current trends for health plan professionals

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...

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...

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...

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...

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

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 ...

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...

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...

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...

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...

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...

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...

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...

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...

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