For a Better Healthcare System, Collaboration is Key

Posted by Florent Moise on Thu, Dec 12, 2019


Zachary Alexander co-wrote this blog post with Florent Moise. 

At a recent conference with health plan leaders, a debate started on the roles of the different players in the U.S. healthcare system: Can health plans, providers and life science companies provide better care and outcomes at a lower cost?


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Orchestrated Outreach: The Key to a Better Member Experience

Posted by Harbinder Raina on Wed, Oct 23, 2019

Rama Rao, Florent Moise and Sean Newcomb co-authored this blog post with Harbinder Raina. This is the second post in a series on improving the member experience.

Member Outreach: A Win-Win Innovation?

As part of our customer experience study, aimed at understanding the drivers of customer experience, we interviewed several health plan executives, and it was very clear from those interactions that plans see member outreach programs as a win-win. Active member outreach helps in improving care management, controlling cost and potentially leading to positive member experience. Aetna, for example, reported that its case management outreach program could save $2 to $9 per member per month. If these estimates remain accurate, Aetna, with its 22.1 million medical members, stands to shave up to $210 million a year from its budget.


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How Health Plans Can Land on the Right Side of the $2 Billion Stars Shuffle

Posted by Anand Rampuria on Thu, Oct 17, 2019

Shreya Raghuraman co-wrote this blog post with Anand Rampuria.

Autumn is typically a time for harvest and gratitude. For Medicare Advantage plans, however, the season can bear an equal amount of fruit and spoil. The CMS Quality Rating System results were recently released, which rewards organizations with a Stars rating (one through five) for achieving quality, health outcome and experience standards. Plans in the quality-based payout (QBP) range of four stars and above could earn up to $600 of additional reimbursement per member annually. For a 100,000-member Medicare Advantage plan, that’s upwards of $60 million of possible gained—or lost—revenue.


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The Value-Based Care Crossroad: How Health Plans Can Remain on Course

Posted by Shruti Rangnekar on Mon, Sep 30, 2019


Peter Manoogian co-wrote this blog post with Shruti Rangnekar.

In recent months, we’ve talked about the current state of value-based care (VBC). Primary care providers (PCPs) have told us they’re familiar with the concept of VBC and have reported moderate participation levels in it, but PCPs also tell us they’re frustrated and confused about the details of these programs and don’t feel that they’re impacting how they practice medicine.


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How to Improve Coverage Literacy: Five Member-Focused Strategies

Posted by Harbinder Raina on Fri, Sep 27, 2019

This is the first blog in a three-part series on improving the member experience.

A Member’s Tale

She stared at the bill in her hand, dumbfounded.


A few months ago, her husband had gotten sick, so sick in fact that the community hospital that had been treating him recommended a transfer to a nearby teaching hospital or his life could be in danger, so they put him into an ambulance and transported him 10 miles away, where, after six weeks of inpatient treatment and many long nights of worry, he finally got well enough to return home.


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