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Editorials

Medicare Advantage Rewards and Incentives: Are we there yet?

Betsy Seals, Gorman Health Group

Yes, Medicare Advantage is finally catching up to the rest of the health care industry, and we are now permitted to offer enrollees Rewards and Incentives.

2015: The perfect storm has arrived

Ray Desrochers, HealthEdge

There is little doubt that the perfect storm is here. A combination of regulatory requirements, changing employer attitudes and consumer buying habits has hit hard, and health insurers are taking the appropriate steps to ensure that they don't become the next Andrea Gail. For many health plans, 2015 will be the year of technology.

Payment integrity in the post-reform era

Paul Vosters, Discovery Health Partners

Many payers face profitability declines while also taking in a huge influx of newly insured members whose risk profiles are unknown. Payers continue to see billions of dollars in error rates on claims each year, and fraud and other abuse further erode the bottom line.

What is effective consumer engagement?

Seth Ravine, Acclaris

The era of consumer-driven healthcare puts the consumer in the driver's seat. However, the added responsibility can be daunting when you aren't sure where to go. They need guardrails.

Creating a better digital member experience

Michael Gordon, Healthx

Member self-service portals have become a must-have for healthcare payers. Members expect and demand them. Yet putting up a portal and just expecting members to use it is a fast track to failure and lost business.

The impacts of IMPACT

Anne Montgomery

The world of Medicare post-acute care is set to change, as a series of reforms ultimately rewrite payments in a sector that accounts for more than 20 percent of all Medicare spending. 

What happened to pairing risks and rewards?

Paul Levy

Here's a point of view guaranteed to upset those who religiously believe (nothwithstanding structural flaws) that the move to accountable care organizations with an accompanying shift of risk to providers is the way to transform the U.S. healthcare system.

Optimizing CMS-regulated customer communications

Doug Cox, Elixir Technologies

For payers that offer Medicare, Medicaid and hybrid government-sponsored plans, the regulations established by the Centers for Medicare and Medicaid Services present significant challenges in generating customer communications that are compliant as well as effective.

The pursuit of value with risk models

Matt Siegel, Verisk Health

The proliferation and variety of accountable care designs in commercial insurance, Medicare Advantage and managed Medicaid highlight the need predict the appropriate cost of care, ensure access to needed services and raise quality. But how can value be measured?

Will stricter controls on painkillers curb abuse and addiction?

G Caleb Alexander, Kevin Fain, Matthew Daubresse

Americans consume a staggering amount of the opioid painkiller hydrocodone, about 99 percent of the world's supply. In October, after 10 years of debate the Drug Enforcement Agency (DEA) reclassified medications like Vicodin, and products that combine hydrocodone with other drugs, as Schedule II controlled substances.

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