Topic: Performance Optimization

The True Path to Improving the Medicare Member Experience

John Gorman

I’ve been struck lately by two new research reports that demonstrate improving the member experience is the top challenge facing Medicare Advantage plans. First, JD Power is out with its 2017 Medicare Advantage Satisfaction Rankings. Among the results: Read more

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Complaint Management – Identifying the Riptides Drowning Your Health Plan

Julie Billman

Do you know the signs of a riptide? Often the general public isn’t aware of riptides when they go to the beach. The change in the way the water moves and breaks on the shore is something lifeguards keep an eye on to keep swimmers safe.

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Evolve from Restrictive to Supportive Medical Management, or Die

John Gorman

I am continually amazed by how many health plans in Medicare Advantage (MA) and Medicaid still cling to restrictive, “Dr. No”’90’s-style managed care practices like pre-authorizations, referrals, and concurrent review. With massive policy changes looming in Medicaid, and the influence of Star Ratings in MA greater than ever, health plans may soon have a gun to their heads: evolve medical management from restrictive to supportive, or die.

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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.

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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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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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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!

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