For Medicare Advantage Organizations (MAOs), the summer months have historically been defined by the high stakes, tight turnarounds and document management challenges of the Annual Enrollment Period (AEP). From the first Monday in June to late September, employees of MAOs clear personal calendars to carry out the demanding responsibilities of modifying all plan documents to reflect a variety of updates, including those for each individual plan offering, as well as the model document language and
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Healthcare Policy Regulation & Reform | News, Analysis, Insights - HIT Consultant
New President – What’s Going to Happen to Healthcare?
High insurance premiums and medical costs don’t discriminate or differentiate based on your political affiliation. Therefore, healthcare should be one of your top priorities for the new administration. As a country we have been passengers passively watching the medical costs increase while the services deteriorate, only reacting when the problem lands on our doorstep.
This is a complex topic with fingers pointing everywhere passing the blame game like a hot potato. In my
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How Medicare Advantage Programs Can Address Social Risk and Improve Health Outcomes
There are almost 33 million people enrolled in eligible Medicare programs. Nearly half are enrolled in Medicare Advantage (MA) plans, and that number is expected to continue its climb. While many MA plans offer services that align with social determinants of health (SDOH) goals, there are still gaps in how these services reach and support vulnerable populations. This challenge is multifaceted. Critical issues include:
An incomplete understanding of how MA services impact different SDOHs
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Transforming The Contact Center Into A Value-Based Care Engine
The most effective way to reduce the amount of money our country spends annually on healthcare – which now exceeds $4.1 trillion – is to help people avoid becoming sick in the first place. That’s the fundamental premise of value-based care (VBC), which focuses on improving patient outcomes and quality of care while driving down costs.
VBC is great in intent and theory, but many provider organizations today are struggling to meet the quality and financial metrics stipulated under these
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Promise of Value-Based Care Through Engagement and Outreach
The transformation of the healthcare landscape is undeniable. With the industry moving toward value-based care, the emphasis has shifted from volume of services to the actual value or outcome of care delivered. And while value-based care holds providers more accountable for results, it also grants resources and time to provide better, more patient-centric care.
But even years into the shift, no comprehensive guidebook for success remains. While providers are rewarded for higher-quality
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Optimizing MIPS Value Pathways (MVPs) for Oncology Practices in 2025
The Centers for Medicare and Medicaid Services (CMS) introduced the MIPS Value Pathways (MVPs) as part of its ongoing revisions to the Merit-Based Incentive Payment System (MIPS) program, which was established in 2017 to encourage ongoing and consistent quality, efficiency, and improvement in medical practices. The MVP framework was designed to ease the burden imposed on clinicians and their administrators who participate in the MIPS program. Traditionally, MIPS scores have been calculated based
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Unpacking Medicare Advantage Terminations and How Plans Can Navigate Them
The U.S. healthcare system has been undergoing its own stress test. Stakeholders are currently experiencing a variety of pressures with a primary focus on finances, including administrative costs. The COVID-19 pandemic is often used as a convenient delimiter for the emergence of these problems, but in reality, tensions were brewing long before now and were caused by a variety of factors. Medicare Advantage (MA) is facing the headwinds of these issues – and as a result, MA
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Millions of Americans Remain Uninsured or Underinsured Despite ACA Gains
What You Should Know:
- A new report from the Commonwealth Fund reveals that despite significant progress in expanding health insurance coverage under the Affordable Care Act (ACA), millions of Americans still lack adequate and affordable healthcare.
- The report highlights the prevalence of coverage gaps, high out-of-pocket costs, and the burden of medical debt, underscoring the need for further policy action to achieve truly universal coverage.
Uninsured and
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Medicaid & Health Equity: Addressing Disparities in Maternal and Mental Health
Recent advancements in healthcare, such as telemedicine, automation, and clinical studies, have propelled the industry forward, unleashing new possibilities for fostering better patient outcomes. While many are lucky enough to reap the rewards of new research and technology, critical communities are being left behind.
The Medicaid population, who typically benefits from progress last, still grapples with harmful biases within the healthcare system that pose extreme barriers to care. A new
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Parakeet Health Launches With $3M for GenAI Voice Platform to Enhance Patient Engagement
What You Should Know:
- Parakeet Health, a generative AI company focused on revolutionizing patient engagement, has announced the launch of its AI-powered voice platform and has secured $3M in seed funding to fuel its growth and development.
- This innovative solution aims to streamline patient communication for healthcare providers, improving efficiency, reducing costs, and enhancing the patient experience.
Addressing a Critical Need
With 90% of patients still
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