What’s coming
The Medicare market has demonstrated that an overall quality rating system like CMS Star ratings is a major game-changer for plan performance, member engagement strategies, and plan bottom line. And it’s no secret that a similar system is on the...
As the health care landscape continues to evolve, so do industry regulations. The latest development? New regulations were released last week by the Department of Health and Human Services (DHHS), bringing new exceptions and clarification to current...
No time to read all 81 pages of the newly released Medicare-Medicaid Capitated Financial Alignment Model Reporting Requirements (let alone the title)? No problem. Here’s the section on CY 2016 MMP core reporting requirements for rewards and incentives programs...
We optimize the MLR numerator. So can you. Let’s talk about how.
For Medicare Advantage (MA) plans, one of the most significant influences on expenditures and profit is the Medical Loss Ratio (MLR) rule. This rule requires that MA plans spend at least 85% of...
