Value-based care is the future of healthcare in the U.S. These four core competencies can help guide your organization toward a model that improves patient outcomes while decreasing costs. Don’t…
Meaningful Measures 2.0 goals are designed to facilitate the ongoing move toward value-based care, which targets issues including person-centered care, safety, chronic conditions, seamless care coordination, equity, affordability and efficiency,…
These four states are taking a boots-on-the-ground approach to addressing social determinants of health. Don’t forget to share this post!
When you can align activities such as prior authorizations, utilization management and operational workflows with regulatory mandates for quality, timeliness, interoperability and reporting, you can improve health plan Star ratings.…
The latest episode of Liberation Lab focuses on CMS changes to Star Ratings and what the shift in weights of different measures means to MA plans. Kimberly Swanson of Network…
Nancy Green, senior vice president at Aveus, sat down with Julie Barnes, founder of Maverick Health Policy, and Debbie Hill, vice president of product management at Medecision, to discuss changes…
The U.S. Department of Health and Human Services has prioritized efforts to contain the COVID-19 pandemic over enforcing HIPAA rules. Don’t forget to share this post!
A game-changing revision to CMS rules for Star ratings puts Medicare Advantage plans under extra pressure to deliver an excellent customer experience. At Medecision, our solutions and services help health…
The latest episode of Liberation Lab focuses on the prior authorization rule affecting utilization management. Julie Barnes, JD, Founder and Principal of Maverick Health Policy, shares insight on what healthcare…
What does the new interoperability and prior authorization rule mean for the patient experience? Julie Barnes, founder and principal of Maverick Health Policy, and Sarah Dencker, vice president of Network…
The healthcare appeals process can be difficult to navigate. How can we ensure that patients easily understand the process and their healthcare coverage? Don’t forget to share this post!
The COVID-19 pandemic has resulted in more people on Medicaid. It’s more important than ever before for the healthcare industry to do its part to ensure compliance with privacy and…
New rules will ease administrative burden, speed up reimbursement and remove fears of accidental violations. Don’t forget to share this post!
Liberation Lab turns its sights to the potential implications of the November 2020 election on US healthcare policy. Our expert guests include Colin Roskey, Principal and Partner at Lincoln Policy…
Moving forward, Fast Healthcare Interoperability Resources (FHIR) will be used for the digitalization of HEDIS quality measures. Don’t forget to share this post!
In January 2019, Medecision launched a yearlong process to achieve MARS-E compliance. Here’s how we did it. Don’t forget to share this post!
In October 2019, CMS proposed changes to the Stark Law, which was enacted in 1988 to prevent physicians from prioritizing financial concerns over patient care. Now, CMS says that changing…
CMS and ONC delays to enforcement give the industry a few additional months to prepare for major overhauls to ensure the appropriate sharing of patient health information. Yet the need…
Medical loss ratio (MLR) rebates hit a record $1.3 billion in 2019 because health plans spent too little on medical claims and too much on administrative costs. How can health…
More state Medicaid programs are now addressing SDOH through managed care plans and Section 1115 demonstration waivers. However, while these Medicaid programs offer states the ability to experiment and innovate…
In his “Automating Compliance in the Cloud” session during the CTO Roundtable at Liberation 2019, Gerry Miller, the founder and CEO of Cloudticity, discussed the inherent benefits and challenges of…
In February 2019, the Centers for Medicare and Medicaid Services (CMS) issued new requirements for Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and Qualified Health Plans, mandating they…
Healthcare organizations’ success under risk sharing and value-based care relies on a well-oiled UM program. Don’t forget to share this post!
Research shows that social determinants of health (SDoH)—such as housing, transportation, access to healthy food and more—are linked to patient outcomes. Managed care organizations are partnering with community and social…
Until recently, Utilization Management was all about how health plans determine preauthorization. But that definition is fast becoming outdated. Don’t forget to share this post!
What does Utilization Management have to do with Population Health? The answer: everything. Don’t forget to share this post!
SaaS application connects provider contract and member enrollment details for real-time authorizations and referrals, eliminates costs and delays tied to manual utilization management and universe creation DALLAS, TX – August…
