Mick Malec

Big things are in store for Medicare Advantage in 2024 and beyond! CMS enacted several new rules impacting health plans, from electronic prior authorization to Star Ratings revisions. Here's a quick glimpse at some key changes: ** Electronic Prior Authorization:** Plans must adopt electronic systems for prior authorization by 2026, streamlining the process for both providers and patients. ** Star Ratings Updates:** CMS is addressing concerns about certain measures and introducing a Health Equity Index in 2027. ** Utilization Management:** Plans must adhere to Medicare coverage rules, post internal criteria, and establish a review committee for utilization management policies. ** Marketing Makeover:** New rules restrict sales calls, mandate plan explanations, and prohibit misleading marketing tactics. ** Medicare Prescription Payment Plan:** Patients with high drug costs can spread them out across the year starting in 2025. This is great news for beneficiaries, but plan sponsors face operational challenges. ** Behavioral Health Access:** Improved network adequacy standards for behavioral health services are coming; CMS aims to ensure better access to psychiatry, psychology, and social work for Medicare Advantage enrollees. ** Agent and Broker Compensation:** CMS aims to reduce potential bias and enhance market transparency. ** Health Equity:** CMS proposes including a health equity expert in Utilization Management Committees and analyzing prior authorization requests through an equity lens. Want to dive deeper? Here's a link to more information: https://hubs.ly/Q02dNPTQ0

Big things are in store for Medicare Advantage in 2024 and beyond! CMS enacted several new rules impacting health plans, from electronic prior authorization to Star Ratings revisions. Here's a quick glimpse at some key changes: ** Electronic Prior Authorization:** Plans must adopt electronic systems for prior authorization by 2026, streamlining the process for both providers and patients. ** Star Ratings Updates:** CMS is addressing concerns about certain measures and introducing a Health Equity Index in 2027. ** Utilization Management:** Plans must adhere to Medicare coverage rules, post internal criteria, and establish a review committee for utilization management policies. ** Marketing Makeover:** New rules restrict sales calls, mandate plan explanations, and prohibit misleading marketing tactics. ** Medicare Prescription Payment Plan:** Patients with high drug costs can spread them out across the year starting in 2025. This is great news for beneficiaries, but plan sponsors face operational challenges. ** Behavioral Health Access:** Improved network adequacy standards for behavioral health services are coming; CMS aims to ensure better access to psychiatry, psychology, and social work for Medicare Advantage enrollees. ** Agent and Broker Compensation:** CMS aims to reduce potential bias and enhance market transparency. ** Health Equity:** CMS proposes including a health equity expert in Utilization Management Committees and analyzing prior authorization requests through an equity lens. Want to dive deeper? Here's a link to more information: https://hubs.ly/Q02dNz5P0

🔐Join Our Cybersecurity Webinar! 🔐 It’s never been more important to protect your technology.📱💻 Register now for an exclusive session with Chris Hauptli, CTO of Value-Based RCM. Chris will break down the complexities of cybersecurity in healthcare, covering who the threat actors are, their motivations, and how you can protect your data. We’ll also ask Chris about how healthcare facilities were affected when faced with the “blue screen of death” last week, and what it means that the cause of the problem was a flawed update to a trusted tool, CrowdStrike’s software to find and neutralize cyberattacks. Feeling overwhelmed by technology and data protection? Chris will simplify the process and provide clear strategies to safeguard your most critical asset—your data. 🛡️📊 In these uncertain times, gain the confidence and knowledge to secure your information. https://lnkd.in/efQkaNNk

Top Four Reasons You Need Accurate Data Mapping: 1. Enhance Quality of Care. 2. Improve Patient Outcomes. 3. Make Effective Data-Driven Decisions. 4. Keep Providers Happy. Learn more about Aesto's data mapping services: https://zurl.co/8JFe

Top Four Reasons You Need Accurate Data Mapping: 1. Enhance Quality of Care. 2. Improve Patient Outcomes. 3. Make Effective Data-Driven Decisions. 4. Keep Providers Happy. Learn more about why you need accurate data mapping: https://zurl.co/fdNk

By embracing available data, cutting-edge technology, and an intelligent marketplace, payers can design solutions that optimize costs across the entire healthcare ecosystem.

Listen Here: https://lnkd.in/gh78yi8g This episode, recorded live at Becker’s Healthcare 9th Annual Health IT + Digital Health + RCM Annual Meeting, features Bimal Desai MD, MBI, FAMIA, FAAP, Chief Health Informatics Officer at Children's Hospital of Philadelphia. Dr. Desai discusses transformative technologies like AI, CHIPS platforms, and remote patient monitoring, emphasizing their potential to reduce provider burden and improve pediatric outcomes. He highlights unique challenges in pediatrics, including state-specific Medicaid policies, teen privacy laws, and the lack of FDA-approved monitoring devices for children, while advocating for innovation tailored to the pediatric population. For more information about Becker's Healthcare, please contact Jessica Cole or Scott Becker. #podcast #healthcare #leadership #innovationinhealthcare