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Editorial

Medicare Advantage plans can prepare for compliance reviews

Tonya Teschendorf, Cody Consulting

Conformity with CMS compliance guidance requires highly efficient communication and effective collaboration between a number of operative departments throughout a health plan.

As healthcare becomes more integrated, information exchange is more critical

Charlotte Hovet, MD, Dell Healthcare Services

The new payment models in the healthcare marketplace all provide incentives for coordinated care as a means of improving outcomes and lowering costs, especially for chronic diseases. As a consequence, 2014 looks to be the year of the health information exchange (HIE).

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President Obama acknowledges the technical issues with HealthCare.gov, pledging his Administration will resolve them soon and asserting that the distressed web portal is not the only way to shop for affordable health insurance available through the ACA.

 

Three years after launching a 750-patient Medicare Advantage collaborative care pilot, Portland, Maine-based independent physician practice NovaHealth and insurer Aetna have shown concrete results in improving care quality and reducing costs. Technology and provider-payer cooperation played a large part in the program's success.

Health insurers are betting on value-based payments, broadly defined, but providers still seem skittish.

Rethinking how it acquires information technologies seems to be giving one insurer an edge, letting it eke out a "trifecta" of lower costs, fewer unhappy customers, and increased revenue.

Network adequacy concerns are starting to generate renewed interest in new health plan provider mandates.

The parallels between the nation's ICD-10 switch and the popular fantasy epic are real.

Advances in molecular and genomic technology are creating a maze of new options for payers and patients replete with quite a few meaningful improvements as well as some dead ends.

The ranks of Medicaid are reaching record levels, giving payers and providers, especially, new opportunities.

In bundled payments, where once there was so much promise, there is now conflicting evidence.

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