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- Regan Pennypacker on Latest Audit Enforcement Actions Issued by CMS
- Kathleen Chapman on 2019 Medicare Advantage Rate Announcement & Call Letter
- Michelle Juhanson on Latest Audit Enforcement Actions Issued by CMS
- Alan Mittermaier on MA and Part D Proposed Rule Increases Plan Flexibility, Reduces Regulatory Burden
- Sharon Willliams on A New Source of Capital for Star Ratings and Clinical Innovations
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Big Week for Medicaid Expansion; Obstacles Ahead
There was quite a bit of activity in Medicaid expansion efforts this week, with remarkable strides made. In case you had trouble keeping up with all the news, here is a rundown of the biggest developments.
CMS Doubles Down on Member Experience
At Gorman Health Group, we have the privilege of collaborating with organizations across the full spectrum comprising our members’ experience – from health plans and providers to vendors and pharmacy benefit managers (PBMs) – and though almost every person I talk to in every type of organization strives to create excellent member experiences, many struggle to successfully do so. The Centers for Medicare & Medicaid Services (CMS) recent pledge to put patients first in all of their programs has changed the calculus of “the member experience” in Medicare Advantage (MA). We’ve heard these words for years, but this time it’s real.
Insights into Common Operations Projects and Findings
One of the best things about being a consultant is that we get to meet a lot of really great people who are passionate about what they do and the members they serve. At Gorman Health Group, our projects span a wide range of activities – from implementing new programs to mitigating production, quality, and compliance concerns. Working with our clients, we see some of the common issues that plague the industry and a variety of best practices. In you attended the Gorman Health Group 2018 Forum in April of this year, you heard a variety of our most common projects and critical findings. If you weren’t able to attend, below are a few of the highlights from that event. As these are common projects and findings, you may want to take a look within your organization to determine if these might be potential issues for your plan. Read more
The 2019 Model Marketing Materials Are Posted. Ready for What’s Next?
As we await the Medicare Communications and Marketing Guidelines (MCMG), The Centers for Medicare & Medicaid Services (CMS) released the 2019 Model Marketing Materials which includes standardized outreach and educational materials for Medicare Advantage Plans, Medicare Advantage Prescription Drug Plans, Prescription Drug Plans, and 1876 Cost Plans.
New Open Enrollment Period: Five Things to Consider
I am in the midst of helping to sell a family member’s house. The house was recently remodeled and looks amazing in the realtor posting. An offer came in for full asking price, and we are now in the inspection phase of the process. This is where things get real. The buyers have an “options clause,” which is an opportunity to walk away from the sale if things aren’t as they expected. One of the inspections showed some foundation damage that if not fixed will result in the sale falling through – and for good reason, as the buyers want a house in good working order.
Telehealth Policy Trends in Medicaid
The Center for Connected Health Policy (CCHP) released its now biannual report on state telehealth policies and Medicaid. While many states are beginning to expand telehealth reimbursement, others continue to restrict and place limitations on telehealth-delivered services. Although each state’s laws, regulations, and Medicaid program policies differ significantly, certain trends are evident when examining the various policies. Live video Medicaid reimbursement, for example, continues to far exceed reimbursement for store and forward and remote patient monitoring (RPM).
