Keeping your wind in the final AEP laps

Debbie R. Mabari
Debbie R. Mabari's picture

Medicare plans are mid-way through the process of creating Annual Election Period (AEP) materials that are due to members by the end of September. At this stage of the game, tension is running high and time is running out.

Patient engagement as a route to better star ratings

Mariza Hardin, Alere Health
Mariza Hardin's picture

Not only are older Americans living longer than in past generations, they also have multiple health problems. If Medicare Advantage plans focus on effective engagement strategies that address these issues, they can improve member satisfaction and outcomes, scores for which are weighted three times more heavily than operation measures.

What about the working class and middle class?

Robert Laszewski, Health Care Policy and Marketplace Review
Robert Laszewski's picture

Perhaps the biggest consumer problem Obamacare has is that the plans with high premiums even after the subsidy, big deductibles, and narrow networks are not attractive to working class and middle class families and individuals who don't qualify for the biggest tax credits.

Lessons learned from consumerism

Tom Paul, chief consumer officer, UnitedHealthcare

In recent years, there has been an incredible transformation in the healthcare industry, especially in the role of consumers. A decade ago, health plans worked with employers to manage almost all health benefit decisions, leaving consumers relatively unaware of the costs associated with their healthcare needs. Not so today.

Four ways to thrive in the midst of change

Sohil Goorha

Though the deadline for complying with significant reforms of the Affordable Care Act has come and gone, payer organizations across the country are still adapting to the newfound complexities of their evolving industry.

The hidden segment

Shiv Gupta

With the first healthcare exchange open enrollment period concluded, savvy health plan marketers are spending much of their time and resources sifting through enrollment data hoping to gaint insights. However, this is a new world for plan providers, and most current marketing plans and sales strategies were developed for commercial and Medicare sales.

Cloud, mobile promise to ease claims, authorization friction

Michael Arrigo

Health care providers have long expressed dissatisfaction with the time they spend coordinating care with health plans and getting paid. Indeed, one of the most inefficient and costly processes for both providers and payers is Prior Authorization.

The need for comprehensive Medicare Advantage compliance reviews

Vanessa Pawlak, Ernst & Young

For Medicare contract sponsors to remain viable, it's now necessary to perform a comprehensive Medicare program compliance review. Proposed rule changes may give CMS additional authority next year.

PBMs are a health plan's Achille's Heel

John Gorman, Gorman Health Group
John Gorman's picture

In this Golden Age of government programs, the health plan industry has never had more exposure to the generally poor performance of pharmacy benefit managers (PBMs). Performance metrics in Medicare, Medicaid and ObamaCare are directly tied to PBM execution, and the recent track record of these companies means they are the Achille’s Heel of insurers.

Group plans more susceptible than ever to security violations

Mary A. Chaput

Many healthcare executives fall prey to two common misconceptions about data breaches: that the only companies making headlines for lax data security are big retailers like Target and that the biggest culprits are teenage hackers or sophisticated teams working in China or Eastern Europe.


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