According to the Centers for Disease Control, social determinants of health have a profound impact on health outcomes – much more, in fact, than the actual delivery of healthcare services. The health of people and communities is heavily influenced by such factors as socioeconomic status, education, social network support, access to care, access to transportation (…)
Over the next few years, health systems will need to decide when and how to make the move to value-based care reimbursement models. Value-based care programs, such as many Medicare Advantage plans, can reward providers for the delivery of high-quality, cost-effective care. Despite the potential for improving both patient care and bottom lines, organizations are (…)
Provider-sponsored Medicare Advantage plans provide an excellent opportunity for health systems to manage the premium dollar through a value-based contract. However, for every example of a successful provider-led plan, there are many more cautionary tales of providers struggling operationally to obtain positive outcomes. As seen in this infographic: Not even half of provider-sponsored MA plans (…)
Medicare Advantage continues to be a popular choice for seniors, with enrollment outpacing overall Medicare growth. Moreover, seniors are gravitating toward higher quality plans, as seen in this infographic depicting the enrollment distribution by plan Star Rating. More than 70 percent of Medicare Advantage Prescription Drug plan beneficiaries are enrolled in plans with four or (…)
Big data analytics tools, paired with buy-in from primary care providers, are enhancing population health management at Mount Sinai Health System. While the majority of healthcare organizations have at least recognized the importance of population health management, large integrated delivery systems with hundreds of locations and thousands of providers often find it difficult to drive (…)
CMS recently released the 2018 Star Ratings for Medicare Advantage plans across the country. CMS created the Star Rating System to reward clinical quality, member satisfaction and service, as well as regulatory compliance. For consumers, Star Ratings provide an easy way to shop for and compare plans during enrollment periods. The difference in one star (…)
Using such data as a source of social determinants of health information can boost the accuracy of population risk predictions. It’s no surprise when your mailbox is full of credit card offers or coupons and catalogues from your favorite stores. After all, it’s fairly common knowledge that credit reporting agencies like Experian and Equifax (which (…)
By Martha Butler, Senior Vice President, Health Plan Operations Autumn is in full swing—the leaves are changing colors, pumpkin spice lattes are everywhere…and CMS just released the 2018 Star Ratings for Medicare Advantage (MA) plans. How did your organization fare? If you’re like the 56% of MAPD plans rated below 4 Stars, you may be (…)
By Ben Kline, Business Development and Joel Andersen, Vice President, Marketing After considerable due diligence, your organization has decided to launch a Medicare Advantage (MA) plan. You evaluated the market and current MA enrollment. You examined market competitors, such as provider-sponsored organizations, regional insurance firms, and large national organizations. You gauged potential competitor responses, trying to figure (…)
By Mitu Ramgopal, Business Development As health systems define their future state vision and how they will achieve the transition to value-based care, one approach that has emerged is to join a provider collaborative. Health systems are coming together to start sharing best practices and work toward common goals. However, it is critical to determine how (…)