Topic: Performance Optimization

Set Up Your Operations Teams for Success in 2018

Julie Billman

I fly often, and it gives me comfort knowing my pilot completes a pre-flight checklist. I often see the pilot out on the tarmac walking around the plane giving it a quick inspection. It is a demonstration he/she takes our safety seriously.

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How to Make Your Next MA-PD Plan Implementation a Success

Julie Billman

Friends of mine built a house. They indicated it was the most stressful event, full of decisions they didn’t know they needed to make, and struggled to agree. The timeline they hoped for was not reality and had to be reworked. While they said they were stronger having gone through the process and they love their house now, it wasn’t the fun event they thought it would be, and they never want to build a house again.

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Creating Your Plan for the Readiness Checklist

Julie Billman

In 2017, the Centers for Medicare & Medicaid Services (CMS) moved from a Readiness Attestation to a Readiness Checklist with a Strategic Discussion with your Regional Office. A movement away from attestations may move some plans to take the process less seriously. CMS raises issues in the Readiness Checklist because they are either critical components or because they are areas of risk. It isn’t often in life we are handed a list we can use to double-check critical components are in place.

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How to Watch for Eclipses in Your Reconciliation Process

Julie Billman

On Monday, the United States experienced the first full solar eclipse since 1979. In order to get the full impact of the eclipse, without causing vision damage, a certain type of glasses or an indirect viewing method was needed. It was an exciting event for those who took the time and had the opportunity to see it. In a small number of locations, it became totally dark for a few minutes and thus easily identified. In other locations, it was not visible without stepping outside to look for it with the right tools.

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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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