Executive Briefing | August 22, 2019

Is Defined Contribution Coming to Healthcare?

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Will new trends drive defined contribution and a new consumer choice model? Just as the employer retirement market shifted from defined benefit to defined contribution (such as a 401k or 403b) nearly 25-years ago,  the employer group health insurance market…

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Executive Briefing | August 22, 2019

Accelerating the Race to Value: The Impact of Regulatory Actions to Improve Price Transparency

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“My Administration seeks to enhance the ability of patients to choose the healthcare that is best for them. To make fully informed decisions about their healthcare, patients must know the price and quality of a good or service in advance.” –…

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Executive Briefing | April 30, 2019

The Rise of Over-The-Counter Programs in Medicare Advantage Plans

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“We’re going to have an interesting discussion in the next 5 to 10 years because Medicare Advantage has always been a smaller portion of Medicare and Medicare fee-for-service has dominated. Well, that’s changing now.” – Alex Azar, Health and Human…

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Executive Briefing | March 5, 2019

Value-Based Care Requirements in Medicaid

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Historically, CMS has pushed towards value-based care for programs that are “helping us move toward paying providers based on the quality, rather than the quantity of care they give patients.” Touted as a transformative reimbursement model, value-based care has historically…

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News | November 16, 2018

HealthScape Advisors Combines with Convey Health Solutions

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Convey Health Solutions (“Convey”) today announced an agreement to merge with HealthScape Advisors, LLC (“HealthScape”) and Pareto Intelligence LLC (“Pareto”), combining Convey’s market-leading set of compliant, cost-reducing member enrollment, service, administration, quality and wellness support solutions with HealthScape’s market-leading strategic…

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Executive Briefing | November 13, 2018

Navigating CMS’ Enhanced Program Integrity—Preparing for the Spotlight

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On June 30th, CMS announced it was enhancing its Program Integrity efforts that focus on addressing improper Medicaid payments and CMS oversight of state Medicaid programs. The announcement introduced 8 initiatives, including stronger audit functions, enhanced oversight of state contracts…

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Executive Briefing | October 30, 2018

Wait… MACRA Impacts Med Supp?

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A tectonic shift is underway in the Medicare Supplemental (Med Supp) market and it’s coming from a source rarely discussed—the Medicare Access and CHIP Reauthorization Act (MACRA). Beginning in 2020, insurers will no longer be able to sell the most…

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hfm Magazine | September 6, 2018

Integrated Revenue Cycle: Coordination Between Insurers and Providers to Ensure Revenue Accuracy

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Traditional revenue cycle management arrangements that focus solely on billing and collections are no longer reliable in the world of delegated risk models, especially for Medicare Advantage (MA) populations. That’s why Pareto recommends an innovative approach to managing value-based payments,…

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Executive Briefing | May 31, 2018

Is Change Good for the Medicare Advantage Market?

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With Medicare Advantage (MA) and Part D plans entering the final stretch for 2019 bid submission, each has undoubtedly spent a significant amount of time thinking about change. In April, CMS released the final policy and payment updates for these…

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Whitepaper | May 23, 2018

Assessing Joint Venture Models for Provider-Sponsored Health Plan Products

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Health systems are well-attuned to the potential pitfalls of launching a provider-sponsored health plan (PSP) without the right mix of expertise, capabilities and capital. Health plans, on the other hand, are actively seeking partners that can deliver tight network alignment,…

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