Tag Archives: Medicare Advantage

What Does the Better Care Reconciliation Act Mean for Medicare Advantage Plans?

David Sayen

In a word, it’s trouble. Let me count the ways.

Top of mind is the Medicaid overhaul. Block Granting Medicaid has been the Holy Grail on the Republican side since Reagan. And why not: the Department of Health and Human Services (HHS) wants to download the risk to the states. Whether it is the per capita limits required by law or the optional Hobson’s Choice of the block grant for the entire population, it means one thing. Pain. States have to balance their budgets, unlike Uncle Sam who has that bottomless checkbook.

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Go-to-Market Strategy: Bringing It All Together

Nilsa Lennig

Go-to-market strategy is truly fantastic as it is literally aligning the entire organization to drive profitable growth supported by a governance structure that helps more effectively manage.

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Global Warming Comes to Healthcare

David Sayen

On June 7, the Health Subcommittee of the House Ways and Means Committee heard and responded to testimony about Medicare Advantage (MA) and, in particular, how the program can be an instrument to advance care coordination and integration. The tenor of this hearing, combined with the recent unanimous passage of the bipartisan Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act by the Senate Finance Committee tells this reader ice isn’t just melting at the North Pole. There is a thaw in the chill that seemed to blanket parts of the healthcare industry since the election.

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Three Compliance-Minded Steps to Take for 2018 Marketing and Sales

Regan Pennypacker

Is it me, or is time flying by? Applications are done, bids are in, new plans are in planning stages, and existing plans are getting ready for the launch of the next benefit year.

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Top Three Areas to Evaluate in Medicare Advantage Customer Service

Julie Billman

A few years ago I lived in Utah, which is an amazingly beautiful state. I visited Bryce Canyon and went horseback riding into the canyon. My horse’s name was Anaconda, and his size lived up to his name. I grew up around horses, but it had been decades since I was on one. The tour started, and it wasn’t very long before I thought I made a big mistake. I had a hard time staying centered on Anaconda, and the other horses were walking right on the edge of the cliff. To top it off, I’m afraid of heights.

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Top Challenges in Provider Data Management

Elena Martin

While health plan provider directory inaccuracies have been at the forefront of the news, regulatory agencies, and consumer protection agencies, the directories are only the tip of the iceberg in how difficult provider data management is for health plans. Plans continue to gather information on providers in a multitude of ways and from a variety of functional areas, continue to create conflicting repositories of provider data, and thus continue to face the painstaking and almost always manual validation of provider information.

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Highlights from 2017 CMS Audit and Enforcement Conference

Regan Pennypacker

The Centers for Medicare & Medicaid Services (CMS) hosted their annual Audit and Enforcement Conference on Thursday, May 11, and addressed the following topics: Read more

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