Category Archives: Health Plans

Spotlight on Caring: Carrie B.

Whether members live alone or even when they have others in the home with them, they can ignore worsening health conditions. It takes an expert perspective — like that of a HouseCalls advanced practice clinician — to identify symptoms that have become normalized. In this case, HouseCalls advanced practice clinician Carrie’s thoughtful physical assessment helped […]
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Leveraging market landscape data for 2021 bid preparation

The Medicare Advantage (MA) bid process is a function of the overall product strategy that a health plan organization wants to put in place over a multi-year time frame in the marketplace. When preparing bids, several entities of each health plan in an organization are needed such as: executive, finance, marketing, sales and operations. During […]
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2020 MA plans: More benefits at little or no cost to members

In 2019, more than 20 million members enrolled in Medicare Advantage (MA) plans. That number is expected to grow to more than 30 million members before 2030.1 For the 2020 plan year, the Optum Advisory Services actuarial practice is highlighting 2020 premium and supplemental benefit changes. We believe that MA growth can help private health […]
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Spotlight on Caring: Ed V.

HouseCalls enables its advanced practice clinicians to be as flexible as possible to adjust to each member’s needs. Just as importantly, our clinicians are trained to be persistent in reaching out to primary care providers, when warranted, to make sure that members get timely help. This flexibility and persistence can make all the difference as […]
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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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