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- Nancy on Making Order from Chaos
- kdambrosio on An “October Surprise” in Medicare Advantage Star Ratings
- Garth D. Weme, CIC on An “October Surprise” in Medicare Advantage Star Ratings
- Clark on Making Order from Chaos
- RP on How to Efficiently Conduct an Audit
Topic: Star Ratings
On the heels of a recent groundbreaking RAND report on racial disparities in Medicare Advantage (MA), the US Department of Health & Human Servicesâ€™ Office of Civil Rights (OCR) issued a regulation that requires serious attention in health plans participating in MA, Part D, Medicaid, and ObamaCare. Itâ€™s a game-changer in advancing health equity and reducing disparities.
Building A New Provider Network or Planning Your Next Service Area Expansion? Donâ€™t Lose Sight of Your Biggest Asset
The sun is shining, kids are out of school, and vacation season is in full swing! While our Health Plan Network and Product teams are taking a few deep breaths after application and bid filing deadlines, we cannot rest on our laurels for very long. Summer is the best time to start planning your next service area expansion (SAE) or even your first step into the Medicare Advantage (MA) world. Maybe you are an established MA plan evaluating where to expand your geographic footprint. Maybe you are a Medicaid plan looking to expand into the Managed Long Term Services and Supports (MLTSS) arena and are wondering what it would take to have a Dual Eligible Special Needs Plan so many of the MLTSS Requests for Proposal (RFPs) are expecting; or maybe you are an Accountable Care Organization looking to leverage your infrastructure and enter the payer world. Perhaps, maybe, summer is the perfect time to start planning for your network needs. Plans need to be even more vigilant in managing their largest asset. Regardless of the size and scope of the organization, your planâ€™s network adequacy and accessibility is a cornerstone of any new initiative.
The geniuses at Sherlock Company, whose benchmarks on health plan administrative standards are considered the gold standard, have released their 2016 findings and the numbers paint a clear picture: Medicare Advantage (MA) is a miserable beast of a product. It’s complicated and labor- and capital-intensive, requiring tremendous patience for executives and investors alike.