Industry News

  • Avoiding Common Pitfalls of Performance Guarantee Surveys

    Avoiding Common Pitfalls of Performance Guarantee Surveys

    Many health plans and pharmacy benefit managers (PBMs) have contractual commitments with their large clients to meet certain performance guarantees (“PGs”), including meeting minimum levels of...

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  • Addressing America's Looming Healthcare Gap Crisis During COVID-19

    Addressing America's Looming Healthcare Gap Crisis During COVID-19

    While putting off care during the initial onset of the coronavirus made sense, continuing to do so will affect long-term outcomes. Here’s how providers can get patients back on track.

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  • Medicare Advantage Star Ratings: The New Patient Experience Imperative for Health Plans

    Medicare Advantage Star Ratings: The New Patient Experience Imperative for Health Plans

    CMS is putting more weight on patient experience measures in its Medicare Advantage and Part D Star ratings. What health plans can do now to improve their ratings.

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  • Three ways payers and providers are improving collaboration during the COVID-19 pandemic

    Three ways payers and providers are improving collaboration during the COVID-19 pandemic

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  • Maximizing Revenue and Optimizing Performance With Quality Measures

    Maximizing Revenue and Optimizing Performance With Quality Measures

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  • The Future of Personalized Patient Engagement: Driving Optimal Population Health Outcomes

    The Future of Personalized Patient Engagement: Driving Optimal Population Health Outcomes

    While technology certainly hasn’t solved all our problems, one thing technology has provided healthcare is the opportunity to really personalize patient engagement at scale.

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  • How Proactive Patient Engagement Can Influence Patient Health During COVID-19

    How Proactive Patient Engagement Can Influence Patient Health During COVID-19

    More than half of approximately 600 consumers (52%) surveyed in mid-March—the time when major metropolitan areas began issuing “shelter-in-place” orders and encouraging “social distancing”...

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  • Gauging Patients’ Healthcare Needs During a Crisis: Lessons from Successful Consumer Brands

    Gauging Patients’ Healthcare Needs During a Crisis: Lessons from Successful Consumer Brands

    What are patients’ most pressing healthcare needs during a crisis? If you ask healthcare plans and physicians, they’ll likely say “communication” and “care.”

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  • Medicare Advantage Star Rating Calculations Change; Act Now to Change 2023 Perceptions

    Medicare Advantage Star Rating Calculations Change; Act Now to Change 2023 Perceptions

    Experience, access, and complaints will matter more in future scores; current studies indicate plans currently are not communicating well with members.

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  • Case Study - JCMC: Technology and Workflow Improvements Lower Overall Costs and Increase Revenue While Improving Patient Service

    Case Study - JCMC: Technology and Workflow Improvements Lower Overall Costs and Increase Revenue While Improving Patient Service

    JCMC’s journey to becoming a model physician group began with a familiar challenge: In today’s fast changing regulatory and payment environment, mid-sized and many large independent physician groups..

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  • American Family Care’s CMO Shares Learnings from Data-Driven Performance Improvement in the Urgent-Care Setting

    American Family Care’s CMO Shares Learnings from Data-Driven Performance Improvement in the Urgent-Care Setting

    Benjamin Barlow, M.D., the CMO of American Family Care, the nation’s largest system of urgent care clinics, explains how AFC has become successful in using data to further performance improvement

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  • CMS Interoperability and Patient Access Fact Sheet

    CMS Interoperability and Patient Access Fact Sheet

    The Interoperability and Patient Access final rule (CMS-9115-F) delivers on the Administration’s promise to put patients first, giving them access to their health information when they need it most an

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  • ONC’s Cures Act Final Rule

    ONC’s Cures Act Final Rule

    The rule is designed to give patients and their healthcare providers secure access to health information. It also aims to increase innovation and competition by fostering new applications.

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  • How Payers and Providers Can Align and Collaborate, with or without Vertical Integration

    How Payers and Providers Can Align and Collaborate, with or without Vertical Integration

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  • Why payer-provider partnerships need more collaboration

    Why payer-provider partnerships need more collaboration

    The number of accountable care organizations (ACOs) reached an all-time high in 2018, notes an article in the journal Health Affairs.

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  • Inside CMS’ 2020 Proposed Changes to QPP

    Inside CMS’ 2020 Proposed Changes to QPP

    What’s at Stake for Medical Practices in 2020 and Beyond? CMS’ 2020 Proposed Rule for the Medicare Physician Fee Schedule calls for a number of changes.

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  • Leveraging The Right Ruler For Measuring Clinical Outcomes

    Leveraging The Right Ruler For Measuring Clinical Outcomes

    Knowing how to properly measure outcomes is as important as having the right clinical resources in place If you’re not measuring your efforts against industry benchmarks, how do you know you’re making

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  • 88 ASCs awarded for excellence in patient satisfaction — 3 details

    88 ASCs awarded for excellence in patient satisfaction — 3 details

    Eighty-eight ASCs were named recipients of the SPH Analytics National Apex Quality Award, a distinction recognizing providers who demonstrate excellence in patient satisfaction.

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  • 5 ways to create and implement better MIPS quality improvement strategies

    5 ways to create and implement better MIPS quality improvement strategies

    The Centers for Medicare & Medicaid Services (CMS) recently announced that 98.4 percent of eligible clinicians participated in the second year (2018) of Merit-based Incentive Payment System (MIPS).

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  • Physicians are facing more demands on their time than ever. What can payers do to help?

    Physicians are facing more demands on their time than ever. What can payers do to help?

    Increased prevalence of complex, chronic conditions. Numerous documentation requirements. Digital transformation and disruption. The shift to value-based care models. With all of the change happening

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