Harnessing the Power of Data: Integrating HEDIS, Risk Adjustment and Social Determinants of Health for Effective Population Health

Harnessing the Power of Data: Integrating HEDIS, Risk Adjustment and Social Determinants of Health for Effective Population Health

– by Lynn Kryfke, MSN, RN, Sr. Consultant, Risk Adjustment | Jon Rogers, Sr. Consultant, Risk Adjustment  Leading healthcare organizations are developing strategies to align their programs and streamline the process of gathering crucial data to better serve beneficiaries. With the goal of achieving population health, managed

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2025 Medicare Advantage Reforms: A Comprehensive Shift Towards Equity, Transparency and Patient-centered Care

2025 Medicare Advantage Reforms: A Comprehensive Shift Towards Equity, Transparency and Patient-centered Care

Charles Baker, VP, Compliance Solutions The Centers for Medicare & Medicaid Services (CMS) continues to build upon its strategy to support person-centered, value-based care through the 2025 Medicare Advantage and Part D programs proposed rule. These proposals, a bold stride towards enhancing health equity, transparency, and patient-centric

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Changes to Medicare Advantage Network Adequacy Requirements for Behavioral Health Services: What You Need to Know

– by Jocelyn Bayliss, Program Lead, Provider Network Management & Tina Gallagher, Market Manager, Provider Network Management In April 2023, CMS issued a final rule that added two new specialty types, clinical psychology and clinical social work, to network adequacy standards. Addition of Specialty Types and Amendments

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Guarding Medicare’s Future: 2025 Proposed Rule to Revolutionize Medicare Advantage Agent and Broker Compensation

Guarding Medicare’s Future: 2025 Proposed Rule to Revolutionize Medicare Advantage Agent and Broker Compensation

Charles Baker, VP, Compliance Solutions The issue of Medicare Advantage (MA) plans paying administrative fees to field marketing organizations (FMOs) and agents is a hot topic. This is particularly true in light of recent congressional oversight hearings and the newly released 2025 Medicare Advantage Part D proposed

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