Topic: Brain Food

Connecting the Dots: The Impact of Health Disparities on Star Ratings

Melissa Smith

Healthcare quality improvement efforts have traditionally looked at healthcare policy, access to care, and the practice of medicine as some of the key drivers to improve clinical quality performance.  Significant advances have been made in recent years to expand and enhance access to high-quality care, to ensure adherence to evidence-based clinical practice guidelines, and to support standardized care pathways while still incorporating patients’ and practitioners’ decisions and preferences into the care planning process.  But as quality improvement efforts in Medicare Advantage have matured, we’ve hit a performance plateau.  Star Ratings measure performance has declined or stagnated on numerous Medicare Advantage quality measures:

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Preparing For The 2017 Call Center Monitoring

Angela Fox

On November 16, 2016, the Medicare Drug Benefit and C & D Data Group of the Centers for Medicare & Medicaid Services (CMS) issued the “2017 Part C and Part D Call Center Monitoring and Guidance for Timeliness and Accuracy and Accessibility Studies”.

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Trump Transition Team Picks Price, Verma to Head HHS, CMS; Providing Predictions for 2017 Agenda

Olga Walther

This week, Representative Tom Price was named the nominee for the new Department of Health & Human Services (HHS) Secretary. This widely expected pick provides us some foresight into what type of agenda to predict from the Trump Administration. Tom Price is one of the strongest opponents of Obamacare, from the very passage of the Affordable Care Act (ACA). Putting such a firm critic of the law as the head of HHS immediately sends the message we will see “below the waterline changes” and chips away at Obamacare before any repeal is even voted on. Price will soon have control of the constant flurry of subregulations and guidance put out by the Centers for Medicare & Medicaid Services (CMS) on a daily basis. Need an example? CMS released its early preview of CY2018 Medicare Advantage rate book growth rates this week. While the 2018 preliminary baseline rate increase is 2.31%, the actual rate will be finalized in April 2017 by the new Administration.

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Leverage Your MOC to Improve Star Ratings & Optimize Risk Adjustment Performance

Mayling Naputi

The Model of Care (MOC) represents the backbone of a health plan’s operational infrastructure and offers powerful potential through which to drive quality improvement, service excellence, and improved health outcomes

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CMS Releases 2018 Draft Letter to Issuers

Olga Walther

This is a time of uncertainty as to the fate of Obamacare and the Exchanges.  While promises of a repeal are now within reach, more than 100,000 consumers enrolled for Obamacare plans the day after the election, the most since open enrollment began this year, signifying the worry that these options will soon be unavailable. Though we do not yet know whether a full appeal or an amendment is in the works, it is certain that significant changes are in store as the new administration steps in.

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The Top Three Benefits of an Operational Assessment

Julie Billman

Times are busy. In Operations departments, they are always busy. We are all doing more with less, which makes things hectic, and everyone is playing catch-up. In the midst of it all, operational assessments, process and efficiency enhancements, and internal compliance reviews are always on the list but are often moved to a future time when things are a little slower – a time that is often just out of reach.

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What Do the 2016 Presidential Election Results Mean for Government Programs?

John Gorman

In a shocking victory, Donald Trump is our new President-elect, and Republicans held on to control of the House and Senate. The sweep gives Republicans wide control to pass significant legislation and reshape the federal government, including the entire federal civil service and the Supreme Court, in the next four years.

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