Category: Thought Leadership

Why Data on Social Determinants of Health is Growing in Importance

January 15, 2018 | By

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 (…)

3 Reasons Why Collaboration is the Right Approach to Medicare Advantage

January 15, 2018 | By

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 (…)

Survey: Health Systems Share Their Progress in Moving to Value-Based Care

January 9, 2018 | By

Change remains constant in healthcare today. As the industry continues to undergo transformative change and emphasize improved quality with lower total cost of care, health systems are making the shift from volume to value. While most health systems are still operating in a primarily fee-for-service environment, many are working toward a value-based care model in (…)

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 (…)

Capitalizing on Comprehensive Care: Cultivating a Medicare Advantage Mindset

November 15, 2017 | By

Author: Richard Jones, Chief Executive Officer of Essence Healthcare & Chief Corporate Development Officer, Lumeris In response to the growing popularity of Medicare Advantage (MA) among consumers, the number of provider-sponsored MA plans is on the rise. Launching an MA plan offers health systems the potential to strengthen their bottom lines while acquiring the capabilities (…)

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 (…)

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