Executive Briefing | April 30, 2019

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

By

“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…

Read More

Executive Briefing | March 5, 2019

Value-Based Care Requirements in Medicaid

By ,

Historically, CMS has pushed towards value-based care (VBC) 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, VBC has historically…

Read More

News | November 16, 2018

HealthScape Advisors Combines with Convey Health Solutions

By

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…

Read More

Executive Briefing | November 13, 2018

Navigating CMS’ Enhanced Program Integrity—Preparing for the Spotlight

By ,

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…

Read More

Executive Briefing | October 30, 2018

Wait… MACRA Impacts Med Supp?

By

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…

Read More

hfm Magazine | September 6, 2018

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

By

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,…

Read More

Executive Briefing | May 31, 2018

Is Change Good for the Medicare Advantage Market?

By

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…

Read More

Whitepaper | May 23, 2018

Assessing Joint Venture Models for Provider-Sponsored Health Plan Products

By

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,…

Read More

Executive Briefing | March 20, 2018

Value-Based Contracting: How to Think Like a Payer

By

It is widely recognized that the rate of healthcare spending in the U.S. is unsustainable. In recent years, experts of all types, from academia to policy makers, agree that the traditional fee-for-service (FFS) approach is a major contributor to our…

Read More

News | February 28, 2018

HealthScape Advisors Achieves HITRUST CSF® Certification to Manage Risk, Improve Security Posture and Meet Compliance Requirements

By

HealthScape Advisors, a leading provider of healthcare consulting and analytics, today announced that the systems* of HealthScape Advisors and its affiliate Pareto Intelligence have earned Certified status for information security by HITRUST. HITRUST CSF Certified status demonstrates that the organization’s…

Read More