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Understanding Health Care Financing in 2022

Speaker: Dr. Gilbert Gimm

Dr. Gilbert Gimm is an Associate Professor in Health Administration & Policy at George Mason University in Fairfax, Virginia. He is a health economist by training with research focus areas in disability and aging, program evaluation, and health care payment reforms. Prior to joining Mason in 2011, Dr. Gimm was a senior researcher for 6 years at Mathematica Policy Research in Washington, DC, where he conducted program evaluations for CMS on the Medicaid Buy-In program, early interventions for workers with chronic conditions, and the financial viability of rural hospitals.

Dr. Gimm received his Ph.D. degree in health economics and policy from the Wharton School at the University of Pennsylvania. Dr. Gimm is currently a principal investigator of a 3-year CDC grant sub-award to evaluate sustainable financing models for community health workers in Virginia and is a co-investigator in a 2-year NIDILRR center grant that uses national survey data to examine rural-urban disparities in access to care for adults with disabilities. His research work has been published in Disability and Health Journal, the Journal of General Internal Medicine, and the American Journal of Public Health.

Speaker: Ed Quick, MA, MBA, CDMS

Edwin W. Quick, MA, MBA, CDMS has over 30 years of experience in health and productivity management from program implementation, to plan design and administration. Ed earned his Master’s in Vocational Rehabilitation from the University of Cincinnati and a Master of Business Administration in Human Resource Management from American University, Washington DC. Ed is currently pursuing a Certificate in DE&I for Human Resources from Cornell University’s e-Learning program.

Currently a global senior leader in the integrated leave, disability and time away space for a large technology company, he was also the Executive Director of Disability Management Services for JP Morgan Chase in Chicago, Illinois, and the Global Leader, Employee Health and Productivity, for General Electric.

Ed has been a volunteer for the Certified Case Management community for over 25 years holding various committee and leadership roles for the Certified Disability Management Specialist Commission including National Chair before the merger with Certified Case Management Commission. Ed has served as the Chair of the DE&I Committee, in addition to his service on Finance, Symposium, and CDMS test development and assessment committees and taskforces. Ed has served as an outside member of the Healthcare Quality Certification Committee and as a Special Panel Member for the Society for Human Resource Management Occupational Safety Committee.

Accountable care organizations (ACOs), value-based programs, Medicare Advantage, Medicaid managed care, and patient-centered medical homes (PCMHs) are examples of health care payment reforms, strategies to control health care costs, and means to improve quality of care. Historically, the U.S. health care financing landscape shifted when Medicare and Medicaid were passed into law in 1965. For several decades after that, traditional Medicare, Medicaid and private insurers used a fee-for-service model, paying for health care services as they were ordered by clinical staff. However, researchers and government analysts determined that this approach was expensive and didn’t prioritize quality outcomes--change was needed. Now the finance landscape differs with the focus on controlling health care costs while at the same time ensuring quality.

What does this mean for health care providers, case managers, and disability management specialists? How can the attention to quality outcomes improve the health of traditional Medicare and Medicaid patients, dual-eligibles, and persons with disabilities? Value-based programs have been in existence for about 12-15 years-how have they improved or changed health care during that time?

Learning Outcomes:

  1. Describe how accountable care organizations differ from patient-centered medical homes, and their overlap with value-based programs;
  2. Identify several reasons for the growing popularity of Medicare Advantage plans and key differences with original Medicare programs;
  3. Compare and contrast traditional Medicaid fee-for-service payments and more recent cost control strategies used by Medicaid managed care organizations, and
  4. Summarize how the changing landscape of health care financing affects clients and the role of case managers and disability management specialists.

Credit Information:
The Commission for Case Manager Certification (CCMC) is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

This program has been pre-approved by The Commission for Case Manager Certification to provide continuing education credit to CCM® board certified case managers. The course is approved for 1 CE contact hour(s). Activity code and Approval number will be awarded on your certificate of completion.

This program has been pre-approved by The Commission to provide continuing education credit to CDMS® board certified disability managers. The course is approved for 1 CE contact hour(s). Activity code and Approval number will be awarded on your certificate of completion.

To earn contact hours/CEs: In order to earn your contact hour(s)/CE, you will have to watch the presentation in its entirety and complete the survey. Once both the presentation and survey are marked as complete, you will receive your Certificate of Completion. If you are a CCM, your CEs will automatically record in your CCMC account.

All planners and speakers have disclosed that they have no relevant financial relationships with any ineligible companies.

Expiration date: 10/23/2025