Topic: Brain Food

Teaming with Providers: Incentives to Achieve Results

Elena Martin

When a team works well together, the members collectively accomplish more than any of the individuals could have accomplished alone. Certainly we have proven that adage true in healthcare as can be seen with the success of integrated delivery systems, Independent Physician Associations (IPAs), and Accountable Care Organizations (ACOs).

Read more

Leave a comment | Share | |

Retail Healthcare – An opportunity for success

Carrie Barker-Settles

Read more

Leave a comment | Share | |

Risky Business. Are You Ready for MACRA?

David Sayen

It turns out Uncle Sam has a plan. He tried mightily to bend that stiff cost curve. He threw everything he had at it ‒ fixed prices, automatic reductions, sophisticated relative value schemes. He could not do it. Turns out the pen (or mouse) is mightier than the sword because almost all of the Medicare benefit spend flows with the ink (or electrons) that is released by the physician’s hand. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a game changer like prospective payment system (PPS).

Read more

Leave a comment | Share | |

Advancement in Analytics

Nancy Djordjevic

It’s all about the numbers! As the Centers for Medicare & Medicaid Services (CMS) tries to quantify more and more aspects of government-sponsored healthcare, metrics are a critical component.

Read more

Leave a comment | Share | |

Is Your Sales Distribution Strategy Up for the Challenge?

April Chambers


It’s already July, and time is ticking! Do you have your sales distribution strategy completed and management staff in place?  With the Annual Election Period (AEP) just a few months away, finalizing your distribution channel, creating sales training, developing telemarketing scripts, and hiring management to oversee all these tasks must be completed now.  In addition, making sure you have compliant marketing materials and a compliant website is more important than ever.

Read more

Leave a comment | Share | |

Why Is Conducting a Part D Operational Assessment so Important?

Debra Devereaux

Medicare Part D is a complex program that is continually in motion. The Centers for Medicare & Medicaid Services (CMS), in an attempt to provide clarity to stakeholders, actively publishes updated guidance to sponsors to assist in process improvement and encourage optimal beneficiary outcomes and experience. Keeping up with Health Plan Management System (HPMS) memos, best practices, yearly call letters, and webinar information is challenging.  Dynamic and ever-changing guidelines inevitably bring uncertainty and risk. Understanding these guidelines and operationalizing a compliant program is key to a successful program and financial sustainability.

Read more

Leave a comment | Share | |

Medicare Program Audits – Four Things Operations Should Be Doing Today

Julie Billman

Do you think the Centers for Medicare & Medicaid Services (CMS) program audits are stressful? We often make it worse for ourselves than it already is. Imagine being in the audit webinar pulling up a case and having CMS say that case was to be excluded from the universes.  Instead of showing your department, processes, and system capabilities, CMS is getting the impression you don’t even know your data well enough to pull a correct universe. What can Operations departments do to get ready? Here are four things you can begin doing today to be ready: Read more

Leave a comment | Share | |