Leading Market Trends and Challenges from the MLTSS Leadership Summit Managed Long-Term Support Services (MLTSS) continues to be spotlighted in discussions of complex care management, whole person care models, health disparities, and the direct care workforce shortage. Managed Care Organizations…

Market strategies to drive transformation of healthcare delivery and payment towards value are at a cross-roads. In response, health plan VBC strategy success will depend on their ability to develop and deploy specialty VBC models. Industry advancements in value-based care…

In the past few years, the COVID-19 pandemic has dominated our attention, disrupting traditional healthcare delivery and access. During this time, member access to care was largely focused on adapting and responding to the pandemic. Now that the industry has largely reached stabilization…

Every January, we provide our perspective on areas of increasing importance and value for health plans for the upcoming year. Our prospective view of 2021 focused on the need for health plans to strike a balance between innovation and investment…

Section I: Introduction Over the past decade, the value movement in healthcare has grown and evolved. Driven by the development and adoption of primary care-led models (e.g., patient-centered medical homes, accountable care organizations or ACOs), payers have experienced a significant…

YOUR PROVIDER DATA QUALITY PROBLEM MAY BE BIGGER THAN YOU THINK… AND IT COULD BE GETTING WORSE Under normal circumstances, inaccurate provider data presents significant operational and financial challenges for health plans. In 2020, these problems have been exacerbated across…

“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.” –…