Dru Jeffery

Which #dental market factors are accelerating the transition to value-based care? Find out in our new white paper with HealthScape Advisors, a Chartis Company and NADP. https://ow.ly/4t9l50TUpQ7

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New in the latest issue of Radar on Medicare Advantage: The 'wild' 2025 MA bid cycle that could lead to market exits, how Aetna and insurtechs like Devoted Health outpaced their peers in the MA open enrollment period, CDPHP credits benefit stability and focus on behavioral health for its fast growth, and more top stories. https://hubs.ly/Q02zSmYw0

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Medicare Advantage gross margins dwarf other plans. In a recent KFF analysis, the gross margins for MA plans were well above other plans in 2023. KFF said that changes in gross margins can reflect changes in profitability and be indicators of financial performance. However, the health policy research group noted that gross margins aren’t the same as profitability since they don’t include administrative expenses or tax liabilities. Since 2015, gross margins for MA plans have gone from $1,425 per enrollee to $1,982, not far from inflation. Moody's has found that MA is more profitable per member than other types of plans but has found its profitability might be diminishing. #medicareadvantage

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New guidelines from CMS for the 2025 Medicare Advantage star ratings are making it more difficult for health plans to achieve or maintain high ratings. These changes will affect bonuses and the benefits plans can offer to members. Key Takeaways: - Higher Cut Points: Tougher thresholds across measures make it harder to score high. - Bonus Impact: Plans with 4+ stars earn key bonuses that fund benefits like zero-premium plans. Fewer high ratings mean fewer bonuses. - Tukey Method Uncertainty: New volatility has resulted in the highest star rating cut points ever. - Challenges for Insurers: Major players like Humana are seeing drops in highly-rated plans. - Focus on Quality: Plans need to close care gaps, engage members, and collaborate with providers to adapt. How We Can Help: Along with our PERS devices, Best Buy Health offers services to help boost Medicare Advantage star ratings: - Social Care Support: Address social needs for better member health. - Digital Literacy: Empower members to use health technology effectively. - Fall Detection & Urgent Response: Ensure timely interventions for member safety. - Health Risk Assessments (HRAs): Close care gaps and improve outcomes. These solutions enhance member experience and can support the quality metrics needed to help plans meet their star rating targets. Read the full article from Lauren Berryman at Modern Healthcare: https://lnkd.in/g38DNir3 #MedicareAdvantage #CMS #StarRatings #HealthcareQuality #BestBuyHealth #MedicarePlans #HealthInsurance #PERS

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Need a refresher on all the changes happening with Medicare Advantage? CMS recently announced the 2025 rate change—and insurance advocacy groups aren't happy about it, saying the base rate fails to account for higher utilization rates and healthcare costs. Then there's the new final rule announced this month, with a host of upcoming changes, and a proposed upcoming rule that will change how CMS determines Star ratings that are so crucial for MA plans. Read our latest blog for a roundup of MA changes. https://hubs.li/Q02vr2DV0

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📊👨‍⚕️ As the U.S. faces a primary care shortage, Direct Primary Care (DPC) is emerging as a viable solution, growing at an impressive rate of 36% annually. This subscription-based healthcare model eliminates the traditional insurance billing system, allowing doctors to maintain smaller patient lists and provide more attentive care. This shift not only enhances doctor-patient relationships but also offers employers a potential strategy to reduce healthcare costs. 🏥💼 Professionals in healthcare and HR: How do you view the adoption of DPC in corporate health strategies? Could this be the future of primary care? #DirectPrimaryCare #Medicare #Employeebenefits #Medicarecoverage #HRInnovation #HRChallenges #DoctorsChoiceusa 

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🏥 While insurance is a crucial part of Revenue Cycle Management (RCM), it's only one piece of the puzzle. 🧩 Innovative MedTech recognizes that effective RCM encompasses the entire patient journey, from pre-admission to final collection and beyond. We go beyond claims submission, focusing on key areas like contractual agreements, patient volume management, data analysis for both rejections and accounts receivable, collection strategies, case management, and a continuous cycle of improvement. Our expertise, combined with a deep understanding of the medical landscape, helps healthcare providers optimize their entire revenue cycle, leading to financial stability delivering exceptional, patient-centered services, the foundation for patient satisfaction. 📈 يعتبر التأمين الصحي جزءاً مهماً من إدارة دورة الإيرادات. ندرك أن الفعالية تشمل جميع مراحل رحلة المريض، مع التركيز على مجالات مثل اتفاقيات التعاقد، وإدارة حجم المرضى، وتحليل البيانات، واستراتيجيات التحصيل، مما يساعد مقدمي الرعاية الصحية على تحسين دورة الإيرادات وتحقيق استقرار مالي وتقديم خدمات متميزة تركز على رضا المرضى #InnovativeMedTech #RevenueCycleManagement #HealthcareInnovation #PatientJourney #MedicalBilling #ClaimsProcessing #FinancialStability #PatientSatisfaction #DataAnalysis #HealthcareProviders #ContinuousImprovement

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1/4 of people dropped from #Medicaid in the past year remain #uninsured, according to #KFF. While it's possible many of them may still be eligible for the program if they re-enroll, there's also a lot of opportunity for #healthinsurance agents to help their communities find #Marketplace or other coverage that works for them. Need help figuring out which places could use you the most? Check out our webinar on prospecting the unwinding:👇

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A significant portion of patient insurance coverage may go unnoticed, leading to missed collection opportunities. However, with Coverage Discovery from Approved Admissions, you can discover previously unknown, active billable coverage and reduce the amount of uncompensated care. Learn how to maximize collections with Coverage Discovery: https://lnkd.in/gKkRRcG6 #InsuranceDiscovery #HealthcareSoftware #RevenueCycle #RevenueCycleManagement #MedicalBilling

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Interoperability standards continue to shape the #healthcare industry from #CMS regulations to #HEDIS reporting. To set themselves up for continued success, payers must anticipate the coming shifts, and stay ahead of the ever-evolving landscape. 💭 A recent byline in DOTmed.com, Inc from our client Cotiviti dives into the necessary steps payers must take to ensure these standards are met for seamless #dataexchange: https://lnkd.in/ghGB_txj #interoperability #datasharing #FHIR 

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This year, the average overall Star Rating for Medicare Advantage Part D plans stood at 4.04, with only 5.69% of plans earning the coveted 5-star rating. Given the frequent updates and adjustments to the Star Ratings rubric by regulators, here are 5 strategies health plans can employ to stay ahead and improve their ratings: 1. Enhance Member Relationships: Utilize digital tools to track and address medication adherence and other health needs. Employ person-centered strategies for outreach and tailor communication channels to match member demographics. 2. Document and Credit All Efforts: Ensure all gap closures and services are properly documented to receive credit. This includes actions taken by providers and pharmacists. 3. Group Measures Thematically: Address related measures together to provide a holistic approach to care, like combining diabetes management with kidney evaluations and eye exams. 4. Stay Adaptable: Be prepared for ongoing changes in the Star Ratings criteria. For example, while the weight of CAHPS measures is decreasing, new indices like the Health Equity Index are being introduced. Adapting to these shifts is crucial for maintaining high ratings. 5. Optimize Your Metrics: Understand the cut points for each measure and set realistic goals. Focus on significant improvements where possible to move closer to the next cut point. By implementing these strategies, health plans can better navigate the complexities of the Medicare Advantage Star Ratings system and strive for higher ratings. Read more! #MedicareAdvantage #Healthcare #StarRatings #HealthPlans #HealthcareQuality #PatientCare #HealthEquity

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Big changes are ahead for #MedicarePartD in 2025. Our analysis covers Rx-HCC risk model updates, bidding changes, benefit redesign impacts & more. Get ready for this crucial transition. https://zurl.co/7VkH #PartDRisk #PartDBidding #CMS #healthcarecompliance

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Four years into implementation, nearly 40% of #MedicareAdvantage plans offer expanded primarily health-related benefits (EPHRB) or Special Supplemental Benefits for the Chronically Ill (#SSBCI). ATI Advisory and LTQA's report, "An Evaluation Framework for Assessing the Progress of Nonmedical Supplemental Benefit Development and Implementation in Medicare Advantage," supported by The SCAN Foundation, dives into the significant growth of these benefits, including in-home support services, food, and transportation to address health-related social needs (#HRSNs). Despite the growth, better data on access, utilization, and outcomes is crucial to understand their true impact on #Medicare beneficiaries' health and wellbeing. As policymakers and stakeholders navigate this evolving landscape, this report is a critical resource for enhancing these essential benefits. Read the full publication: https://lnkd.in/dHChUjF5 ATI Advisory, The SCAN Foundation

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Connie Health has acquired Keen Insurance Services, positioning Connie Health as a leading force in the Medicare navigation market. Keen's healthcare provider relationships and strong partnerships perfectly complement Connie Health's personalized, tech-driven Medicare navigation support. This fall, Medicare beneficiaries will review plans during one of the most confusing Medicare Annual Enrollment Periods. They will search for a trustworthy agent to navigate the system and find a new plan that suits them. As big insurers depart markets, Connie Health will be even more prepared to help beneficiaries navigate their Medicare journey. #conniehealth #medicare #medicareadvantage #medicaresupplement #medicarepartd #partd #prescriptiondrugplans #inflationreductionact #keeninsuranceservices #keeninsurance #keen #merger #acquisition #business #entrepreneur #mergers #mergersandacquisitions #investment #investing #startup #news #businessowner #investors #businessdevelopment Endpoints News

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While not quite the bump received after last year’s record inflation, the health savings account limits will still receive an increase for 2025, as determined under Section 223 of the Internal Revenue Code. Learn More:https://ow.ly/tvVQ50RBWmF #HSA #HealthSavingsAccount #FinancialPlanning

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