Category Archives: Health Plans

Uber inspired scheduling software reshaping the clinician experience

So who knew we needed a new taxi service? We were all used to calling for a taxi. Getting someone on the line telling us a driver would be dispatched shortly. Then the waiting came. Not sure who would show up or when. Uber saw an opportunity to use the latest mobile technology to transform […]
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Medicare Advantage competitive positioning in 2018: Analyzing the market landscape and plan offerings

For the seventh year in a row, Medicare Advantage (MA) plan enrollment is projected to increase to a new, all-time high.1 In this growing market, in order to maintain favorable competitive position in the marketplace, MA plans need to compete on an increasingly complex array of product features and plan attributes including premiums, benefits, quality […]
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What’s driving your pharmacy costs?

Increased demand for prescription drugs, expensive specialty medicines, price inflation and widespread chronic illness are causing a greater strain on health plan and patient pharmacy resources. To more effectively manage these costs, plans need to understand the drivers of their trend, identify actionable data and consider a multi-pronged approach to control spend while deriving value. […]
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Taking a three-pronged approach to personalizing the consumer journey

The health care market is in the midst of transformative change. Demographic shifts and regulatory and societal changes are intensifying pressures on consumers and health systems alike. As consumers take on personal responsibility for their care while navigating a complex and dynamic market, businesses are challenged to differentiate themselves by delivering value, innovation and exceptional […]
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Medicare Advantage risk adjustment: How deep is the well?

Health plans realize the value of comprehensive risk and quality programs to meet the needs of providers and members. These programs are also critical to addressing increasing regulations and the focus on quality. For Medicare Advantage in particular, it’s important to address quality as defined by the Star Rating system and the bonuses that are […]
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Boost Star ratings with a focus on CAHPS®

In a value-based model world, there are fewer points of differentiation for health plans seeking to show increasingly engaged consumers that quality comes first. Plans are beginning to realize that establishing a year-round focus on the annual Consumer Assessment of Healthcare Providers & Systems (CAHPS®) survey is essential to reaching that level of separation. CAHPS […]
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Best practices for analyzing the Medicare Advantage revenue cycle

The Medicare Advantage market is in the midst of change. Contractions in capitation rates continue to pressure health plans to improve operations and tighten their financial management. For payers offering Medicare Advantage products, Part C and Part D, the risk-adjustment cycle represents a significant challenge to achieve both transparency in operational processes and forward visibility […]
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Aligning risk adjustment and quality management

Many health plans maintain separate risk adjustment and quality management programs, with purposefully siloed objectives and metrics. But aligning the two enables true transparency from data to analytics, and provides numerous benefits: Revenue growth Improved outcomes Reduced medical spend Managing at-risk populations requires health plans to have the appropriate controls and processes in place that […]
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Maximize savings with an enterprise payment integrity strategy

Health plans transforming their business models to accommodate new markets and new lines of business may also experience a strain on their payment integrity programs. This strain can create membership fluctuations, business complexities and regulatory mandates across all areas of claims processing. Without a vigorous payment integrity strategy, these pressures can create competing or misaligned […]
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Modernizing Medicaid: Mega-Reg implications health plans should know

Payers manage a multitude of responsibilities as it relates to their Medicaid membership. From regulatory adherence, and payment integrity optimization to enrollment management, the current, and sometimes, complex canvas of Medicaid oversight is now growing.   The Department of Health and Human Services (HHS) issued a new ruling earlier this year with the intention to […]
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