Business Sponsors
Effective Population Health Management in a Changing Arena
Altegra
3/15/2016
Success in today’s health plan environment requires nimble population health management (PHM) that stretches beyond what historically defined successful PHM practices. Today, driving health outcomes, quality scores, cost trends and member-retention rates – all products of well-executed PHM -- are critical in amassing a solid standing in the market.
OOPC Deconstruction: How do PDPs maintain meaningful differences?
Milliman
3/15/2016
Many standalone Medicare Part D Prescription Drug Plan (PDP) sponsors exhibit significant variation in formulary coverage among plan offerings in a given service area. This variation is driven in part by the Centers for Medicare and Medicaid Services (CMS) requirements for “meaningful differences” between PDPs offered by the same PDP sponsor in the same region.
RowdMap, Inc. Joins Centers for Medicare and Medicaid Services (CMMI), Johns Hopkins Healthcare and American Medical Association at Auburn University Policy Conference
3/29/2016
Joshua Rosenthal, PhD, Chief Scientific Officer and Co-Founder at RowdMap, Inc., will be speaking on how identifying, quantifying and reducing low-value care is key to achieving success in value based programs and risk arrangements in order to capture value from population health programs.
Special Registration Fee for the Empower Care Management Conference
4/11/2016
Empower is the country’s premier care management conference for health plan leaders from government health plans serving vulnerable and at-risk populations.
Why Outsource Prior Authorization?
4/12/2016
Today, a lot of health plans are asking themselves these questions: “Why outsource prior authorization to a specialty vendor when the health plan is the one controlling the daily
tasks of the operation? Wouldn’t this just add more complication to the process?”
Corporate Governance Annual Disclosure Model (CGAD) Law and Regulation
5/5/2016
The states with a June 1, 2016 filing requirement are California, Iowa, Indiana, Louisiana and Vermont. If you have a company domiciled in any of these states, you will need to file the CGAD this June only in your state of domicile. Your Company will file the CGAD with the financial examiner in your domestic state. Contact your examiner with any questions.
Pareto Intelligence Member Economics: Value Add Services to Alliance Members to Improve ACA and MA Performance
5/8/2016
As part of the recent partnership and execution of a GPO contract between HealthScape Advisors and the Alliance, HealthScape is pleased to offer exclusive, value add services to Alliance plans.
The Rise of the Empowered Healthcare Consumer
Patricia Birch & William Shea, Cognizant Business Consulting
5/9/2016
Welcome to the world of the engaged, aware and empowered healthcare consumer. Transformative market forces, coupled with rapid advances in digital technologies, are placing consumers at the center of an increasingly virtualized, personalized and delocalized healthcare system.
EDGE Complete with RVC – May 2016
5/24/2016
For many, the recent ACA-mandated edge submission was fraught with challenges, stress and complexities – all compounded by the challenging nature of working with CMS. And it’s not over. While submission is complete for this year, it’s time to prepare for the 2016 benefit-year submission by evaluating processes for work errors, discrepancy management and orphan claim elimination.
Beyond Compliance: Properly leveraging ERM for additional value
Shawn Dahl & Adam Marshall, RSM US LLP
5/27/2016
While many companies leverage enterprise risk management (ERM) from a compliance perspective, the approach is much more than just a one-way street. Too often, risk management efforts focus on regulatory and compliance demands versus strategic and business objectives. However, changing the perspective of ERM can be a competitive differentiator, creating additional operational, cultural and financial advantages for any organization.
Three Trends Affecting Care Management
AxisPoint Health
6/6/2016
The healthcare system in the U.S. is undergoing rapid and dramatic transformations. Health insurers are facing changes due to healthcare reform, continued growth in healthcare spending, an aging population, and an increasing number of people with chronic diseases. Here are three important trends that will impact the care management industry in the next three to five years.
Why Insurers Should Take Their Cues from the Travel Industry
Lance Hood, Array Health
6/6/2016
When consumers visit the Expedia or Delta Air Lines websites, not only can they book an airline ticket, they can also quickly and conveniently purchase everything related to the trip: car rental, travel insurance, hotel bookings, etc. For insurers, taking a lesson from the travel industry inspires a new way to leverage ecommerce to strengthen their affiliate marketing programs.
Uncovering the Value of Member-PCP Relationships
Altegra Health
6/6/2016
Improve health outcomes; lower the cost of care. It’s the mantra of the healthcare industry, and as the matrix of solutions grows in complexity, one healthcare basic delivers on both objectives: the member-primary care provider (PCP) relationship.
Health Plans are Revisiting Their Transparency Strategy
6/22/2016
A “perfect storm” of market trends is leading health plans to take another look at transparency. Consumer out-of-pocket costs are skyrocketing. And at the same time, consumers are mostly unaware of the huge price variations for routine medical procedures and test.
Stepping back from the edge
Candice Keichline, Altegra Health
6/27/2016
For many, the recent ACA-mandated edge submission was fraught with challenges, stress and complexities – all compounded by the challenging nature of working with CMS. And it’s not over. While submission is complete for this year, it’s time to prepare for the 2016 benefit-year submission by evaluating processes for work errors, discrepancy management and orphan claim elimination.