How well do you know your members? Member segmentation, or stratification, is the foundation of…
Clinical
Set Your Plan Apart with an OTC Benefit
Two of the buzz phrases most frequently heard in the health care community now are…
New Medicare Opioid Management Initiatives
The Centers for Medicare & Medicaid Services (CMS) held a webinar on December 27, 2018,…
CMS Program Audit Frequently Asked Questions – What Did We Learn?
On February 8, 2019, the Centers for Medicare & Medicaid Services (CMS) published its Audit…
How Will the Final Parts C and D Appeals & Grievances Guidance Impact You?
The Centers for Medicare & Medicaid Services (CMS) published its final combined Parts C and…
Proposed Star Ratings Changes in 2020 CMS Draft Call Letter
Proposed Star Ratings changes reinforce CMS commitment to private sector innovation and creativity by incenting…
Changes Are Ahead for C-SNPs and D-SNPs
The Centers for Medicare & Medicaid Services (CMS) announced yesterday that beginning in 2020, all…
Preparing Your Care Management Team for Optimal Performance
As many plans are preparing to write a new Model of Care (MOC) for a…
Bundled Payments Report Issued
Bundled payments capitate medical care at the episode level. It is one of the few…
The Doctor Will Call You Now
I worked in government for a very long time, but when I went back to…