Topic: Brain Food

President Trump’s FY 2018 Budget Provides Framework for Government Health Program Funding Battles

Olga Walther

On May 23, 2017, the White House released President Trump’s budget request to Congress for Fiscal Year (FY) 2018. Simultaneously, the Department of Health & Human Services released their budget in brief, explaining the agency’s budget proposals. The budget is a symbolic mission statement from the administration and will undoubtedly clash with Congress’ spending bill. The budget has already received sharp criticism not only from Democrats but from the moderate Republican faction as well. While this generally means we will see a rejection of many of the proposed line item changes, the budget, read alongside the American Health Care Act (AHCA) bill, provides a framework of the fights and ideology we should expect in government health programs for the next few months. Here are some of the most noteworthy proposals and their potential impacts: Read more

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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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Marketing Takeaways from CMS’ Spring Conference

Diane Hollie

Although the Centers for Medicare & Medicaid Services (CMS) Spring Conference is typically thought of as a “compliance” conference, there is always important information that comes from the conference which affects Marketing. It is important to understand the information coming today instead of waiting for a CMS memo or the Medicare Marketing Guidelines (MMG). It is also a great way to hear how CMS personnel are thinking about a subject instead of just trying to infer their thoughts from the MMG. The following are some takeaways that may affect you and your plan.

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CMS Announces Two New Enrollment Changes in ACA Exchanges

Olga Walther

While Affordable Care Act (ACA) talks have hit a stalemate in the Senate, the Centers for Medicare & Medicaid Services (CMS) made good on its promise to make changes to the regulation in an attempt to both ease the regulatory burden and potentially increase enrollment in 2018. CMS made two enrollment changes for the small business Exchange and the individual Exchange. While the impact on consumers is not yet clear, the two moves will dynamically change the relationship between brokers, agents, and consumers and may actually be an efficient step by the new administration to boost coverage sign ups in 2018.

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Guidance on the 2016 HHS-Operated Risk Adjustment Data Validation Program

Jessica Smith

Last week, the Centers for Medicare & Medicaid Services (CMS) announced the 2016 Health and Human Services Operated Risk Adjustment Data Validation (HHS-RADV) would be conducted as a pilot year in the same aspect as the 2015 HHS-RADV. This announcement came two days after the final risk adjustment data submissions were due to be submitted to the EDGE server for 2016 dates of service.

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A New Source of Capital for Star Ratings and Clinical Innovations

John Gorman

For years, every conversation we’ve had with clients about improving Star Ratings and launching clinical innovation projects involved a common barrier to progress: money. So for months, we have been working to bring a new source of capital to the health plan and provider industries to help drive this evolution, called social impact investing. We are getting some early successes and can ask, “If money was no object, what initiatives would you chase?”

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The Twin Icebergs Dead Ahead for TrumpCare

John Gorman

I sure hope Republicans enjoyed their victory lap for getting the American Health Care Act (AHCA) through the House by the thinnest margin, because there are two huge icebergs dead ahead: the backlash, and the Senate.

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