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Most Recent Episode

Season 2
February 2024

Unlock the Potential of Prospective Programs


Tune in to learn the importance of matching provider practices with a provider engagement program that suits the operational structure of the practice.  

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Season 2
February 2024

Unlock The Potential of Prospective Programs

As more and more provider organizations enter into risk sharing agreements, provider engagement programs are experiencing a surge in participation. Provider engagement programs improve the collaborative relationship between plans and providers but not all programs are suitable for every practice...

Season 2
January 2024

NLP For Coding & Compliance

NLP is used in medical coding to enhance the speed, efficiency, and quality control for MAO risk adjustment. Tune in to discover the opportunities and limitations of NLP, why NLP is not replacing medical coders, and how organizations can customize NLP engines to meet....

Season 2
December 2023

RADV—The Future of Reimbursement Accuracy

In light of the 2023 Final Rule regarding RADV audits and potential extrapolation loss, plans are seeking ways to strengthen reimbursement accuracy...

Season 2
November 2023

Regulatory Concerns In Enrollment Technology

There is a distinct advantage to enrollment technologies that are built specifically for CMS's enrollment and dis-enrollment regulations for Medicare Advantage and Part D.  One such specification includes...

Season 2
BONUS EPISODE 001

2024 Star Ratings Industry Report

We discuss the variables that influenced performance and why it's the second year in a row, the average Star Ratings have declined and some plans might be seeing less than ideal performance. More than a third of plans saw a Star Ratings decline this cycle. 

Season 2
October 2023

Shifting Measures In Stars—Making The Quick Pivot

In this episode, we discuss the significant changes in the weight of Star measures in the 2023 Final Rule, the removal of the Reward Factor, the addition of the Health Equity Index, and how to play Stars like a math game...

Season 2
September 2023

The Science of Predicting Member Conditions

Many plans attempt to close as many prospective gaps in a year as they can and whatever they cannot close in that year is sent to retrospective programs. This is a costly approach that tends to over-suspect and...

Episode 1
August 2023

Medicare Ad Graphics—The Overlooked Element

Best practices for Medicare and Medicare Advantage marketing and ads continue to evolve as greater numbers of seniors integrate digital activity, such as online news and Facebook, into their daily routines. While the goal of any campaign is to stop-the-scroll and convert...

Season 2 Trailer
July 2023

Season 2 Trailer

 Topics include risk adjustment, quality measures, technology, data security, operations, health management, member engagement, start-up and growth tactics, legal and regulatory. 

Episode 12
May 2022

A Business Case For Interoperability

CMS Interoperability and Patient Access Final Rule was developed to connect healthcare technology systems  so members can access their own data. All CMS-backed plans...

Episode 11
April 2022

How Technology Workflows Influence Quality of Care

Technology is essential for today's care management operations, yet it's important to recognize that technology can either help or hinder the business. At its best, technology offers a reduction in...

Episode 10
March 2022

Ethics, Data Science, and SDoH

Social determinants of health (SDoH) is an important variable to consider when interacting with Medicare Advantage populations and as the healthcare system increases its...

Episode 9
February 2022

Leveraging HEDIS Data

HEDIS hones in on 5 domains of care and measures whether the healthcare services rendered are actually improving conditions. The domains include effectiveness of care, access or availability of care, experience of ...

Episode 8
January 2022

The Technology Debt Dilemma—Why Cloud Operations Are Essential

Technology debt is the cost of maintaining legacy software systems over time, often built in hard code. Updates and workarounds are expensive and the process for implementation is slow, but there's also the...

Episode 7
December 2022

Innovations In Claims & Payment Models

It’s hard to imagine a time when claims were submitted on paper. In 2003, Medicare required electronic submission of all claims via an electronic data interchange (EDI) for auto-adjudication. This means claims are...

Episode 6
November 2022

Generational Differences In Technology Usage

The concept of marketing segmentation isn't new, but what may be new, is the idea of generational segments within the Medicare market. Until recently, messaging...

Episode 5
October 2022

Improving CAHPS With Existing Data & New Perspectives

The weight of the CAHPS survey has steadily increased over the years from 8% in 2014 to 32% of the overall Star Rating in 2021. Scoring is complex and there’s no one size fits all strategy...

Episode 4
September 2022

Strategies For Reducing Gap & Chase Timeframes

In the context of risk adjustment gaps, there are two overarching goals—to identify and accurately predict member conditions. To do this, health plans are reliant on...

Episode 3
August 2022

Digital Tactics For Member Engagement

Marketing and communications in the Medicare Advantage space have evolved significantly in the past five years. Leaving behind a one-size-fits-all outreach approach, today’s best practice is...

Episode 2
July 2022

Next Generation Care Technology

In this episode, we explore the origins of care management, reactive versus proactive models of care, ways to coordinate care with real time data, practical uses for...

Episode 1
June 2022

Future of Stars

2021 was the first year that CMS shifted away from clinical metrics and skewed the weight towards member experience. Health plans will need to address matters such as...

Trailer
March 2022

Season 1 Trailer

Join us for insider insights and perspectives for healthcare executives of government-sponsored health plans. We’re talking to the experts about...