,000 members from 147 health plans located in 22 regions across the United States.
Where are the Gaps?
While...