An Olive Branch and an Alarm Bell: Implications of the Final Rule and Rate Notice on Star Rating Performance
Kimberly Switlick-Prose, MPH,
CMS’s Final Rule offers financial relief but raises the bar on quality and equity. For Medicare Advantage plans, success now depends on prioritizing personalized care, understanding member and provider impact, and acting with precision across the care continuum.Read
Medicare Advantage Star Ratings: Were you surprised by the Star results?
Kimberly Switlick-Prose, MPH,
The recent Medicare Advantage Star Ratings serve as a wake-up call: the number of 5-Star plans and the percentage of members in 4+ Star plans are at their lowest in five years. This decline, driven by CMS’s stricter cut points and the shift to the Health Equity Index, demands that health plans adopt data-driven strategies and strengthen value-based care to remain competitive.Read
Avoiding Regulatory Scrutiny Through a Strong Risk Adjustment Compliance Culture
Brandon Solomon,
Achieving complete, accurate, and compliant risk adjustment outcomes is more important than ever. Discover how to build a strong compliance culture that safeguards against regulatory scrutiny and enhances your organization’s resilience in a challenging landscape.Read
Interactive Analysis: 2023 ACA Risk Adjustment Transfer Payment Results
Christopher Steibel,
Pooja Denchanala,
Analyze the results of 2023 ACA risk adjustment transfer payments by issuer and state through an interactive dashboard.Read
Encounter Data System (EDS) Submissions for MA Supplemental Benefits
Brandon Solomon,
EDS is the single source of information used by CMS to calculate risk scores and the initial, mid- and final-year payments to MAOs. Introducing supplemental benefit data, which will not impact risk scores or financial payments, adds a complicating factor to an already complex encounter data submission process.Read
Convey Health Solutions Names Dan Finke as Chief Executive Officer
Convey Health Solutions (Convey), a leading healthcare technology and services company, has appointed healthcare executive Dan Finke as chief executive officer. Finke succeeds Stephen Farrell, who has served the company for more than a decade.Read
Improve Data Ownership to Fast-track Your Risk Adjustment Strategy
Pareto Intelligence,
There are key areas of your risk adjustment program worth examining closely when reviewing your analytic progress.Read
Avoiding Inaccurate CMS Data Submissions and Supercharging Your Data Process
Pareto Intelligence,
To ensure accurate encounter data, it's important to have a thorough understanding of the data process. Address systemic issues early to avoid spending administrative resources on closing gaps year after year.Read
Interactive Analysis: 2022 ACA Risk Adjustment Transfer Payment Results
Austin Bostock,
Fiona Dassum,
Analyze the results of 2021 ACA risk adjustment transfer payments by issuer and state through an interactive dashboard.Read