Recent trends are affecting providers’ revenue cycles and altering how providers should manage those cycles. Basic RCM is no longer enough.
The US health insurance industry continues to be defined by uncertainty. The 25 articles in this compendium can help health insurers navigate the changes ahead.
The findings in this Intelligence Brief provide an introductory perspective on how the next US administration and Congressional Republicans may approach altering the ACA and related legislation. The information is based on publicly reported information released through December 8, 2016. Our Reform Center team is continuing to refresh this perspective on a real-time basis and is closely analyzing potential implications and economic impacts for each policy element under a full range of scenarios.
In October, CMS released the Medicare Advantage Star ratings for 2017. By analyzing CMS’s data, we uncovered trends indicating it will be critical for payors to continue to invest in their capabilities if they want to deliver quality programs that receive a Star bonus.
What states, private payors, providers, and technology companies are doing to control costs and improve outcomes for individuals with behavioral health conditions or in need of long-term services and support, including those with intellectual or developmental needs.
When people get to the age of 75, chances are they’ll stay put—with their health plans at least. According to our Annual Enrollment Period (AEP) survey of 2,208 senior consumers, the Medicare population is a loyal bunch, and loyalty increases with age.
We analyzed CMS’s data covering 642 MA plans and prescription drug plans across the 50 states to develop a perspective on the payor industry’s Stars performance.
Following the decision to become a value-based provider, how did the Emory Healthcare Network look to make transformation real?
What happens when our paradigm of care is challenged, and a new model is built from the ground up?
This intelligence brief discusses the likely impact (on both reimbursement rates and MA margins) of the provisions contained in the the final 2015 Rate Announcement and Call Letter for Medicare Advantage and Part D programs.
Five misconceptions are limiting payors’ ability to take advantage of the opportunities in the MA market—but those opportunities are considerable. To succeed in this market, payors must balance tailored investments in local-market planning and care-delivery effectiveness with greater administrative efficiency.