Health Systems Continue to Launch MA Plans…But Must Meet CMS’s Demands on Quality

December 19, 2017 | By

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 (…)


Highly Rated Medicare Advantage Plans Attract More Seniors

December 12, 2017 | By

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, PCP Engagement Aid Mount Sinai with Population Health

December 4, 2017 | By

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 (…)


Reach for the Stars

November 29, 2017 | By

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 Personal Financial Data to Improve Healthcare

November 28, 2017 | By

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 (…)


Your Star Ratings Just Came Out…Now What?

October 26, 2017 | By

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 (…)


Need to drive MA plan membership? Don’t ignore your Marketing and Sales strategy

September 13, 2017 | By

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 (…)


Thinking about joining a provider collaborative? Not so fast…

September 8, 2017 | By

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 (…)


White Paper: 40 Years in the Payment Reform Wilderness: DRGs to Nirvana

June 14, 2017 | By

In a perfect world, a well-functioning healthcare delivery system should provide the right care at the right time in the right place, while being accountable for clinical and financial outcomes. But the current method of paying for healthcare is broken. Since the inception of Medicare more than 50 years ago, the system has been designed (…)


White Paper: Reinvent & Reimagine Population Health: Interconnected Care Delivery

June 14, 2017 | By

In this paper, Reinvent & Reimagine Population Health: Interconnected Care Delivery, Lumeris author Kamesh Somanchi discusses the steps required for developing an interconnected platform to support value-based care delivery. While various population health management technology solutions have enabled healthcare organizations to start their transition to value, full transformation requires a comprehensive strategic and operational platform-based (…)


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