A federal Medicaid program is providing just more than $3 million in funding for the state’s early childhood program known as Reach Out and Read.
The program will be conducted by the N.C. Department of Health and Human Services with matching funds.
DHHS said the reading initiative is one of the first in the country among state Medicaid programs.
The goal is improving literacy and language comprehension through participation from low-income children who would be eligible for Medicaid or the federal Children’s Health Insurance Program
Meanwhile, the federal Centers for Medicare and Medicaid Services said the program has proven in other states to have improved patient-clinician relationships and well-child visit attendance.
“Expanding Reach Out and Read recognizes that children’s healthy development and early literacy are intertwined,” Dr. Mandy Cohen, the state’s health secretary, said in a statement.
“This program meets families where they are and through people they trust.”
Reach Out and Read partners with pediatric primary care locations to deliver training for medical providers, literacy tools for families, and to encourage healthy routines and relationships through shared stories.
CMS has begun the process to define value based purchasing arrangements for drugs in the Medicaid program, with a focus on the value delivered by a drug to the individual patient. One key change to regs is to allow manufacturers the ability to report multiple best prices.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
New value-based pricing approaches could save up to $228 million in federal and state dollars through 2025.
The final rule codifies a broad definition of VBP, which can better align pricing and payment to observed or expected evidence and/or outcomes-based measures in a targeted population. (Image: Shutterstock)
States, private payers and manufacturers now have more flexibility to enter into value-based purchasing (VBP) arrangements for prescription drugs under Medicaid. The Centers for Medicare & Medicaid Services on Monday finalized regulatory changes to modernize Medicaid prescription drug purchasing and drive payment innovation.
“Rules on prescription drug rebates and related reporting requirements have not been updated in thirty years and are thwarting innovative payment models in the private sector,” CMS Administrator Seema Verma said. “Medicaid’s outdated rules have consistently stymied the ability of payers and manufacturers to negotiate drug reimbursement methods based on the actual outcome of the treatment. A new generation of approaches to payment methods is needed to allow the market the room to adapt to these types of curative treatments while ensuring that public programs like Medicaid remain sustainable and continue to receive their statutorily required discounts.”
Under current regulations, prescription drug manufacturers face challenges accounting for VBP arrangements in their Medicaid best price reporting to CMS. This has the unintended consequence of hindering providers, insurers and prescription drug manufacturers in their efforts to develop innovative payment models for new drug therapies and other innovative treatments. Current regulations also discourage payers and manufacturers from designing new payment arrangements based on the value their product may provide.
With the new flexibilities under this final rule, manufacturers are expected to be more willing to negotiate with payers, including Medicaid, with drug pricing being driven by the value of their drug to the individual patient. New genetic-based treatments initially may be expensive but in the long run offer significant value to the patient and payer.
Payers will be able to negotiate prices with manufacturers for these genetic-based treatments based upon outcomes and evidence-based measures such as reduced hospitalizations, lab visits and physician office visits, ensuring that if such measures fail to support the value of a drug, the payer is not held accountable for the full price.
The final rule codifies a broad definition of VBP, which can better align pricing and payment to observed or expected evidence and/or outcomes-based measures in a targeted population. The final rule also allows manufacturers to report multiple best prices instead of a single best price when offering their VBP arrangements to all states. By making these changes, effective in January 2022, CMS hopes to encourage VBP arrangements and negotiations to help make new, innovative therapies more available to all patients. As a result, it is estimated that these new
VBP approaches could save up to $228 million in federal and state dollars through 2025. Basing payment on the effectiveness of a given therapy can foster innovation in the treatments that are most beneficial to patients, while reducing overall health-care spending and hospital visits. When payers are positioned to be stronger negotiators with drug manufacturers, Medicaid beneficiaries will benefit from better access to prescription medications.
best viewed on a tablet, using quality headphones (if you can read and listen to music at the same time).
Here is your treasure map. You might want to take a look at it.
Hit play and start reading.
Whiskey Tango Foxtrot. End of review.
I guess I have to do better than that.
I have avoided writing this for about 2 months now. I think you can guess why. If the past Year in Reviews (YERs?) have been a beer to get you tipsy, this one is 4 hits of acid and a side of peyote. It’s rough. Heaven help us all as I try to look back and find meaning in this hellscape of a year.
I am sorry I meant to say this peaceful protest of a year.
Please don’t cancel me.
Or take away my adrenochrome or my goats. More on both of those later.
There were also giant blue butterflies. More on those later, too.
I promise the payout is worth it this year. Read it all the way to the end. There is that blue butterfly. But don’t skip to it because it will make no sense without all the rest.
If this is your first time to these Year in Reviews that I do
Here’s a guide:
I take a long time to wind up.
I cover a lot of ground, mostly in loosely connected glimpses into things that stuck out to me as meaningful duringthe year.
I attempt to stitch it all together with a metaphor that I introduce early, hide more and more throughout and then bring back to make the final pop both mentally and emotionally.
I will most likely make you mad.
I hope to make you think.
I will share the Gospel at some point, and if for any reason I forget to (which I doubt I will because I read these things over and over and over when editing), please call or email and ask me to share it with you. Whether or not you already believe. I love to tell the story.
If I do my job right, we all have a good laugh, a good cry, and feel human again at the very end.
P.S. Each Year in Review gets its own unique icon. This year’s candidates are:
Whenever you see the butterfly one, you can click on it to listen to a recommended soundtrack for the section. This will include and either a song I wrote or a song from someone else I think is appropriate in the context of the section.
P.P.S. This year’s review may end up making you feel worse than before you read it. Caveat Reador.
P.P.P.S. I am an extreme person. If I didn’t have a blackened heart before 2020, I certainly do now.
If you end up liking this (a surprising number of people do and that is scary / humbling), here are links to past reviews
Then you know all the stuff above, whether you realize it or not.
But this year is, of course, different. In other years, I sat down over several multi-hour sessions and poured out my mind and heart to my audience. This year its more like I am on a sidewalk in a deserted alley somewhere, vomiting on all fours with snot and tears and rage gushing out of me. You have been warned.
I have placed links throughout if you just need to hit the escape button and get lost in a great song or a related wiki entry or similar.
Oh yeah, the business
Are you a healthcare industry nerd? Join our team! It’s amazing. And this is literally the first thing you see as part of our New Team Member Onboarding Process.
For whatever weird reason, I have almost no distinction between my work and my life. Clients seem to like it because it makes healthcare consulting human. And genuine human-ness is loved by anyone remotely human. So clients become friends.
I always publish the YER out to the business site to hit both parts of my life, I guess. So I need to give everyone some business-ey updates first. Price-to-pay and all that. Then we can get back to the life stuff.
Maybe I’ll do a timeline.
January – February Brought on a new Partner and Chief Growth Officer. He is simply put the only person I would trust to run the business instead of me. He’s smart, thorough, kind and always learning. His name is Kris.
March– COVID started to be real. The HIMSS conference got cancelled and anyone who wasn’t yet woke to COVID in healthcare was now. Clients starting cancelling contracts.
April-ish– We seriously asked ourselves if we would be on the ropes in 6 months, decided we were ok with whatever happened and that we were going to give it our all either way. We pivoted completely into understanding how COVID was impacting our clients and audience. We called them up- human to human- to ask how they were doing. We did listening sessions with executives to hear what was important to them now in this new reality.
May– I said to the team “Hey- let’s do a four-day virtual conference all about Medicaid and COVID. It’ll be easy.” We pulled it off by mid-June and hundreds of people sat through 4 solid days of health plan CEOs, CMS officials and state Medicaid Directors discussing what they were doing about COVID. Sarai was absolutely amazing during all this (and actually ran the thing live for about an hour while I had a medical emergency during a speaker session).
June– August– Business picked up. New clients. New friends. All of sudden a lot bigger team. Building out a dream team of consultants is probably the best part of 2020 from a work side. And we made sure we thought about how to be human across our team. You haven’t lived until you’ve heard very important government officials talk about the dangers of crashing a Serbian wedding over Zoom happy hour.
Sept-October- Lots of fun and fulfillment delivering on all the stuff Kris sold. Getting to work with experts who were your heroes 15 years ago is an amazing thing. Started the newsletter back up.
November- Started working on spreading human-ness again back to the audience with the MegaMixTape project. People loved it.
December- Now on track for best year ever as business. Excited about what’s next. Planning our first real in-person conference. Theme: Humans. Or maybe hugs.
Ok, that’s it for the business update for 2020. Back to the reason you’re here.
Descent into madness
The soundtrack for this section includes 3 songs I wrote: 1) Ring the Bell: A song I wrote during the time of the events described below. Kind of serves as a nice score while reading the below if you are game for eerie electronic stuff. 2) End of the World– sad guitar stuff; and 3) Morning Coffee– If you need a little pick me up after all that, this is sort of like if you went to a jazz brunch and someone used coke instead of powdered sugar on your French toast. But pulled back the edge with a lot of Ginseng.
My wife was watching international news (she has a much more effective Twitter feed than I do for healthcare items, which is funny because I am the healthcare half of us.. but then again I guess the past 5 or 6 years being a complex auto-immune / blood disorder patient probably makes her pretty qualified in the “healthcare” bucket) and was asking me if I was “watching this Wuhan thing.”
“Nah,” said the guy with the public health degree from Johns Hopkins. “Probably no big deal.”
She continued to watch it develop and continued to nudge me on it, so that by early February I was asking colleagues in the healthcare industry- “Hey, are you watching this Wuhan thing?”
Their response- “Nah. Probably no big deal. Are you going to the HIMSS conference this year?”
I then realized even the people who should be watching this were not. And if they were not, then I was certain those in my social circle (non-healthcare people, friends and family) absolutely were not.
So in early March I dropped everything and pivoted 180 away from the healthcare industry and towards my social circle.
Late February and Early March
In which I believed educating people was the answer.
I went to Facebook to share as much information as I could. (Before this I might have gone on Facebook 3 times a year).
And what I found terrified me.
A solid majority of people I knew thought this was all a George-Soros funded hoax designed to unseat Trump.{1}
The “same as flu” crowd.
The “its 5g bats sending messages from cell towers on behalf of Bill Gates and the New World Order” crowd.
The “Q anon” cult.
You know. The people who murdered 300,000 Americans (and counting) with their selfishness and their 2-standard-devs-to-the-left capabilities.
Those guys.
But in March, I had not yet realized how willfully ignorant about millions of Americans have become. I still thought “if only they could get some accurate information, translated in a way that laypersons can understand, they’ll make some hard adjustment to their lifestyle and we can be done with this in a month or so.”
That was where my head was at in March 2019.
This was basic infectious disease. Change a few small behaviors, stop the spread. Viruses stop when there are no more victim opportunities.
Forming (and informing)
Late March
But anyway. Back to before I gave up. In March I stood up a curation team.
I enlisted the support of people whose medical and public health opinion I trusted. Doctors in ERs in multiple states. Former (and current) state health and CMS officials. A DC press guy (you know who you are Mr. MFAR). The plan was simple. Text me any articles you think are helpful and I will get them out to my Facebook circle.
We called this Ringing the Bell.
It took off like wildfire.
Very quickly it got to the point where we needed more help. People reading all the stuff we were putting out and resharing it (dubbed “Bell Ringers”) needed help understanding it. So then we pulled in half a dozen or so doctors, psychiatrists, biochemists and public health professionals to explain and discuss (in the comments) the articles we were putting out.
To look back on this now, it is amazing that we were Ringing the Bell in this way. Getting out information that most people were not seeing anywhere else. And that has a lot to do with the bubbles and filters and knowledge ghettoes we build for ourselves with modern media. But that’s a whole other topic that I don’t have time to cover here.
We were Ringing the Fuck Out of the Bell until we got everyone’s attention. {2}
Pretty quickly I was organizing all the news stories of the day into sections (clinical, supply chain, social unrest, data..) and running a Facebook Live “news show” every night. At one point we had something like a hundred people watching it regularly.
I made our Facebook profile public to make sure we could get the word out. Stacy hated that but understood why. People from all over the country followed it. I would get phone calls from people I have never met asking me to help them think through whether to drive 12 hours to get their elderly parents so that they could quarantine with them. Or callers asking “What is a cytokine storm? Can I give my baby elderberry?”
I did my very best to answer and to explain what I did or didn’t know. I was completely humbled by them trusting me. And completely broken by the realization that this was how bad it was: people were blindsided by a cataclysmic, world-changing event without sufficient information for them to respond to it. So much so that they were calling a stranger across the country to ask for advice. All because some person they knew saw this guy on Facebook.
April
A bitter pill
It sucks to see things coming from further off than most everyone else. Bad things.
Remember we were way early in the deaths and even in the cases at this point. I would say things like:
“If there are 500 reported cases in Alabama, I promise there are really 10,000 running around out there.” Turns out that was probably pretty close.
Or when the CDC said on a Friday that 200 people indoors was safe, I would say that was nuts. And then on aSunday (two days later), when they dropped it down to 75- I’d say of course 76 is not safe. And so on and so forth.
And when the Imperial College study came out showing peak American death in June for America around 2M dead, I spent hours explaining what that number really meant. And that Trump’s counter-number of 80,000 dead total was nonsense.
And when I told people we would have a completely divided country of over masks (in April), few listened.
When you are one of the few who is willing to read the clearly legible handwriting on the wall, its very lonely. And this is not one of the ones where later saying “I told you so!” has any joy to it at all.
I think it was in late April that I realized The Bell Had Been Rung. I began to pivot back into writing music. I began to try to find small ways to relate to the people I would interact with over the phone. Dealing with a pandemic from a business perspective involves a lot of phone calls. I remember praying for customer service representatives a lot during this time. One lady and I had a twenty-minute conversation about each of our wedding stories. She had taken a cruise for her honeymoon right before the COVID cruise ships happened.
Remember that? When cruise ships were trying to find a port that would let them in? Or what about the USS Comfort that went to NYC in the initial onslaught? So much has happened.
In the beginning I prayed over every UPS, USPS or Amazon driver I saw at the fence. Out loud. For their protection during this time. God used that to minister to them but also to me.
June to November
Retreat and Surrender
By June I was angry. Educating had not worked to change people’s behavior. And I am still seeing lots of pictures even now (December) of groups of people with no masks at Christmas parties.
Spreading death.
A pox on their houses.
So I turned to memes. At first I put out a steady stream of them.
I do believe shame and guilt (but more so guilt) likely have more of a role to play in stopping this disease than we realize. Hell, maybe even more a role than the vaccine.
Instead of narrating all my meme adventures, I’ll just let you click through them in this slideshow below. I’m sure you’ll get the idea.
Lost more than a few friends over these. Made some new ones, too. Would do it all over again.
December
Remembering and Reflecting
But looking back at all this, I just don’t know what to make of it.
I had tried to warn people. To ring the bell. Many listened. More did not.
And it hurt me.
No. It broke me.
Most of the madness part is over. If you have been hiding behind the couch while the scary man screams, its ok to come out now.
Human Contact
As I sit down to write this (design started November 21- I always start these at least a month early) I have not hugged my momma in 250 days. She is still alive. She lives less than 5 miles from me. I have seen her many times in since March.
But I have not hugged her.
We have seen many friends and family during this time. In our yard. From 20 feet away. You see, we take this seriously. We don’t think that the tiny little exceptions we want to make ourselves (or someone else) happy are exceptions to the fundamental principles of infectious disease. So we have been home since March 12, 2019. And when I say home, I mean home. We go out for doctor’s visits (my immunosuppressed wife still needs those even while America parties). That’s it.
But anyway, back to March 12th.
That’s my youngest son’s birthday. And we celebrated it by eating icecream for dinner at Top It Off (a local icecream place). We lived it up. All 6 of us got all the fixins – sprinkles, gummy bears, heath bits, oreos, almonds. Whatever nasty combination each of us wanted, because I knew we would not be coming out again anytime soon.
And just when we had been getting into a good rhythm as a family going to eat Italian every Tuesday at Vecchias. Or the library twice a week. Or church. Or thrift stores.
I keep two lists (mentally) along these lines.
There are the lists of things I am heartbroken for my children about that COVID (and her helpers, Deniers and Downplayers) has taken away. Things like chess tournaments for Nora. Or any of them playing with their little friends. Or trips to visit Grandpa in his new house in Florida. Or the cross-country road trip we had planned for last April. (I was going to chair a dental conference in Arizona, of all things).
Then there is the list for my wife and I. When (or will?) my wife be able to go wander aimlessly through a thrift store for hours to veg out after a crazy week of homeschooling four kids? When will she be able to see her daddy again and hug him?
You keep different lists once you have kids and get married. The real lists are not for yourself.
I do have a list for me- full of stupid crap- similar to most of selfish America, I guess:
Will I see an opera again? (funny that’s something I COVID-pine for, even though I haven’t been to the opera in 20 years)
Or go out to eat at a restaurant and sit for hours?
Or go to another conference?
Or see another Auburn football game?
Or play an open mic night with my new guitar?
For me, there is only 1 thing on my list
When will I hug my momma again?
Lists. Lists.
So many lists
If I could boil down my biggest problem in life, and if I am honest (that’s always the hard part, right?) its that I compulsively write down lists all the time. Lists of ideas. Lists of tasks. Lists of things I want to do, lists of places I want to go. Lists of books I want to write. Lists of regrets. Lists of songs I want played at my funeral. Lists of lists.
Lists can be good. They can help you organize. They can pull things out of your head.
But for me they are shackles.
If it goes on a list, I feel it must be done. Someday. No matter how long it takes. It must be completed, or purchased, or replaced with something even better. I have lists I have kept for more than 10 years, and I still am compelled to try and complete them.
I use any productivity tool I can find. Evernote, OneNote. David Allen’s Getting Things Done.
I have a Kanban view on my entire life. I literally organize my life into numbered areas that are each statements meant to help me get un-lost while on my lists:
1-Clay Loves God
2-Clay Loves Stacy
3-Clay Loves the Kids
4- Clay Loves Friends and Family
5- Clay is Blessed With Work
6- Clay is Blessed With Resources
7- Clay is Blessed With Pursuits
And all the items on all the Lists go into one of those buckets.
Sometimes this is a good system.
When you need to get back on the wagon and get things done, it is very helpful to have a wholistic structure. You find your place and fall into line. Its easier to put one foot in front of the other when you at least have a general belief that where you put that next footstep is meaningful in some way.
And if you are a voracious reader/doer/maker, this is a very good system for organizing your thoughts and information needed to Complete Your Lists.
But sometimes even the best systems cannot keep it all on track. Sometimes you have to just make things with your hands and set the list down for a while.
It was helpful that I had a List of Unfinished Outdoor Projects once COVID hit.
Finishing up projects
another list
Remember in government school when we would come back from summer vacation and have to do a report of what we did over the break?
Here is the List of Things I Built This Summer:
Approximately 1,500 feet of wooden fence
A 200ftx200ft pen for the goats and ducks
Four 80-foot long irrigated beds in the garden
A completely organized workshop
A greenhouse
A new bedroom for my 12-year-old daughter for her birthday (needed to be a big birthday to try and distract from COVID)
A deck addition to the treehouse I built years ago
A chicken run and nesting box under the new treehouse deck to house our 7 (now 6) new chickens
A barn to house our 2 new goats, 5 old ducks and 2 new ones
A new system for growing plants in my basement (right now I am growing lavender, lupine, hyssop, chamomile, and parsley under grow lights)
A goat playground
A smaller pen for the goats near the barn for rainy days
A pond for the ducks (they are most happy on water)
An herb garden near the above ground pool
Oh yeah, a 20×20 foot box to handshovel roughly 15,000 pounds of sand into to put our new above ground pool on. We live on a slope so I needed to create “level.”
A “children’s garden” of three 12-foot long raised beds near the treehouse
A covered “loading dock” – which is a platform for delivery drivers to use
Lots of other smaller projects, and I’m sure a few major ones that I just forgot
I’d like to say that these all were finished in an orderly fashion. Each one done before moving onto the next. But they were not.
For the longest time, our 2 little acres of heaven sat strewn with piles of building materials as I bounced unfocused-ly from one project to the next.
When times get tough, I build things.
And when I realized the benefit of Building Things As Therapy, I went all in. Or aller-in. I was already pretty crazy about it. And it of course got me in good shape. Digging hundreds of post holes and shoveling tons of material will do that.
You should see my National Naked Gardening Day photos (I put those on Facebook). I looked amazing. And happy.
What happens when you click this image? (2021’s NNGD will be May 2nd, by the way).
Time for a music break? Maybe listen to these 2 before Pushing Through. (Many people can’t read and listen to music at the same time). Or maybe later…
Grasping for a new motto
As you know (if you have been here before), I try to suss out some sort of congealed truth in these YERs. And then I fashion it into a motto for the next year.
I am struggling to find the motto for 2021. I just can’t get myself to believe the locusts have stopped eating. Underneath it all, I think I fear 2020 and 2021 will be sandwiched together, distinguishable only by their peaks and valleys.
Two people on a zoom Christmas party in 2021:
“Remember that month in 2020 where we only had a few hundred deaths a day and not 2,000?”
“Yeah, that was great. Had one of those in 2021, right? March, maybe?”
COVID infects both our brain and our bodies. All our souls are in a supernatural ICU right now, choking and sputtering. Staring at the hospital walls wondering when (or if) we will get better. It has robbed us of so much that its hard to see what remains. Or even remember what was there before.
I wanted so badly to make the 2021 motto be “Pushing Through.” Its something Daddy used to say. He’d say “son, when you’re in those dark clouds- just keeping pushing through. You’ll get through it eventually.”
But eventually has become a lost year. The clouds are more than 300,000 dead Americans. Or a nation of Deniers and Downplayers who dishonor those dead by continuing to go to gatherings.
These are some dark clouds, Daddy.
I miss you so much and I want your words to still work on this one. But I just don’t think they will.
Straining to see the light
New motto?
I finally got a telescope for the kids this year. Well for me, really. I think this is something middle-aged dads do. I can remember a dad of a friend of mine doing this 20 years ago. Jimmy bought an amazing telescope (he spent money on toys and man was it worth it to be around him. Guitars, a new jeep. Telescopes). And he also leased this 10×10 spot on top of a mountain in Alabama where a hundred or so other stargazers would go on winter nights to look at those burning lights so far away.
I am now the same age Jimmy was when I met him. This amazes me.
Jimmy, I know there is almost zero chance you are reading this. But if you are, I want you to know you were a good dad. And not just to your own kids. Thank you for doing cool things with us. You absolutely got that part 100% right.
But back to my telescope. I mean the kids’ telescope.
We all have this idea that we can work a telescope. Point it at the sky when there are tons of stars. Turn a few dials and voila, each of us is Galileo.
Seems easy, right?
Not so, friends. Not so.
Putting it together is easy enough. But then you get to the lenses and eyepieces. And you realize you have no idea what a Barlow lens is. Or whether the 10mm or 25mm one is better.
You just want to point that thing at stellar awesomeness and call the kids over and let the magic happen.
Turns out magic takes learning some new skills.
Lesson 1- find the darkest part of your yard. Standing next to your living room window with the lights on inside the house is not optimal.
Lesson 2- learn the difference between the lights atop a cell tower a mile away and Venus.
Lesson 3- Use the finder scope and point it at something big. Like the moon. Don’t go looking for Rigel your first time out.
Lesson 4- Realize that the kids are not interested in watching you learn how to do this in real time. They are waiting for you to say – “Hey, come look at this!”
One more pro-tip: Bring a bar stool out to the driveway so they can sit and NOT TOUCH anything on the telescope. As soon as they bump it you have to start all over. And they run back in to play Mario and you are left alone in the cold again. Straining to see the light.
Its amazing how visible light is if you are looking for it. Our universe is mostly darkness (much like our hearts). Rigel (Orion the Hunter’s right foot) is 860 light years away- but even I can find it if I look.
So maybe I have another 2021 candidate motto: Straining to See the Light.
Maybe what we are experiencing now is much like ancient Jews experienced during the Intertestamental period (the hundreds of years between the transmission of Malachi and when John the Baptist showed up telling people to make way for the LORD).
I imagine they had a similar question on their lips- God, where are you? Help us to strain to see the light, Lord. Help us to know the difference between light and dark.
Christmas Lights
So when you don’t go out at all, you look for things you can do in a car. We drive an hour one way to get our goats their shots. Or to deliver duck eggs to a high school friend because she is allergic to chicken eggs. {3}
And this time of year offers a unique opportunity to take a car ride with 4 children under 13 that doesn’t drive you nuts. Just make sure to follow this list:
Everyone goes potty before you head out.
Ensure that you know where the spare house key is, since you don’t really need keys when you don’t go out for 9 months. Getting locked out would probably put a damper on a fun night looking at the lights.
Take your new small dog with you for the ride.
I forgot to mention all the new animals we have gotten. We now have 17 animals:
7 ducks
2 goats (Vincent Van Goat and Mr. Tumnus)
6 chickens (they had names until the kids realized I am serious about eating them once they stop laying eggs)
Dixie, our perfect cat
Doc our new dachshund (sort of)
We got Doc as a birthday present for our youngest. She turned 6, which is of course a big birthday for any kid. But any kid who has a COVID birthday needs something special. Thus, Doc.
I realized in September, with Stacy’s birthday that all my little family- my entire society right now, which honestly is a huge blessing to have this amazing crew as my society- will have at least 1 birthday during this pandemic. With no friends. No eating out. No trips.
Mark was the last one to have a birthday not in quarantine. Mine was first (in April), but I honestly never care about my birthdays. Then Nora’s (when I built the new bedroom). Then Stacy’s (when I built the barn). Then Glory’s – when we got the dog.
Of all things that really rip me up (tore up from the floor up- love that phrase), it’s the impact this has on my kids. And we will turn around soon, and Mark will have his first quarantine birthday.
But anyway. The dog.
Doc is a dachshund-terrier mix. That makes him a derriere.
Thank you for laughing at my joke.
Back to Christmas lights.
We have a gigantic neighborhood less than a mile from us. I mean huge. At least 500 houses are in this thing. And we get lost every single time we go into that beast. Its sort of like a medieval forest upon approach. You enter it with some trepidation, knowing you may not make it back out. But somewhere deep in there is a magical item. Maybe a house made out of candy. Or a lost falcon you need to retrieve. Or a friend you only see once a year. Something that pulls you into the forest.
In this case it was Christmas lights and the attendant accoutrements.
We saw lots of lights. And mostly colored lights. Which is awesome because I love colored lights because they are more real. More of-the-people. The vox populi of lights, if you will (and even if you won’t). Stacy does not like colored lights. But she is starting to see their value. Funny how things you thought you had the luxury of not liking pre-global-pandemic, you start to find a place for them on one of the shelves in your heart.
We saw giant Santas. Some riding elephants (we live in Alabama. But War Eagle!). We saw Snoopy flying his plane. Minions. An entire sidewalk lined with Snowmen lights. Gorgeous green wreaths made of lights. Nativities.
Some yards were meticulous displays of ordered, thoughtful beauty. Some were slapdash menageries of 5 years’ worth of buying whatever Lowe’s or Home Depot had on clearance each year after Christmas was over. It was all magnificent and just what we needed to see that night.
We saw beauty. All made of lights.
But we also got lost.
At one point I heard Nora call out from the back – “hey, you know we have passed this house 3 times now.”
Yes, Nora. I know.
I had thought that if I could get back to the one house I knew (one of Stacy’s dear, dear friends who is fighting cancer during this madness), then from there I could get back out of the forest (this huge neighborhood). Somehow if I could make it back to a place I knew, I could then make it back home.
I was proud that I had navigated back to the friend’s house. But from there I kept getting lost. Going in circles. Hitting lots of dead ends. So many cul-de-sacs. At one point I even recognized the same pile of sticks and leaves I had seen twenty minutes before.
My strategy was not working.
And I did not want to use the normal way of getting back home. The GPS.
But in the end, I had to. And of course, it got us back home (just 1.5 miles away).
I guess all that hit me pretty hard. We were straining for the light. But we were hitting dead ends. We were looking for the beauty. Trying to get back home. But it wasn’t working.
We had to pull out the GPS. I guess when you are lost in the forest, following the breadcrumbs back out may be your very best strategy.
What are our breadcrumbs during this insanity? Have they been stolen by a fairy-tale villain, intent on keeping us lost in the forrest so that the calamity continues and the hopelessness grows?
Coffee cups, widows, fireplaces, and hatred
I am sitting by my fireplace once again this year to write this thing out over the course of probably ten hours and three weeks. Laptop in hand (lap) and coffee cup within reach.
I have a funny thing about coffee cups. I think coffee tastes very different depending on the cup (something about differential heat conduction of materials, or maybe the shape of the rim focuses the heated air rising into my nose a little differently, like different wine glasses or the ones you drink a Stella in). So I end up using 4 or more cups throughout a morning. This drives my wife insane.
In the summertime I will leave them all over the yard as I garden. This also drives my wife insane.
Let’s do one more list for old times sake
First and second cups of coffee (between 4 and 5am)- There is what I call The Porcelain Cup. It’s a thin-walled cup that usually delivers a strong but clear flavor. I usually have my first cup of coffee in this one.
Third cup of coffee- Then there is The Batman Cup. Gifted to me by my youngest son, it is special – but it also carries the boldness of coffee in a more compact taste profile than The Porcelain Cup. I usually have my third cup of coffee in this one.
4th cup of coffee- The Callaway Cup. It is special for 2 reasons: 1 it is shaped like a small terra cotta pot that any gardener instantly recognizes; and 2- we got it on a trip to see Christmas lights with my momma last year, right before The World Changed.
Cups 1 and 2
Cup 3
Cups 4+
Then there is The Daddy Cup.
Its this one. The one I have been showing you different sides of this whole time.
It has 4 Bible verses on the sides of it, each in a different colored rectangle. Each verse explains a key part of the Gospel.
In this sense, this cup really is The Gospel Cup.
It is the one thing of my father’s I have.
And I stole it from Momma. Really just borrowed and never brought it back. But I knew I would never bring it back, so really I stole it.
It has a taste profile similar to The Batman Cup. Strong, bold and compact, and a little off. Like Daddy was.
But lately I have found I avoid drinking from this cup.
I don’t drink coffee in this cup very often anymore. Maybe once every 3 weeks. Maybe.
I think that is for two reasons mostly. The main reason is that it just reminds me so damn much of my father. And when you got to have such an amazing father like I did, and you miss him more with each birthday of your children that passes, or each gray hair you find in your own beard- you just need a break from the aching sometimes.
And he loved coffee. Crappy coffee in my opinion.
He drank it all day long. I think more as a communion with others more than anything else. Some people bond over beers. Or cigarettes. Daddy got into your heart over the course of a cup (or pot) of coffee.
And when I drink from The Daddy Cup, I see him. Very vividly. All his weird facial expressions. All those moments of him lost in thought. And now I see myself with those same expressions. Those same moments of undisclosed thoughts. And in these visions- these memories- I commune with him across the divide of death. In memory I ache.
And during this terrible Dark Night of America’s Soul, I just don’t need another cause of heartache right now. We are all just one more straw away from breaking, and I am no different.
Momma still drives down to the National Cemetery to visit Daddy pretty often.
Nothing will stop that woman from loving that man. Not death. Not COVID. Not bitter cold temperatures. Nor near-breaking-down old cars driven by a 72 year old lady all alone on a country road heading south to see him. Or at least the patch of earth where half of him (his body) lies under a cold stone.
Momma knows the other half (his soul) sits near the Father somewhere.
And that she will sit next to him and laugh again one day. That laugh that you can only have with your partner. Your other half of your One Flesh. The one I still get to have with Stacy each day.
But there is another reason I don’t like to drink out of The Gospel Cup lately.
My heart is so blackened by this past year. By what I have seen from my fellow humans. By what I have seen in myself. Our Total Depravity.
Their ability to convince themselves that the deaths of hundreds of thousands of people are not real. (Or are less important than keeping up their normal lives). {4}
My ability to hate them for it.
I have been changed by this. And not in a good way.
A seething hatred has flooded my heart. And I fear even The Gospel Cup may not break this heart of stone one more time.
I know I should not hate. But I simply cannot see these people the same after seeing their response to all this. I look at them the same way I do people who support abortion. Both groups have convinced themselves the horror is not real. That The Life is not human. Or does not rise to the level of Human needed for change in behavior or policy or law.
But somehow I made my peace with abortionists long ago. Somehow I was able to compartmentalize my disgust at their depraved, evil, acceptance (promotion) of the slaughter of innocents.
I guess I need to figure out a way to put COVID Downplayers and Deniers in that same box. To find a fake, but practical peace. To quarantine their vileness from my eyes so I can pretend to love them again.
I want The Gospel Cup to tear my heart up. To make it beat again. To make it love all my brothers and sisters again.
If anything can do that, The Gospel Cup can. A good cup of coffee in that cup- a communion with my father and my Father- can work wonders. A wonder working power.
Wrapping Up
I just hope we can all listen to this song on New Year’s Eve 2021 and feel its relatable.
I can’t not at least attempt to point you towards some options for hope in all this.
Maybe you need a list.
Maybe you need to burn your fucking lists.
Maybe you need to build something.
Or call an old friend.
Or make a new one over Zoom (it can be done).
Maybe you need some inspiring questions. Here’s 2:
What will you do with the time between now and when this is over?
What will be the first thing you do when this war is over?
Maybe our lives become hybrid mottos of what our fathers passed onto us and what we are now trying to pass on to our children.
If this is the case I guess I am somewhere in between Push on Through and Strain to See the Light. Just maybe I am flying desperately in a rickety early 1900s wooden bi-plane, lost in a dark expanse of clouds, peering frantically with my telescope hanging out of the cockpit- straining to see the light.
Just maybe.
I don’t think I will really know until I can hug my momma again.
Momma holding me, with Aunt Linda staring into my baby face.
And Finally Here is That Blue Butterfly I Promised at The Beginning
If I survived 2020, I can survive anything.
You can too.
Fight against the darkness.
Strain to see the light.
Push through those dark clouds.
FIN
This concludes Clay’s 2020 Year In Review.
Thank you for reading. I love you all.
Love- Clay F.
P.S. There’s more goodies below if you want to check them out.
The Cat Shirt.
A few small Christmas gifts from me to you
And if you made it this far, it means I can trust you with a small box of more goodies.
A pushing thru / straining to see the light playlist
I tried to pull only energetic or encouraging songs (a few darker ones made it through like “Wrecking Ball”, but I wanted even those to have dramatic, cathartic hooks). I spread so much gloom I figured I need to do some penance by giving you something to dance in your underwear to on New Year’s Eve. Its not like anyone is looking this year – so live it up. But if you put this on sometime, do send me a note or text to let me know someone checked this out. It might be a small, small connection that makes us both feel human again.
More Music
He Stopped Loving Her Today
Willie Tribute
7 Bridges Road
The Dance
A prayer for America
Struggling to know how to pray during this time? Try this one-
Dear Heavenly Father,
Whatever is next, prepare us for it.
Give us your strength to survive it and in the surviving not further debase ourselves.
Give us a vision of an America focused on you that does not involve human kings. Release us from the slavery of selfishness. Help us to make truly hard sacrifices.
Hear our prayer!
Dear Jesus,
Please forgive us for what we have done to each other. For our dismissal of all these dead humans you love so much. For evangelism opportunities we squandered.
Please cleanse our blackened hearts. Please forgive us our many sins. Help us to love the Active Shooters.
Dear Holy Spirit,
Please guide our thoughts and our words. Teach us more about The Son. Carry us through whatever is next. Be our Helper. Please!
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LDH plans to release a Request for Proposals (RFP) in Spring 2021 to solicit proposals to provide Medicaid managed care services to its more than 1.6 million beneficiaries. To offer your input, visit ldh.la.gov/MCORFP21 and complete the online form, or email your feedback to healthy@la.gov and include “MCO RFP 21” in the subject line. The deadline for all feedback is Tuesday, December 29, 2020.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
Curator summary
Expansion advocates in NE are angry that the Medicaid agency did not participate in a hearing; the Governor’s office send information on the level of activity agency staffers have related to the pandemic right now.
The Nebraska Department of Health and Human Services declined to participate in a virtual legislative hearing Tuesday that was held to review the state’s Medicaid expansion program, triggering expressions of disappointment and some outrage from state senators.
Sen. Sara Howard of Omaha, chair of the Legislature’s Health and Human Services Committee, said the refusal to participate was unprecedented and disrespectful to all Nebraskans.
“It’s extremely disappointing and unprecedented that the governor’s office could not take 30 minutes to jump on a Zoom call to update the legislative branch on health care for low-income Nebraskans during a pandemic,” Sen. Adam Morfeld of Lincoln said.
HHS is an executive branch department that operates under the governor’s authority.
The department sent an information sheet to the committee along with a letter from CEO Dannette Smith that pointed to a number of federal, state and local meetings that department leadership is required to participate in at this time as part of the state’s response to COVID-19.
Smith said the department is working to finalize its portion of the state budget recommendations that are due early next year while disbursing CARES Act funding and responding to COVID-19 emergency needs.
Expansion of Medicaid services to an estimated 90,000 low-income Nebraskans was delayed almost two years after Nebraska voters approved an initiative that Morfeld helped lead.
Washington, D.C. – In recent years, physicians and researchers have been focusing intensely on preventable pregnancy-related deaths, finding that the leading causes are cardiovascular/coronary conditions, infections, excessive bleeding, pre-eclampsia/eclampsia, and cardiomyopathy. Medicaid financed nearly half of all U.S. births in 2018, and in some states covers over 60% of births.
Records have also shown that pregnant patients on Medicaid have a higher rate of severe maternal morbidity and mortality than those with private health insurance. The statistic is unsurprising; Medicaid beneficiaries are primarily low-income individuals, who experience high rates of chronic illnesses and adverse health challenges. Black women have also been found to experience a disproportionate number of pregnancy-related deaths.
Given Medicaid’s ties to both a large number of births in the U.S. and to populations with a greater likelihood of chronic conditions, Senators Pat Toomey (R-Pa.) and Sherrod Brown (D-Ohio) have teamed up to propose new prenatal care initiatives for Medicaid enrollees.
“Nearly 700 women died last year in the United States as a result of complications from pregnancy and childbirth, but we know that as many as two-thirds of these deaths may be preventable,” said Senator Toomey. “This legislation will help improve health outcomes for pregnant women and mothers enrolled in Medicaid by increasing information and resources to better monitor and treat at-risk pregnancies, as well as inform Congress on policies that may assist states in reducing maternal deaths.”
“A mother’s chance of surviving pregnancy shouldn’t depend on her zip code or the type of insurance she has,” said Brown. “Too many mothers are dying. As the death rate continues to skyrocket, the disparities in maternal mortality have increased along with it, further contributing to the Black maternal health crisis – and that has to change. By meeting moms where they are, listening to health experts, and establishing best practices, we can improve health outcomes and keep more of our mothers and children healthy and safe.”
The proposed legislation, called The Supporting Best Practices for Healthy Moms Act, would:
Create a national advisory committee on reducing maternal deaths to:
Establish best practices for Medicaid-covered care providers to screen, monitor, and treat at-risk pregnancies
Generate culturally competent materials to inform pregnant patients about potential risks during pregnancy, birth, and postpartum
Identify best practices for tracking maternal mortality trends
Report to Congress on payment disincentives or regulatory barriers to the transfer of pregnant patients between facilities before, during, or after birth
A short summary of the bill can be found here. The full version of the bill is available here.
As states struggle to control the cost of prescription medicines, a new report found pharmacy benefit managers pocketed more than $89 million collected on behalf of the Florida Medicaid program — and the consultants who ran the analysis recommended state officials rework the arrangements.
The report found that PBMs appear to have profited from what is known as spread pricing, which refers to the dispensing fees that these companies pay pharmacies but then bill at a different rate to state Medicaid programs. In this instance, the PBMs working with managed care plans made $8.64 for each Medicaid prescription, which accounted for 9.5% of total plan spending.
The Payment Integrity Information Act of 2019 requires CMS to periodically review programs it administers, identify programs that may be susceptible to significant improper payments, estimate the amount of improper payments, and report on the improper payment estimates and the Agency’s actions to reduce improper payments in the Department of Health & Human Services (HHS) annual Agency Financial Report (AFR).
The Office of Management and Budget (OMB) has identified Medicare Fee-For-Service (FFS), Medicare Part C, Medicare Part D, Medicaid, and the Children’s Health Insurance Program (CHIP) as at-risk for significant improper payments. CMS utilizes improper payment measurement programs for these programs and continues to address the drivers of improper payment rates through aggressive corrective action plans.
In response to the COVID-19 Public Health Emergency (PHE), CMS exercised its enforcement discretion to adopt a temporary policy to suspend all improper payment-related engagement/communication or data requests to providers and state agencies between March and August. To minimize burden on providers and states, CMS modified some of the improper payment statistical methodologies to be able to timely report rates in the 2020 AFR based on data already collected at the time of the PHE or that providers or states voluntarily submitted. CMS will still meet the statutory national-level precision requirements that the rates are +/- 3 percentage points at a 95% confidence interval.
It is important to note that improper payment rates are not necessarily indicative of, or measures of, fraud. Instead, improper payments are payments that did not meet statutory, regulatory, administrative, or other legally applicable requirements and may be overpayments or underpayments. Additionally, improper payments do not necessarily represent expenses that should not have occurred. For example, current OMB guidance states that when an agency’s review is unable to discern whether a payment was proper as a result of insufficient or missing documentation, this payment should be considered an improper payment. A significant amount of improper payments is due to instances where a lack of documentation or errors in the documentation limits CMS’s ability to verify the payment was paid correctly. However, had the documentation been submitted or properly maintained, then the payments might have been determined to be proper. A smaller proportion of improper payments are payments that should not have been made or should have been made in different amounts and are considered a monetary loss to the government (e.g., medical necessity, incorrect coding, beneficiary ineligible for program or service, and other errors).
FY 2020 Estimated Improper Payment Rates and Improper Payments (Billions)[1]
Program
2019 Improper Payment Rate
2019 Improper Payments
2020 Improper Payment Rate
2020 Improper Payments
Medicare FFS
7.25%
$28.91
6.27%
$25.74
Medicare Part
C
7.87%
$16.73
6.78%
$16.27
Medicare Part
D
0.75%
$0.61
1.15%
$0.93
Medicaid
14.90%*
$57.36*
21.36%*
$86.49*
CHIP
15.83%*
$2.74*
27.00%*
$4.78*
*Medicaid and CHIP 2020 estimated improper payments are not comparable to years prior to 2019, due to the reintegration of the PERM eligibility component.
Medicare FFS (Part A and Part B)
CMS estimates the Medicare FFS improper payment rate through the Comprehensive Error Rate Testing (CERT) program. Each year, the CERT program reviews a statistically valid stratified random sample of Medicare FFS claims to determine if they were paid properly under Medicare coverage, coding, and payment rules. The reporting period for the Fiscal Year (FY) 2020 Medicare FFS improper payment rate included claims submitted during the 12-month period from July 1, 2018 through June 30, 2019.
The FY 2020 Medicare FFS estimated improper payment rate is 6.27 percent, representing $25.74 billion in improper payments. This compares to the FY 2019 estimated improper payment rate of 7.25 percent, representing $28.91 billion in improper payments. The decrease was driven by reductions in the improper payment rates for home health and skilled nursing facility claims.
Home Health – $5.90 billion decrease in estimated improper payments (2016 to 2020) due to corrective actions such as policy clarification and Targeted Probe and Educate (TPE) for home health agencies.
Skilled Nursing Facility – $1.00 billion decrease in estimated improper payments (2019 to 2020) due to a policy change related to the supporting information for physician certification and recertification for skilled nursing facility services and TPE for skilled nursing facility services.
Medicare Part C (Medicare Advantage)
The Part C improper payment estimate measures improper payments resulting from errors in beneficiary risk scores. The primary component of most beneficiary risk scores is based on clinical diagnoses submitted by plans for risk-adjusted payment. If medical records do not support the diagnoses submitted to CMS, the risk scores may be inaccurate and result in payment errors. The Part C estimate is based on medical record reviews conducted annually, where CMS identifies unsupported diagnoses and calculates corrected risk scores. The FY 2020 Part C improper payment data is representative of enrollee data generated from the Calendar Year 2018 payment year.
For FY 2020, the Part C improper payment estimate is 6.78 percent, representing $16.27 billion in improper payments. This represents a decrease from the FY 2019 rate of 7.87 percent, representing $16.73 billion in improper payments, and was driven primarily by Medicare Advantage organizations submitting a greater number of medical records that validated the diagnoses for which they were paid.
Medicare Part D (Prescription Drug Benefit)
The Medicare Part D improper payment estimate measures the payment error related to inaccurately submitted prescription drug event (PDE) data, where the majority of errors for the program exists. CMS measures the inconsistencies between the information reported on PDEs and the supporting documentation submitted by Part D sponsors including prescription record hardcopies (or medication orders, as appropriate), and detailed claims information. The FY 20202020 Part D improper payment data is representative of PDE data generated from the Calendar Year 2018 payment year.
For FY 2020, the Part D improper payment estimate is 1.15 percent, or $0.93 billion in improper payments. This represents an increase from the FY 2019 estimate of 0.75 percent, or $0.61 billion in improper payments.
Medicaid and CHIP
CMS estimates Medicaid and CHIP improper payments through the Payment Error Rate Measurement (PERM) program. The improper payment rates are based on reviews of the FFS, managed care, and eligibility components of Medicaid and CHIP in the year under review. The PERM program uses a 17-state rotational approach to measure the 50 states and the District of Columbia over a three-year period. By this approach, CMS measures each state once every three years and national improper payment rates include findings from the most recent three-year cycle measurements. Each time a cycle of states is measured, CMS utilizes the new findings and removes the respective cycle’s previous findings. The review period for the FY 2020 Medicaid and CHIP improper payment rate included claims submitted from July 1, 2018 through June 30, 2019.
The FY 2020 national Medicaid improper payment rate estimate is 21.36 percent, representing $86.49 billion in improper payments. The FY 2020 national CHIP improper payment rate estimate is 27.00 percent, representing $4.78 billion in improper payments. Factors that led to these improper payment rates include:
One area driving the FY 2020 Medicaid and CHIP improper payment estimate is the continued reintegration of the PERM eligibility component, which was revamped to incorporate the Affordable Care Act requirements in the PERM eligibility reviews.CMS will complete the review of the remaining 17 states and the District of Columbia under the new eligibility requirements over the next year and establish a baseline in FY 2021 once all states are measured under the new requirements.
Based on the measurement of the first two cycles of states, the major drivers of the increased Medicaid and CHIP eligibility improper payments are a result of the following:
Eligibility errors are mostly due to insufficient documentation to affirmatively verify eligibility determinations or non-compliance with eligibility redetermination requirements. The majority of the insufficient documentation errors represent both situations where:
The required verification of eligibility data, such as income, was not done at all and
There is indication the eligibility verification was initiated but there was no documentation to validate the verification process was completed, and non- compliance with eligibility redetermination requirements.
The CHIP improper payment rate was also driven by claims where the beneficiary was incorrectly determined to be eligible for CHIP, but upon review was determined eligible for Medicaid, mostly related to beneficiary income calculations, household composition, and third party liability coverage.
Non-compliance with requirements for provider revalidation of enrollment and rescreening.
Continued non-compliance with provider enrollment, screening, and National Provider Identifier requirements.
Supplemental information related to the FY 2020 Medicaid and CHIP improper payment results will be published on CMS’s website – www.cms.gov/PERM – in early 2021.
Exchange Improper Payment Measurement
While a FY 2016 risk assessment concluded that the Advance Payments of the Premium Tax Credit (APTC) program is susceptible to significant improper payments, the program is not yet reporting improper payment estimates for FY 2020. CMS is committed to implementing an improper payment measurement program as required by PIIA. As with similar CMS programs, developing an effective and efficient improper payment measurement program requires multiple, time-intensive steps including contractor procurement; developing measurement policies, procedures, and tools; and extensive pilot testing to ensure an accurate improper payment estimate. CMS will continue to monitor and assess the program for changes and adapt accordingly. In FYs 2017 through 2020, CMS conducted development and piloting activities for the APTC improper payment measurement program and will continue these activities in FY 2021. HHS will continue to update its annual AFRs with the measurement program development status until the reporting of the improper payment estimate.
CMS Actions
CMS is committed to reducing improper payments in the Medicare FFS, Medicare Part C, Medicare Part D, Medicaid, and CHIP programs. While we have made some progress on reducing the improper payment rates in Medicare, we are not satisfied and more work needs to be done to achieve increased and consistent reductions in the future by expanding existing initiatives as well as innovative new processes. CMS’s program integrity strategy relies on a multifaceted approach that includes provider enrollment and screening standards, enforcement authorities, and advanced data analytics, such as predictive modeling. This strikes an important balance by preventing improper payments while reducing the administrative burden on legitimate providers and suppliers. For additional information on the improper payment rate estimates and/or the Agency’s actions to mitigate improper payments, please visit https://www.hhs.gov/about/agencies/asfr/finance/financial-policy-library/agency-financial- reports/index.html
###
[1] CMS FY 2020 AFR improper payment data reported does not represent payments that occurred during the COVID-19 PHE period but represent claims submitted July 1, 2018 –June 30, 2019 for the Medicare FFS and Medicaid/CHIP improper payment measurement programs and data generated from Calendar Year 2018 for Medicare Parts C and D improper payment programs.
BOSTON — The state Attorney General’s Medicaid Fraud Division recently announced that it had recovered more than $45 million for MassHealth during federal fiscal year 2020, which ended Sept. 30.
The division secured 27 civil settlements with various entities, including home health agencies, mental health centers, ambulance providers, and individual doctors and practices. An additional 11 providers and individuals were charged criminally with defrauding MassHealth, and three individuals were charged criminally with abuse, neglect, or financial misappropriation in long-term care facilities.
For whatever weird reason, I have almost no distinction between my work and my life. Clients seem to like it because it makes healthcare consulting human. And genuine human-ness is loved by anyone remotely human. So clients become friends.
