Jaime Melkonoff, MBA

The new health insurance rules for senior citizens are a step in the right direction, aiming to provide better health coverage and make insurance more accessible and affordable for the elderly #2050healthcare #eldercare

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#Questionforgroup Sales and marketing is often a healthcare compliance officer's biggest headache. How would the oversight plan look for the insurer that acquires an insurance broker? CVS Health has acquired #medicareadvantage broker Hella+Health. The broker firm guides consumers through the Medicare plan selection process via the company’s wholly-owned, licensed insurance agency. The company provides the following services: #Medicare eligibility and coverage coaching, Medicare plan shopping, and tracking changes to the Medicare market or an individual Medicare plan. The acquisition comes around the time that CVS Health revealed a somewhat sour Q1 2024 report, largely due to its Medicare Advantage business. The healthcare company cut its operating income by more than half due to its lower Medicare Advantage #starratings and higher Medicare utilization. Net income dropped to $1.12 billion, a steep decline from $2.14 billion in 2023. While the broker states it doesn't push certain plans, it does derive revenue through commissions. If Hella+Health is obliged to receive a reward for a sales quota under its contract with a company, the reward is donated, the company states. #CVSHealth saw its total revenues for the Health Care Benefits segment increase, in part due to #Medicare growth. Aetna, a CVS Health Company Medicare Advantage plan enrollment grew from 3.38 million enrollees at the end of March 2023 to 4.20 million by the end of the first quarter of 2024.

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Great conversation here between my colleague Blake Watts and our friends over at Leader's Edge Magazine! Blake discusses point solution fatigue, the importance of investing in health tech, and what makes Ochsner Connected Health a unique player in how we approach chronic disease management with employers nationwide. #HealthTech #EmployeeWellness #ChronicDiseaseManagement #DigitalHealth #ValueBasedCare #Diabetes #Hypertension #GLP1 #Obesity

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Drex DeFord Advises Simplifying Healthcare for Vendor Risk Reduction: https://lnkd.in/dDvhYsDF First Health Strategic Advisory Board Member & Healthcare Strategist Drex DeFord dives into pressing concerns around the increasingly complex, difficult to manage, and frequently targeted healthcare environment. Drex’s conversations with This Week Health fuel meaningful conversations to spur the change necessary for improving health sector resilience. We’re proud to have such a dedicated member of the healthcare cybersecurity space advising our leaders and ensuring First Health is at the forefront of digital health security innovation. For more insight into First Health’s leadership and board members, visit https://lnkd.in/gQUx5BzD or contact First Health at info@firsthealthadvisory.com. #CISO #CIO #CTO #CDO #Compliance #HIPAA #HealthcareIT #HealthcareSecurity #CyberRisk #ThirdPartyRisk #RiskAssessment #Cybersecurity #HTM #DigitalHealth #PatientSafety

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well worth the read if you are in managed healthcare.

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Are you collecting or analyzing health equity-related data? This Centers for Medicare & Medicaid Services paper will help you harmonize with CMS data definitions, standards, and stratification practices. https://go.cms.gov/4adltwr #healthequity #data

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Learn how Texas Health Dallas, a hospital operated by Sg2 member Texas Health Resources, is focusing on both the patient experience and the customer experience. via HealthLeaders https://bit.ly/3Va3F0Y

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Cigna Group allegedly exaggerated the health conditions of its enrollees to fraudulently obtain hundred of millions in federal funds. Read more: https://direc.to/fhHz Cigna Group significantly impacts healthcare today by expanding its pharmacy and medical customer base, as evidenced by a 25% increase in pharmacy customers and a growth in medical customers. Additionally, Cigna's involvement in healthcare trends and innovations, such as the Better Care Bulletin, showcases its role in improving health outcomes and integrating technology in healthcare. The HHS Office of Inspector General (HSS-OIG) combats healthcare fraud through rigorous oversight, investigations, and audits. It collaborates with the Department of Justice (DOJ) to enforce laws and impose penalties on fraudulent activities, as seen in actions against the Center for Medicare and Medicaid Services (CMS) fraud. #unitedseniorassociation #USA #eldercare #FDA #seniorliving #ADA #AI #NIH #patientcare #compliance #hospitals #OIG #healthcare #HHSOIG #digitalhealth #HSS #CMS #assistedliving #nursinghomes #seniorcare #medicare #seniorcitizen #homehealthcare #caregiver #dementia #inhomecare #seniorhealth #kloekorby #alzheimers #mentalhealth

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Learn how data management can elevate value-based care. Discover how to overcome data management challenges and drive better patient outcomes. Learn about the latest VBC trends, including CMS's goal for 100% Medicare beneficiary coverage by 2030 and the projected $1 trillion market value. Don't miss out on key strategies to enhance interoperability, enable real-time data access, and integrate external data sources for comprehensive patient care. Read our latest blog post to transform your healthcare organization's approach to value-based care: https://buff.ly/3xIRbo4 #ValueBasedCare #HDMP #HealthDataManagement"

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More info on the 2025 Proposed Rule - "CMS is still tweaking PDGM, including an annual recalibration of the 432 case mix weights, and a resetting of LUPA thresholds. He also urged providers to pay close attention to the wage index." Need help understanding the changes coming in 2025 and how it will impact your reimbursement? Bartlett Strategy Group, LLC can help you!

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The last thing mental health providers need is a more complicated system to use on top of the complex care cases they handle around the clock. New technologies providing digital solutions allow you to focus on the most important thing—the client. 

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Higher utilization in Medicare Advantage will force payers to further reduce reimbursements to providers through rate cuts, increased denials, downcoding, benefit reductions (more bad debt) and excessive administrative hassles. Now is the time to increase Medicare Advantage reimbursements for 2025! We are working with our clients to issue MA RFP’s to payers to strategically align with 1 or 2 MA plans next year and address declining MA yields. We can help you develop and execute your MA strategy to improve overall reimbursements. Let us show you how! Learn more about how to optimize your Medicare Advantage Contracts👉 https://lnkd.in/gRB3rMw3 #EllsworthConsulting #HealthcareInnovation #ConsultingServices #HealthcareLeadership #PayerNegotiations #HealthcareConsulting #HealthcareManagement #ContractNegotiation #HealthcareContracts #ContractStrategies #ContractSolutions #NegotiationSuccess

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New in today's Radar on Medicare Advantage: Large payers hint at MA benefit cuts in 2025, why risk-bearing providers should pay close attention to payers' margins, San Francisco Health Plan prepares to launch a new D-SNP, and more top stories. https://hubs.ly/Q02vX7GV0

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CommonSpirit Health Mountain Region is holding it's ground against Anthem, Inc. for a contract that provides reasonable reimbursement. Anthem claims costs rise for the patient under the new contract, CommonSpirit claims reimbursement is too low to cover the costs for their members. Anthem profits in 2023: $5.95B or 3.6% margin CommonSpirit profits in 2023: -$1.3B yes, that is a loss... -3.9% Margin Who's making more money off of Anthem's members? Health insurers no longer buy risk - history shows us their profits are guaranteed. Healthcare Insurance is irretrievably broken.

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In September 2022, the Centers for Medicare & Medicaid Services (CMS) competitively awarded us a nine-year contract for Contact Center Operations (CCO), which helps more than 75 million Americans access Medicare and health insurance under the Affordable Care Act. For more than six years, our team has been the passionate voice on the other end of the line, helping Americans navigate their healthcare options every day. However, despite historically high customer service ratings and uninterrupted performance, HHS is recompeting the contract 7 years early to insert an unnecessary union organizing agreement, which is a flawed fix to a non-existent problem. The recompete requires the contractor to negotiate and execute an organizing agreement with any and all labor unions who informally claim to represent the employees, even if employees are not interested in joining by forcing employees into a labor organization. This inappropriate decision to recompete these services violates long-standing policy that the United States government remains impartial between federal contractors and labor organizations. Maximus is challenging the premature, improper, and unlawful re-procurement of our highly successful operation. Check out this piece by The Washington Post: http://spr.ly/604294a06 It does a great job explaining the motivations behind HHS’ decision to rebid the CCO contract and provides helpful insight into what this means for our employees, the communities where they live and work, small businesses, and millions of Americans who rely on this program.

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An Outpatient Clinical Documentation Improvement (CDI) program offers substantial advantages to healthcare organizations by elevating patient care and operational efficiency. By integrating risk stratification with chronic conditions, enhancing quality measures, addressing social determinants of health, and establishing a collaborative team empowered by technology, such strategic initiatives result in improved patient outcomes and streamlined operations.

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A very nice article highlighting and summarizing 'real world' insights and strategies for success in #MedicareAdvantage by leading healthcare organizations, including Henry Ford Health. Worth the read!

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