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Jonathan Kaye is founder and president of Health Data Innovations;

Better decisions await the organizations who have complete and accurate claims data. It’s difficult to close a care gap when you don’t know the gap exists in the first place. 

Why ingesting claims data is harder, and more important, than you think | Viewpoint

By 2050, it's estimated that 139 million people worldwide will have dementia, but by today's standards, 60% will be undiagnosed. It's clear that there's a significant gap in dementia detection and care, but what can your organization do about it?

Get perspectives from clinical leaders and neuroscience experts about the underlying causes and consequences of these gaps, practical opportunities to address them, and a proven roadmap that shows how leading health systems have successfully transformed their dementia screening and care processes.

Closing the Dementia Care Gap: Expert Insights and Proven Strategies for Health Systems

The maternal mortality rate in the U.S. has increased by 

, often due to factors like lack of access to care and inadequate screening for risk factors.

While it may not be the first solution to this crisis that comes to mind, birth doulas can be key to turning these numbers around and beginning to make a meaningful difference in each of the above areas.

Focused on offering comfort, advocacy, and guidance, doulas are trained to provide physical, emotional, and informational support to individuals throughout every stage of the process—before, during, and after birth. Doulas are an extension of support that improves the birthing experience for all, with their presence linked to positive outcomes, including reduced cesarean section rates and fewer preterm births.

Recognizing the benefits of doula support, Washington state’s Apple Health (Medicaid) launched a 

 in January 2025 for the first time, a milestone in addressing birth inequities.

Aiming to enhance maternal and infant health outcomes by making doula support more accessible to Medicaid recipients, the birth doula benefit will support increased access, improved maternal health, and support for doulas across the state. This innovative approach is a powerful model for other states, demonstrating how policy can create more equitable and healthier birth experiences.

More individuals can access essential doula services by reducing financial barriers for patients and widening geographic reach. This personalized support improves maternal health through better birth experiences and outcomes, enhanced postpartum support and service coordination and reduced health disparities.

For example, Medicaid members who are American Indian and Alaska Native are less likely to receive a postpartum visit after delivery (48%), but initiatives such as 

’s proactive support and education around birth doulas have helped raise this rate to 61%. The new benefit also supports doulas through increased reimbursement, with birth doulas now eligible for a $3,500 payment per delivery—the highest Medicaid reimbursement for doulas in the nation.

While the new birth doula benefit is crucial to improving maternal and child health equity, there remain significant challenges in ensuring equitable implementation. Throughout the country, workforce capacity, regional disparities, cultural representation, and public awareness remain barriers to access.

With a limited number of doulas—approximately 

, there is a deep need for increased recruitment and retention. Although the recent changes to state programs have introduced new opportunities, they also include complex certification requirements and administrative challenges, which make it difficult for doulas to enroll. 

Efforts to ensure the program is truly equitable requires that healthcare leaders acknowledge existing geographic disparities, especially for those in rural areas who face gaps in availability due to limited resources and fewer trained doulas. Transportation barriers also make it challenging to access these essential services.

Additionally, many Medicaid recipients represent diverse cultural and linguistic communities and often face difficulties finding doulas who are culturally competent and understand their unique needs, which can hinder the effectiveness of doula care.

There are still too many lingering misconceptions regarding the role of doulas and how they can benefit from their support. With a lack of resources and education, underutilization of this valuable service could continue without intentional efforts to inform communities of the options available to them—at no cost.

Developing and expanding doula care is essential to improving maternal and infant health outcomes, particularly for underserved communities. To ensure the new doula benefit is successful, healthcare leaders must focus on increasing access to training, investing in outreach and education, and promoting cultural competency within the profession.

Healthcare providers, policymakers, and community organizations must work to advocate for the equitable reach of Apple Health’s birth doula benefit program, ensuring all birthing individuals receive safe, inclusive, and positive support.

Demetria Malloy, MD MSHS, is the chief medical officer and chief health officer of Community Health Plan of Washington.

Doulas can improve the birthing experience for all, with their presence linked to positive outcomes, including reduced cesarean section rates and fewer preterm births.


Topic

Why expanding doula care is vital for healthier communities | Viewpoint

Despite determined and even desperate efforts to save the Crozer-Chester Medical Center, the hospital is closing its doors.

Prospect Medical Holdings, the owner of Crozer Health, said 

it had no choice but to shut down the health system

 in the Philadelphia suburbs amid mounting costs and the inability to find another buyer. Crozer Health includes the Crozer-Chester Medical Center, and Taylor Hospital, which shut down last week.

Now, Crozer-Chester Medical Center is closing today. The emergency department has already been shut down, and the medical center is looking to transfer its few remaining patients. The medical center’s roots date back more than 160 years.

The hospital is based in Chester, a small city of about 33,000. Nearly one-third of the city’s residents are in poverty, and many don’t have reliable transportation.

Pennsylvania State Sen. Tim Kearney, a Democrat representing Delaware County, says he’s worried about those needing emergency care, and really any kind of medical attention. The community has very few healthcare providers.

With the medical center’s closure, “Chester is a healthcare desert,” Kearney tells Chief Healthcare Executive®.

Kearney is leading efforts to prevent similar hospital closures in Pennsylvania, as he and other lawmakers 

are pushing for changes in state law governing hospital sales

. Elected officials and lawmakers alike fault private equity owners for shuttering the system and the loss of thousands of jobs.

The closure of Crozer-Chester and Taylor Hospital follow the loss of two other hospitals in Delaware County in the past few years.

Prospect shut down Delaware County Memorial Hospital and Springfield Hospital in 2022. And Crozer Health has weathered fears of closure repeatedly.

“It’s been like a train wreck that's been happening really over the last two years,” Kearney says.

Delaware County had six hospitals a few years ago, and now only two are remaining to serve the county’s 584,000 residents: Mercy Fitzgerald Hospital, part of Trinity Health, and Riddle Memorial Hospital, part of Main Line Health.

The loss of Crozer-Chester and Taylor Hospital 

poses major problems for residents in Delaware County who need care

, but Kearney says the outlook for the small city of Chester is especially worrisome. Many in the small city don’t have reliable transportation. So even though Chester is part of the Philadelphia region, many will find it harder to get care or get to another hospital in an emergency.

“There's all these hospitals in Philadelphia, there's hospitals in Wilmington, but that's just time,” Kearney says. “It's extra time to get there.”

With Crozer Health closing, nearby hospitals prepare for more patients

A 283-bed teaching hospital, Crozer-Chester operated the only trauma center in Delaware County. Taylor Hospital had 107 beds.

Crozer-Chester also operated a highly regarded burn unit. “It had an incredible reputation as a great facility,” Kearney says.

Peggy Malone, a nurse at Crozer-Chester Medical Center, told Chief Healthcare Executive last week that 

she’s worried about lives being endangered

 due to longer trips to other hospitals for emergency care.

‘“Everybody wants to take our patients right now,” Malone says.

“But the reality is, what happens tomorrow? Next week? Next month? Which is what I have said all along. These patients can't get anywhere else. They don't have the transportation.”

Even those who own a car are facing much more time getting to one of the other hospitals, and many Delaware County roads are choked with traffic in the congested Philadelphia suburbs.

“It's not always the easiest county to maneuver around with, with traffic, and it's putting an incredible strain on people, but it's also a huge strain on the EMS system,” Kearney says.

Crozer Health’s closure also brings real pain to the Delaware County economy, with more than 3,000 people losing their jobs.

Some doctors and nurses have already applied to other hospitals and health systems in the Philadelphia region. Clinicians may be better positioned to find work sooner since many hospitals struggle with filling all of their vacancies, but some of them may not be assured of getting a new job.

‘Even the clinicians … there is a shortage, but there's not that big a shortage,” Kearney says. “There are more people who work at Crozer who are not gonna be able to find jobs.”

Dr. Monica Taylor, chairwoman of the Delaware County Council, praised the Crozer Health staff who remained on the job even amidst threats of closure.

“They stayed true to their work,” Taylor said in an interview last week. “They stayed to the very end, and they have been there for our community. They have served our residents. And, yeah, it's just really impressive that that's what that's where they want to be, that's who they want to serve.”

Some job fairs are being set up, including one in Subaru Park, home of the Philadelphia Union, the pro soccer team.

The loss of two hospitals also is a blow to the other businesses around those hospitals. Kearney says the fallout will be widespread.

“It’s such a kind of horror story that people have difficulty trying to focus on to figure out exactly what it's going to be,” Kearney says. “But we know it's going to be severe.”

Officials and residents alike are seething at Prospect Medical Holdings. Prospect 

, with the company listing debts of more than $400 million. 

State lawmakers and Delaware County put up millions

 to keep Crozer Health operating in hopes of finding another buyer, but Prospect said it had no alternative but to shut the system down.

Leonard Green & Partners, a private equity firm, held majority ownership in Prospect Medical Holdings from 2010 through 2021. Given the experience at Crozer, Kearney and other lawmakers say they are looking to establish safeguards to prevent private equity firms from buying hospitals, neglecting them and heading out of town.

Kearney and other lawmakers are looking to pass legislation giving Pennsylvania’s attorney general the power to review hospital sales and mergers to determine if they’re in the public interest. Pennsylvania Gov. Josh Shapiro has urged lawmakers to approve such a law.

Kearney is especially interested in provisions that would bar private equity firms that own hospitals and nursing homes from selling their land and renting it back. He said that arrangement devastated Crozer.

“They were being charged $36 million in rent for property that they used to own,” Kearney said.

Under private equity ownership, Prospect didn’t adequately invest in the facilities, Kearney said. When Delaware County Memorial Hospital closed in 2022, other health systems were interested in buying the facility, but changed their mind when they saw its condition, he said.

“Every single one of them came out saying, this is a tear down,” Kearney says.

Kearney and other lawmakers have asked Pennsylvania Attorney General Dave Sunday 

to pursue possible criminal charges against Prospect

. But he acknowledges that may be a difficult case to bring.

Still, Kearney and other local officials are determined to prevent other communities from losing their hospitals. And Kearney says there’s bipartisan support for such measures in the wake of Crozer’s closure.

“Crozer has been there since the Civil War in Chester,” Kearney says. “They managed to survive all sorts of things, but it really couldn't survive private equity.”

Hospitals and private equity: Scathing Senate report shows concerns cross party lines

Prospect Medical Holdings is shutting down Crozer Health, which includes the medical center and Taylor Hospital. Taylor shut down last week, and Crozer-Chester closed Friday.

Crozer-Chester Medical Center is closing, and a city becomes a ‘healthcare desert’

Healthcare stakeholders are increasingly committed to value-based care (VBC), but many providers are still waiting to reap the financial benefits of these contracts.

Given that we are now 15 years after the passage of the Affordable Care Act—and given how many innovative value-based payment models have sprung up in its wake—hospitals and health systems are looking for the root causes of sluggish returns on VBC. 

While there are many components to successful VBC contracts, claims data may actually be one of the most underappreciated keys for health systems looking to unlock faster success.

The industry is catching on: Data integration is getting more time in the limelight as healthcare leaders reflect on VBC. After the National Association of Accountable Care Organizations (NAACOS) fall conference, 

 that data integration was top of mind: “Building a seamless data infrastructure that links claims and clinical data across payers and providers takes time and effort, but it is essential to managing patient risk effectively.”

To say that linking claims and clinical data across payers and providers requires “time and effort” is likely understating the issue: Ingesting claims data on the provider side is incredibly difficult, yet also foundational to nearly every work stream in value-based care.

First of all, ingesting claims data is new for providers. They are used to sending 

claims data in the context of documenting services and sending bills to health plans for payment. That puts health plans in the more privileged position of being experts at ingesting claims data and analyzing it for business purposes.

Meanwhile, providers—who are just now starting to ingest aggregate claims feeds to gain a more holistic view of the patient and move the needle on quality metrics—are playing catch-up. This asymmetry of experience means that health plans have more information at their disposal when it comes to VBC contracts. Understandably, it’s an imbalance that provider organizations are eager to correct.

Second, data layouts from payers are not at all standardized.

There is little consistency in the way payers deal with simple issues including basic variable definitions. But more importantly, there is even less consistency in significant areas that impact downstream analysis, including the way payers reflect: adjustment, reversal, and denied claims; multiple claims for a single event; definitions of financial fields; eligibility spans; initial and final claims; masked diagnoses; and whether the data is a full refresh or an incremental update. 

No two payers are the same, and small misunderstandings in how different payers present their claims and eligibility information can have big impacts on the accuracy of downstream analytic output.

Additionally, these layouts change frequently. Some of these layout changes are small, but when a hospital is managing contracts across multiple payers and each data set includes anywhere from three to 15 files, a series of small changes can throw a meaningful wrench in operations.

Managing these data sets requires a combination of technical expertise and industry knowledge, and these staff are difficult to recruit and retain. Providers may staff these functions with existing IT or analytic resources, and often find out that the specific skill sets, knowledge and experience to integrate the claims data do not exist in these internal resources.

Third, the logistics and operations required to manage all these incoming datasets is a complex task, even before anyone actually works with the data they contain. Providers with one or two VBC contracts may be able to cope, but those who have multiple contracts will soon find managing the incoming files onerous.

Managing the flow of incoming data files requires a system to identify received files, late files, missing files, duplicate files and a way to track operational activities around this function. Managing the content of the incoming data requires a system to dissect and analyze the incoming files to validate the content of the files, specifically related to the population included in the data, the dates of services provided and the consistency of the content of the data files.

Any change in content requires attention and validation before the data can be passed through the ingest process. Small changes that may be difficult to detect may end up significantly impacting downstream analysis, so the ingest process has to be thorough and complete to ensure confidence in the data being passed through for analysis. 

Working with data across multiple payers requires a combination of technical expertise and industry knowledge; finding staff with these skills is no small feat.

So, given these challenges, what is the upside of overcoming these barriers? In almost all cases, hospitals and health systems can expect higher confidence in their VBC operations—and here’s why.

Better decisions await the organizations who have complete and accurate claims data. It’s difficult to close a care gap when you don’t know the gap exists in the first place. It’s nearly impossible to understand how providers are performing against population health contracts if the aggregate data for that patient population is incomplete.

Many hospitals and health systems have invested, rightfully so, in analytics teams that are capable of running sophisticated analyses across multiple key VBC areas: HEDIS reporting, care gap closure, network analysis, cost and utilization tracking, population health management, and managing downside risk, among others.

But these reporting areas are only as useful as the underlying claims data—if there are holes, or if a new layout renders it unloadable, then the analysis that departments and C-suites rely on can be misleading. Provider organizations risk making business or care delivery decisions based on faulty data, which undermines the goals of value-based care in the first place.

Claims data is hardly new and shiny in the healthcare industry. But the way claims data are used, and by whom, has shifted significantly with the rise of value-based care. Providers are realizing the difficulty of maintaining in-house expertise given the constantly changing data streams.

Before spending significant time and effort refining their programs and contracts, health systems should make sure that the underlying data is sound. The wrong decisions can be costly, not only for data teams, but for all VBC priorities.

The hospitals and health systems that figure out the data piece of the puzzle will stay ahead of the pack in a competitive environment.

Jonathan Kaye is founder and president of Health Data Innovations.

Attention across the nation is rightly focused on potential massive and drastic Medicaid cuts under consideration by Congress that would imperil health care for nearly 80 million of our most vulnerable neighbors – low-income families, expectant moms, children and senior citizens, as well as individuals with disabilities.

Rural hospitals caring for communities in America’s heartland – which are already struggling – will be further devastated by these cuts, making access to quality health care another unobtainable element of the American Dream.

The 13 hospitals that make up Hospital Sisters Health System serve small communities throughout Central and Southern Illinois, and Northeastern Wisconsin. The populations in these towns often reflect higher reliance on Medicaid, especially among children. According to the McCourt School of Public Policy at Georgetown University, 

, Illinois, home to HSHS St. Mary’s Hospital, rely on Medicaid. In Brown County, Wisconsin, home to HSHS St. Mary’s Hospital Medical Center and St. Vincent Hospital in Green Bay, 

Medicaid cuts could reverse nonprofit hospital sector recovery

As representatives of nonprofit, Catholic health care, HSHS views health care as a basic right.

For us, health care service is more than an occupation – it is a vocation. We treat every patient with the same love and compassion St. Francis showed to lepers banished to live outside medieval city walls.

Medicaid – along with Medicare – was created in that same spirit in 1965, with President Lyndon B. Johnson noting the new health insurance program jointly funded by the federal and state governments reflected an American tradition, 

: “never to ignore or to spurn those who suffer untended in a land that is bursting with abundance.”

Who among us has not been vulnerable at some point in their life, or knows a relative, friend or neighbor who has? Public opinion polls bear out this sentiment, with the nonprofit health policy research group Kaiser Family Foundation (KFF) 

 two-thirds of U.S. adults have some connection to Medicaid. Additionally, more than three-fourths hold a favorable view of the program.

The human toll of these cuts would be unconscionable, and the economic impact devastating. KFF 

 state governments could shoulder additional Medicaid costs of $1 trillion over the next decade if the federal government caps its contribution per enrollee and withdraws its 90% match to states that expanded Medicaid under the Affordable Care Act.

We support the dignity of work, yet potential work requirements for Medicaid participants appear counterproductive, since 

 shows nearly two-thirds of Medicaid adults are already working, usually at low-paying jobs that either don’t offer insurance or do so at unaffordable rates.

The overall result of these proposed changes: States would be forced to dramatically scale back their Medicaid programs, hurting enrollees and impacting practically every hospital across the country – including those HSHS operates. Medicaid accounts for 

 in Illinois hospitals, according to the Illinois Health and Hospital Association, while the program 

makes up 14.5% of total gross patient revenue

 in Wisconsin hospitals, according to the Wisconsin Hospital Association.

Hospitals urge Congress to protect Medicaid from steep cuts

Hospitals across the U.S. are still grappling with COVID-19 fallout, facing workforce shortages and shrunken margins. As a nonprofit system, HSHS is not profit driven. Yet we must operate on some measure of solid financial footing to carry out the legacy of our founding and current Hospital Sisters.

Our Sisters founded four of our Illinois hospitals 150 years ago this year, and within days of their arrival from Germany were knocking on doors, seeking donations. We keep that drumbeat alive today, but we cannot continue our mission on contributions alone.

We urge Congress to maintain federal funding commitments for the Medicaid program to prevent structural changes that would rob coverage from those in need. Our federal lawmakers must remember their mission in representing all constituents for the common good.

Damond W. Boatwright is president and CEO of the Hospital Sisters Health System.

Rural hospitals caring for communities in America’s heartland will be devastated by these cuts, writes Damond Boatwright, CEO of the Hospital Sisters Health System.

Congress must preserve Medicaid funding to safeguard health care for our neighbors in need | Viewpoint

To healthcare leaders, the measles outbreak represents not just a public health threat but an indication of dropping vaccination rates.

As cases continue to climb, here’s an overview of the measles outbreak, what is known, and lessons to be learned.

Q: How many measles cases have been reported?

A: There are now 884 confirmed measles cases, according to 

 released Friday by the Centers for Disease Control & Prevention. The CDC released the latest numbers Friday.

Q: How many deaths have been attributed to the outbreak?

A: There have been three fatalities reported to this measles outbreak, health officials say.

Two children in Texas have died due to the measles

. None of the three were vaccinated, officials said.

there had been no deaths attributed to measles since 2015

. After a decade with no fatalities, three people have died.

Q: How does this outbreak compare to previous years?

A: With 884 confirmed cases, the number of measles cases this year has more than tripled compared to a year ago. There were 285 confirmed cases in 2024.

A: Most of the cases have been reported in Texas. There have been 646 confirmed cases in Texas since late January, the Texas Department of Health said Friday. The state has confirmed 22 new cases since Tuesday.

But there have been cases now reported in 29 states, the CDC says.

Q: How many patients with measles required hospital treatment?

The number of cases is far higher than last year and continues to climb, the CDC says. Officials say it's critical to get more people vaccinated. 

Jonathan Kaye

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