Topic: Performance Optimization

GAO Recommends Use of Disenrollment Data to Strengthen Oversight in MA Program

Olga Walther

In a newly released report, the Government Accountability Office (GAO) recommended the Centers for Medicare & Medicaid Services (CMS) examine data on disenrollment by health status and the reasons beneficiaries disenroll to strengthen oversight of the Medicare Advantage program. The Department of Health & Human Services concurred with GAO’s recommendation.

Read more

Leave a comment | Share | |

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.

Read more

Leave a comment | Share | |

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

Leave a comment | Share | |

Implementation Goals: Four Critical Components to Your MA-PD Work Plan

Julie Billman

Starting your Medicare Advantage Prescription drug (MA-PD) plan on the right foot and staying out of the non-compliant spotlight are two important goals for implementing your new plan. The 2018 MA-PD Application Cycle is coming to an end, and new health plans are moving through their first bid process. Ideally, your implementation is well underway, having started the end of 2016 for a January 1, 2018, effective date. Additionally, some organizations are now considering entries into MA-PD for a 2019 or 2020 start date. No matter which group you are part of, there are several key things which should be included in your work plan that are often not considered in your original implementation. Don’t worry – if they aren’t on your work plan yet, there is still time for 2018!

Read more

Leave a comment | Share | |

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?”

Read more

1 Comment | Share | |

Takeaways from the Gorman Health Group 2017 Client Forum

John Gorman

The Gorman Health Group 2017 Forum concluded last week in New Orleans with over 200 of our closest clients and partners. As we enter our 21st year, we returned to where it all began for us, with a little startup called Peoples Health, our first and closest client who now dominates southern Louisiana. The Forum ended the day JazzFest 2017 began, so many of us stayed to enjoy the festival and the best of New Orleans heritage and culture.

Read more

Leave a comment | Share | |

Achieving Better Outcomes through an Effective Agent/Broker Onboarding Program

April Fleming

As we head into bid and application season, one of the common needs that comes to mind is systems. While everyone acknowledges the need for a claims or enrollment system, there are often functions throughout the organization that can benefit from the efficiency and productivity of an automated process.  One such example is agent management.

Read more

Leave a comment | Share | |