Category Archives: Health Plans

Spotlight on caring: Marcia K.

The home visit is a vital way to connect with members in a way that enables them to more fully communicate their concerns and needs. But first you have to earn their trust — from the call to set up the visit, to the invitation to sit on their couch. Each HouseCalls advanced practice clinician […]
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Social determinants of health data challenges and their impact on risk and quality

The impact of social determinants of health (SDOH) on patient care is becoming more and more critical. Over the past few years, the Centers for Medicare & Medicaid (CMS) has focused on addressing SDOH for all members. This shift may affect risk and quality success and requires an evolution in coding capabilities within existing documentation […]
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HEDIS measures, ECDS and telehealth: Are health plans ready?

According to the National Committee for Quality Assurance (NCQA), the Electronic Clinical Data Systems (ECDS) reporting standard represents a step forward in adapting the Healthcare Effectiveness Data and Information Set (HEDIS®) to accommodate the expansive information available in electronic clinical data sets for quality improvement.* In addition, the growing use of telehealth reflects overall health […]
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Health plan drivers of innovative risk and quality provider reimbursement programs

Over the course of the past few decades, provider reimbursement has taken on different forms with varying degrees of acceptance and success. Many have had their share of challenges and opportunities, but for the most part, all were intended to create an environment that modified behavior, created visibility and perhaps motivated providers to achieve a […]
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Health plans recognize need to improve encounter data quality

Health care organizations are under increasing pressure to reduce costs. An important consideration is whether revenue for risk adjusted populations, including Medicare Advantage plans, is based on complete and accurate reporting of the health of your membership. Most health plans immediately look to their risk adjustment programs, such as in-office and in-home assessments, to ensure […]
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Spotlight on caring: Christy T.

The connection between our HouseCalls advanced practice clinicians and a member’s care team cannot be overemphasized. As our clinician Christy so aptly demonstrated in this example, we are an extension of that care team to identify and alert members as well as their care providers to clinical issues. In this member’s case, there was no […]
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Spotlight on Caring: David R.

In addition to rigorous training to prepare our HouseCalls advanced practice clinicians, we also equip them with powerful screening tools. These tools, like the QuantaFlo™ system noted in this example, amplify each clinician’s ability to assess a member’s well-being from the comfort and ease of their home.   When the member reported having leg pain, our […]
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Spotlight on Caring: Kelly Z.

It’s humbling to think how a HouseCalls visit can make a big difference in a member’s health. It requires significant training and a practiced eye to evaluate a situation so that you can understand what may be really happening. In this example, our clinician Kelly’s thoughtful, highly responsive action helped mitigate what could have been […]
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Spotlight on Caring: Lisa T.

Member education is a vital part of each HouseCalls visit. We are deeply committed to enabling members to be more engaged with their health care providers and health care choices. That is why our clinicians are well equipped with educational resources, and encouraged to take the time needed to answer member questions. This is exactly […]
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Emerging trends and complexities of genetic testing reimbursement

Complexities of genetic testing reimbursement Genetic testing has become an increasingly important and effective tool in identifying and treating disease. Genetic testing can confirm or rule out suspected genetic conditions as well as determine whether a person can pass those conditions onto their offspring. This can help clinicians focus on the correct treatment as quickly […]
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