Medicare Advantage (MA) plans are dealing with some notable setbacks and losses in projected earnings per share because of falling Star Ratings.
Realization of technology investments is critical for improving STAR ratings and HEDIS® measures in a timely manner and for producing the outcome and performance measures required in value-based care contracts.
Over a decade of programs championed by the Center for Medicare and Medicaid Innovation, focusing on accountable care and bundled payments, have had some notable successes. Private value-based care arrangements, structured by health plans and state Medicaid departments have had some significant achievements.
Competitive pressures and complex regulatory plan performance reporting requirements create an additional challenge – acquiring correct and accurate data to demonstrate the best possible value to potential members, governmental agencies, and employer purchasers.
Transforming raw data into actionable insights is essential for Fast healthcare Interoperability Resources (FHIR) standards and improving HEDIS scores. Learn more from this roadmap on how to achieve scalable efficiencies for managing clinical data at the enterprise level. The strategic value of clinical data is growing significantly for payers, but finding the right types of clinical data and gaining access to it remain challenges in the current healthcare ecosystem.
Verinovum, Inc. recently utilized marketing partner Envision Health to execute a third-party market research study of Medicare Advantage (MA) programs in seven payer organizations of varying sizes and demographics. The goal of the study was to better understand the role and structure of MA programs within different kinds of payer organizations and how these payers and programs obtain and use clinical data for their most pressing needs.
Disease management (DM), which has been around since the 1970s and became more prevalent with the advent of managed care, was designed to improve patient quality of life. By helping to ensure continuity of care and equipping patients with education and resources to better self-manage their conditions, people with chronic disease were shown to have better outcomes than those who did not participate in disease management programs.