Care Management

Payer Virtual Care Management Platform Prioritizes Holistic Care

by Victoria Bailey

Blue Cross Blue Shield of Rhode Island (BCBSRI) has introduced a new virtual care management platform to offer a more convenient way for members to receive care coordination services and to improve...

How AI Supports Low-Risk Member Identification, Care Management

by Kelsey Waddill

Artificial intelligence (AI) can shed light on trends within low-risk member populations so that health plans can prevent them from progressing into the high-risk category. There are a couple of key...

Humana Announces MA Chronic Disease Management, SDOH Model

by Kelsey Waddill

Humana has launched a pilot program for Humana Care Support to help seniors with chronic disease management through integrated care management and improved data analytics, the payer...

Payer Seeks to Lower Behavioral Health Hospital Readmissions

by Kelsey Waddill

Blue Cross & Blue Shield of Rhode Island (BCBSRI) is partnering with Butler Hospital to address behavioral health hospital readmissions through methods such as care management and...

How Payers Can Improve Care Management To Enhance Quality, ROI

by Kelsey Waddill

Payers are not leveraging care management to its fullest capacity and they have an opportunity reform their care management programs to improve quality of care and return on investment, a report from...

Medicare Advantage Quality of Care Surpasses Traditional Medicare

by Kelsey Waddill

Medicare Advantage quality of care exceeded traditional Medicare, particularly in preventive care, a recent Better Medicare Alliance study revealed. “The hallmark features of Medicare...

Highmark Health Plan Brings Inpatient Quality to MA Home Health

by Kelsey Waddill

Highmark Health Plan and Contessa are collaborating to raise post-discharge home health to inpatient quality of care levels for Medicare Advantage members. "Creating a value-based experience that...

Medicaid Spend Grows 2.9% in FY 2019, Medicaid Enrollment Flat

by Kelsey Waddill

Overall Medicaid spending growth was at 2.9 percent for fiscal year (FY) 2019 but is projected to trend upward in the new year, while Medicaid enrollment growth was flat and will continue to be so in...

WellCare, Kentucky Homeplace Partnership Reduces Emergency Room Use

by Emily Sokol, MPH

A partnership between WellCare and Kentucky Homeplace showed a reduction in emergency room utilization and cost of care. The partnership aimed to help over 2,000 residents of rural Kentucky with...

How Care Management, Risk Stratification Cuts Medicaid Spending

by Kelsey Waddill

Better care management and risk stratification can help state Medicaid agencies cut spending on high-cost patients, according to a recent report from the Government Accountability Office...

Payers, Providers Spar Over Proposed Prior Authorization Regulation

by Kelsey Waddill

America’s Health Insurance Plans (AHIP) and Blue Cross Blue Shield Association (BCBSA) joined together to defend prior authorizations in a statement submitted to the Committee on Small...