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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Executive Briefing | February 15, 2018

What Does EGWP Stand For? Untapped Potential!

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Employer Group Waiver Plans (EGWP) are often an untapped market within a comprehensive Medicare Advantage (MA) and Senior Market strategy for many regional health plans. Group retiree markets are changing due to pressure on retiree benefits. Refreshing your group retiree…

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Executive Briefing | September 19, 2017

What is Your Medicare Advantage Chronic Care Strategy?

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Nearly 150 million adults are living with at least one chronic condition in the United States. According to a recent RAND study, this chronically ill population accounts for hundreds of billions of dollars in healthcare spending annually and represents approximately…

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hfm Magazine | August 1, 2017

Medicare Advantage 2.0: Next Generation Growth Strategies

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Health systems generally recognize Medicare Advantage (MA) as being an important market segment, but many lack effective growth strategies and tactics for engaging and retaining consumers in this dynamic growth market. Successful strategies are predicated on the use of data-driven,…

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Executive Briefing | July 20, 2017

You Can’t Spell MACRA Without MA

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Is your organization MACRA ready? If so, you have probably invested significantly in infrastructure, innovative policies and procedures focused on care management, and consumer engagement strategies. MACRA is here to stay, but have you considered the broader Senior Market opportunity?…

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Executive Briefing | March 1, 2017

The Siege Continues: Justice Department Investigating Four Additional Medicare Advantage Plans

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WHO IS AT RISK The federal government has indicated that it is still investigating, and could ultimately join a false claims whistleblower qui tam action against Aetna, Inc., Humana, Inc., Cigna, Inc. (through its Bravo Health unit) and Health Net,…

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Executive Briefing | February 20, 2017

Medicare Advantage Plans Under Siege: Another Whistleblower Lawsuit

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In a court decision last year in Swoben v. United Healthcare, the United States Court of Appeals for the Ninth Circuit held that an allegation—that a Medicare Advantage Plan performed a “biased” HCC-RAF retrospective medical review designed only to identify…

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Executive Briefing | December 6, 2016

Does MACRA Still Matter?

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By now you are undoubtedly familiar with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The resulting Quality Payment Program (QPP) and its two participation pathways – Advanced Alternative Payment Models (APMs) and Merit-based Incentive Payment System (MIPS)…

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