Taking Action: How States Are Using Medicaid 1115 Waivers to Address SDOH
These four states are taking a boots-on-the-ground approach to addressing social determinants of health.
Improving Health Plan Star Ratings
When you can align activities such as prior authorizations, utilization management and operational workflows with regulatory mandates for quality, timeliness, interoperability and reporting, you can improve health plan Star ratings.
2021 Star Ratings: Bottom-Line Impact and Strategies
The latest episode of Liberation Lab focuses on CMS changes to Star Ratings and what the shift in weights of different measures means to MA plans. Kimberly Swanson of Network…
Star Ratings Now Focused on Member Experience
Nancy Green, senior vice president at Aveus, sat down with Julie Barnes, founder of Maverick Health Policy, and Debbie Hill, vice president of product management at Medecision, to discuss changes…
Pandemic Leads to Relaxed Penalties for HIPAA Violations
The U.S. Department of Health and Human Services has prioritized efforts to contain the COVID-19 pandemic over enforcing HIPAA rules.
Star Ratings and the Need to Improve Consumer Experience
A game-changing revision to CMS rules for Star ratings puts Medicare Advantage plans under extra pressure to deliver an excellent customer experience. At Medecision, our solutions and services help health…
The Prior Authorization Rule and Advancing Utilization Management Performance
The latest episode of Liberation Lab focuses on the prior authorization rule affecting utilization management. Julie Barnes, JD, Founder and Principal of Maverick Health Policy, shares insight on what healthcare…
What the Interoperability and Prior Authorization Rule Means for the Patient Experience
What does the new interoperability and prior authorization rule mean for the patient experience? Julie Barnes, founder and principal of Maverick Health Policy, and Sarah Dencker, vice president of Network…
Managing the Appeals Process for Medicaid Populations
The healthcare appeals process can be difficult to navigate. How can we ensure that patients easily understand the process and their healthcare coverage?
Improving Compliance for Medicaid Populations
The COVID-19 pandemic has resulted in more people on Medicaid. It’s more important than ever before for the healthcare industry to do its part to ensure compliance with privacy and…
Final Updates to Stark Law Will Ease Transition to Value-Based Care
New rules will ease administrative burden, speed up reimbursement and remove fears of accidental violations.
Post-Election Healthcare Policy Implications
Liberation Lab turns its sights to the potential implications of the November 2020 election on US healthcare policy. Our expert guests include Colin Roskey, Principal and Partner at Lincoln Policy…
Making Measurable Improvements in Healthcare Quality
Moving forward, Fast Healthcare Interoperability Resources (FHIR) will be used for the digitalization of HEDIS quality measures.
Medecision’s Path Toward MARS-E Compliance
In January 2019, Medecision launched a yearlong process to achieve MARS-E compliance. Here’s how we did it.
Proposed Stark Law Changes Reflect Move Toward Value-Based Care
In October 2019, CMS proposed changes to the Stark Law, which was enacted in 1988 to prevent physicians from prioritizing financial concerns over patient care. Now, CMS says that changing…
CMS and ONC Interoperability Rules: What Do the Latest Updates and Enforcement Delays Mean for the Industry?
CMS and ONC delays to enforcement give the industry a few additional months to prepare for major overhauls to ensure the appropriate sharing of patient health information. Yet the need…
Leveraging Utilization Management to Reduce Medical Loss Ratio Rebates
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…
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…
Automating Compliance in the Cloud
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…
New Rules From CMS Carry Heavy Weight for Payers
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…
Risk Sharing Requires Health Plans to Hone Utilization Management Process
Healthcare organizations’ success under risk sharing and value-based care relies on a well-oiled UM program.
Addressing Social Determinants of Health Can Lead to Better Health Outcomes
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…
“Utilization Management” is all about saving health plans money. Or is it?
Until recently, Utilization Management was all about how health plans determine preauthorization. But that definition is fast becoming outdated.
Utilization management: What’s it got to do with population health?
What does Utilization Management have to do with Population Health? The answer: everything.
Medecision Launches Aerial UM Connector™ to Drive In-Network Referrals and CMS Reporting Compliance for Government Health Plans and TPAs
SaaS application connects provider contract and member enrollment details for real-time authorizations and referrals, eliminates costs and delays tied to manual utilization management and universe creation DALLAS, TX – August…
