It’s network development season, and CMS’ recent changes to network adequacy requirements merit taking a closer look at where new MA plans can take root, and where existing plans can further expand their service areas.
The Value in Shifting to a Value-Based Care Model
The pandemic has shown us that the fee-for-service model was just as fragile as we thought it was. There is now a tremendous sense of urgency to change the way in which care is provided, and making the shift to value-based care may be the key to success.
Why the OEP is So Important This Year
A global pandemic and Presidential election year have created uncertainty surrounding this year’s AEP. However, there are a few things we know for certain and this year, health plans should be prepared with an intentional OEP strategy.
CMS Network Adequacy Changes & the Impact to Medicare Advantage Plans
CMS’ recent network adequacy updates will open doors for plans to provide services in counties that would have otherwise proven difficult to meet network adequacy requirements.
HEDIS Measure Changes and Updates
In a year where we find ourselves using the word “unprecedented” far too often, NCQA’s recently released HEDIS updates continue the trend. GHG’s Melissa Smith summarizes the high-impact measure changes in this article.
CMS’ Proposed Addendum to Part C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance
On July 7, 2020, CMS distributed a draft addendum to address changes required for Integrated DSNPs for Unified Appeal and Grievance processing in the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance. Noteworthy changes are summarized here.
GHG Welcomes Kate Rollins, Senior Vice President of Population Health & Clinical Innovations
GHG is thrilled to announce that Kate Rollins, MSN, RN, has joined GHG as the Senior Vice President of Population Health & Clinical Innovations. Kate is a Clinical Nurse Specialist with over 20 years of healthcare experience, specializing in clinical strategy and operations.
