Interviews

The Future of Medicare Advantage Risk Adjustment Data Validation

by Kelsey Waddill

Around four years passed between when CMS proposed the new rule on Medicare Advantage risk adjustment and when the Medicare Advantage Risk Adjustment Data Validation final rule was published. As stakeholders review the long-awaited final...

How States Can Prepare for 2023 Medicaid Redeterminations

by Kelsey Waddill

On April 1, 2023, states will begin the Medicaid redetermination process as part of the public health emergency unwinding. After anticipating this moment for the last two years, states finally received an official start date in the...

Going Beyond Benefits: How Employers Can Assess, Create Wellness Culture

by Kelsey Waddill

In the wake of the coronavirus pandemic, many employers expanded their mental health benefits to improve employee wellness. However, research has indicated that more mental health benefits do not necessarily equate to a robust...

Top Predictions for Health Insurers, Employers in the New Year

by Kelsey Waddill

Health insurers and employers face a challenging landscape in 2023, but these obstacles are accompanied by opportunities for growth, according to experts’ top predictions. Three years after the first wave of the coronavirus pandemic...

How Payer, Provider Alignment Enables Simplified Medical Billing Format

by Kelsey Waddill

When Banner|Aetna conducted market research and asked their members to name the primary barrier that prevented them from engaging easily with healthcare, the payer’s leadership did not expect the answer to involve medical...

Improving Accessibility for Spanish-Speaking Seniors in Medicare Advantage

by Kelsey Waddill

Over the phone, a Spanish-speaking senior explains to an Anhelo Salud (Anhelo) representative her recent history with Medicare. During the conversation, the representative realizes that different health plans have enrolled the senior in a...

How Employers Can Achieve a Fair Price in Hospital Negotiations

by Kelsey Waddill

Across the nation, Americans are feeling the pressure of escalating prices in nearly every area of life, from the grocery store to the clothing store to the gas pump. The hospital room is no exception. Hospital costs represent a...

How AZ Medicaid Expanded Its Role in Social Determinants of Health Coverage

by Kelsey Waddill

In September 2022, Arizona Health Care Cost Containment System (AHCCCS)—Arizona’s Medicaid program—received the Robert Wood Johnson Foundation’s 2022 Medicaid Innovation Award in “Initiatives to Address Social...

Value-Based Care Implementation Requires Investments, Collaboration

by Victoria Bailey

Prioritizing the shift to value-based care has been at the forefront of the healthcare industry. But the road to transitioning from fee-for-service to value-based payment models is not always smooth. Convincing payers of value-based...

How One Payer Expanded the Boundaries of Maternal Healthcare Benefits

by Kelsey Waddill

Investing in maternal healthcare may seem like a natural decision on an individual level, given the influence that positive, healthy parenting can have on a person’s life and the many healthcare needs that parents face. In reality,...

How MN Medicaid Used Community Engagement to Address Health Disparities

by Victoria Bailey

Addressing health disparities within state Medicaid programs can help ensure that all beneficiaries have equal access to quality care. Prioritizing community engagement is key to reducing these disparities, according to Julie Marquardt,...

How the Inflation Reduction Act Will Impact Employers, Health Plans

by Victoria Bailey

While the Inflation Reduction Act of 2022 will likely improve member retention and curb healthcare costs for enrollees in the individual market, the impact on the employer market is less clear. As Medicare negotiates lower drug prices,...

Top Factors Influencing Employer Sponsored Health Plan Premiums in 2023

by Kelsey Waddill

Employers face a challenging set of circumstances as they try to establish employer-sponsored health plan premiums for 2023. The second half of 2022 has introduced many variables that can affect healthcare prices. On the individual...

Top Payer Strategies Around Payment Models for Advanced Therapies

by Kelsey Waddill

In early 2020, fifteen healthcare leaders—spanning a wide range of backgrounds from government to industry to academia—converged for a little over a day to discuss a single, pressing issue that affected each of their fields:...

How Payers Can Move Providers Along Value-Based Care Continuum

by Kelsey Waddill

Payers can offer essential support to providers starting their journey through the value-based care continuum, while further research on value-based care in Medicare Advantage can help inform payers about best practices in this...

What Are Employer Sponsored Wellness Programs?

by Kelsey Waddill

What are employer-sponsored wellness programs and how are employers using these programs to advance employee wellness? The need for greater employer involvement in employee health and wellbeing is well-documented. At the beginning of...

Top Challenges, Benefits of At-Home Coronavirus Testing Coverage

by Kelsey Waddill

In the first quarter of 2022, payers witnessed significant changes in at-home coronavirus testing coverage with mixed reactions. These changes—and the influence of the coronavirus pandemic on preventive care—present both...

How to Introduce Medicare Advantage Caregiver Benefits in SNPs

by Kelsey Waddill

Payers cannot ignore the crucial role that caregivers play in members’ health, wellness, and recovery, and should consider supporting caregivers through Medicare Advantage caregiver benefits, especially in special needs...

Applying Whole Person Care to Digital Care for Underserved Members

by Kelsey Waddill

Payers have a significant role to play in ensuring that underserved populations receive whole person care, particularly among Medicaid beneficiaries. First, they can serve as a bridge between Medicaid beneficiaries and their primary care...

How to Hone Wellness Programs Using Social Determinants Data

by Kelsey Waddill

Are wellness programs working? This question is a common refrain for employers and their payer partners, but the answer remains ambiguous. On the one hand, some studies have supported wellness programs as a cost-effective way to...