Medical loss ratio (MLR) rebates hit a record $1.3 billion in 2019 because health plans spent too little on medical claims and too much on administrative costs. How can health plans leverage their utilization management programs to better balance their medical and administrative expenses?
Mitigate Compliance Risks by Addressing These Key Documentation and Billing Challenges for Medicaid Managed Care Plans
More state Medicaid programs are now addressing SDOH through managed care plans and Section 1115 demonstration waivers. However, while these Medicaid programs offer states the ability to experiment and innovate through various approaches, several compliance and regulation challenges must be reconciled.
In his “Automating Compliance in the Cloud” session during the CTO Roundtable at Liberation 2019, Gerry Miller, the founder and CEO of Cloudticity, discussed the inherent benefits and challenges of digitizing medical data and automating compliance in the Cloud.
In February 2019, the Centers for Medicare and Medicaid Services (CMS) issued new requirements for Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and Qualified Health Plans, mandating they provide enrollees with immediate electronic access to health data by 2020. So what do these new requirements mean for those payers?
Healthcare organizations’ success under risk sharing and value-based care relies on a well-oiled UM program.
Research shows that social determinants of health (SDoH)—such as housing, transportation, access to healthy food and more—are linked to patient outcomes. Managed care organizations are partnering with community and social support providers to address SDoH to deliver better health outcomes.
Until recently, Utilization Management was all about how health plans determine preauthorization. But that definition is fast becoming outdated.
What does Utilization Management have to do with Population Health? The answer: everything.