“Every child deserves to grow up with a mother. Ensuring all citizens have access to care ensures children have access to a healthy mother.”
– Dr. Angela Reddix
According to Healthy People 2030, “Many people in the United States don’t get the health care services they need. Healthy People 2030 focuses on improving health by helping people get timely, high-quality health care services.
About 1 in 10 people in the United States don’t have health insurance.1 People without insurance are less likely to have a primary care provider, and they may not be able to afford the health care services and medications they need. Strategies to increase insurance coverage rates are critical for making sure more people get important health care services, like preventive care and treatment for chronic illnesses.
Sometimes people don’t get recommended health care services, like cancer screenings, because they don’t have a primary care provider. Other times, it’s because they live too far away from health care providers who offer them. Interventions to increase access to health care professionals and improve communication — in person or remotely — can help more people get the care they need.”2
[1] Berchick, E.R., Hood, E., & Barnett, J.C. (2018). Health Insurance Coverage in the United States: 2017. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2018/demo/p60-264.pdf [PDF – 1.4 MB]
[2] Health Care Access and Quality, Healthy People 2030. Retrieved from https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality
ARDX partners with federal, state, and local governments, and nonprofit and for-profit organizations to collaborate on and translate regulatory policy and guidance into useable, digestible information for the insurance providers and health care providers to use to communicate with their beneficiaries to increase access to information.
Our solutions for delivery of information include a variety of products and services: webinars, training, facilitation, computer-based trainings (CBTs), podcasts, videos, manuals, operational documentation, training materials, job aids, exercises/scenarios, and live cloud-based solutions.
Case Study
Case-in-Point: CMS defines Health Equity as, “the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.”(Health Equity. Centers for Medicare & Medicaid Services. Read More)
ARDX has partnered with CMS since 2006 to advance health equity by designing, implementing, and operationalizing policies and programs that support health for all the people served by their Medicare Part C and Part D and Affordable Care Act (ACA) Stakeholder programs, eliminating avoidable differences in health outcomes experienced by people who are disadvantaged or underserved, and providing the care and support that their enrollees need to thrive.
Specifically, ARDX has partnered with CMS to maximize CMS community’s understanding of complex topics on Medicare enrollment and eligibility, payment, Risk Adjustment (RA), Risk Adjustment Data Validation (RADV), Encounter Data (ED) for Part C, and Prescription Drug Event Data (PDE) for Medicare Part D. ARDX contributions to the Encounter Data System included a thorough examination of the Fee-for-Service system in an effort to provide CMS with recommendations for modeling the encounter data system for Medicare Advantage. ARDX support continues with assistance to the Center for Program Integrity to obtain their goal of eliminating or reducing fraud, waste, and abuse. This assistance extends from data analytic support that compared Fee-for-Service claims data with Medicare Part C data to predict the impacts of COVID-19 and fraud with factors that included provider place of service and diagnoses. We are also reviewing RADV appeals and making Medical Record Review Determinations (MRRD) and Payment Error Calculation (PEC) determinations.
Similar to our extensive experience with Medicare Part C and Part D, ARDX has supported the Affordable Care Act (ACA) for CMS’ Center for Consumer Information and Insurance Oversight (CCIIO) since 2012 as they have implemented the Marketplaces to provide insurance options for all Americans. The regulations and scope of the ACA have grown significantly since it was first enacted, and as a long-standing partner with CMS, ARDX has continued to collaborate with CCIIO on various initiatives across a multitude of changes to ACA regulations, through multiple presidential administrations, and through the COVID-19 pandemic to ensure continuity in communication regarding the Marketplace programs and the onboarding of new programs.
