Papa’s Post

To lead effectively amid the 2025 Medicare Advantage and Part D Final Rule changes, leverage data-driven compliance measures, employing predictive analytics to anticipate and prevent regulatory breaches. Champion ethical marketing practices, employing sentiment analysis to ensure transparency and authenticity in communications. Forge partnerships with community organizations to enhance access to behavioral health services, utilizing geospatial analysis and machine learning to optimize resource allocation. By pioneering these strategies, healthcare analytics leaders can navigate regulatory complexities while ensuring equitable care delivery. #DataDrivenCompliance #EthicalMarketingr #EquitableCare #PredictiveAnalytics. https://lnkd.in/eq3vf6qs

Health plans must prepare for Star Ratings changes to stay ahead of the curve and boost their performance. In this YouTube webinar, "Rising Stars: Optimizing MA Star Ratings with Star Intelligence," Cotiviti experts walk through how to prepare for the upcoming changes and improve Star Ratings performance. View our webinar to: -Understand confirmed and proposed changes to CMS Star Ratings -Learn how to drive program success by shifting from retrospective review to prospective monitoring -Discover the Star Intelligence capabilities that enable health plans to simulate program changes, enhance resource allocation, and help optimize Star Ratings Subscribe to our YouTube channel for more insights: https://lnkd.in/g8Uzyjs9 #HealthPlans #healthcare

Health plans must prepare for Star Ratings changes to stay ahead of the curve and boost their performance. In this YouTube webinar, "Rising Stars: Optimizing MA Star Ratings with Star Intelligence," Cotiviti experts walk through how to prepare for the upcoming changes and improve Star Ratings performance. View our webinar to: -Understand confirmed and proposed changes to CMS Star Ratings -Learn how to drive program success by shifting from retrospective review to prospective monitoring -Discover the Star Intelligence capabilities that enable health plans to simulate program changes, enhance resource allocation, and help optimize Star Ratings Subscribe to our YouTube channel for more insights: https://lnkd.in/g8Uzyjs9 #HealthPlans #healthcare

We're all seeing the growing friction between health systems and MA plans. I don't think there are any easy answers here, but two paths are beginning to emerge: closer collaboration between providers and payers through value-based contracting, and providers starting their own MA plans. As always, data and analytics lay the foundation for these transformations. Thanks Katie Adams and MedCity News for the opportunity to discuss!

In our latest episode, Dr. Shannon I. Decker, PhD., MBA, MBA, M.Ed., M.Ed. explains the latest developments in Medicare Advantage. Learn about the key trends, major shifts, and practical advice for healthcare organizations adapting to these transitions. Don't miss this critical discussion on what to expect for Medicare Advantage in 2025! Tune in to watch: https://lnkd.in/d8_pM4WN #drshannon #persivia #healthcare #data #medicareadvantage

The Long-Term Quality Alliance (LTQA) will be holding a virtual member discussion on the 2025 Medicare Advantage and Part D proposed rule on Tuesday, December 19, from 1-2pm ET. The proposed rule focuses on several areas of importance to LTSS stakeholders, including dual-eligible special needs plans (D-SNPs), supplemental benefits, and behavioral health network adequacy. Join LTQA to discuss the implications of this proposed rule on LTSS and those who fund, deliver, and use them. Representatives from Community Catalyst and VNS Health will share their perspectives to kick off the discussion. Comments on the proposed rule are due to CMS on January 5, 2024. LTQA’s member discussions aim to create an opportunity for our members to share learning and discuss the latest LTSS policy and research. Register here: https://lnkd.in/gf2TuaRi Read the 2025 Medicare Advantage and Part D Proposed Rule: https://lnkd.in/dkZBjX4H

Medicare #AEP is just around the corner. How do beneficiaries decide which plan to choose? When beneficiaries research Medicare Part C and Part D plans, you can bet they will look at the star ratings given by the CMS. These ratings are always top of mind for plans, but they are a complex topic for those new to the space. That's why we're sharing this introduction to Medicare star ratings, which gives an overview of where star ratings came from, why they are important, and what trends to expect in the future. Read it now: https://ow.ly/ZCvK50PT6oI If you want more #Medicare content, especially around effective outreach strategies, be sure to give us a follow so you don't miss any insights! #ItsAllAboutHowYouSayIt

📢 Meet Jake Reason,VP of MSA Services. With his forward-thinking approach and unwavering dedication to achieving defensible outcomes, he's a true asset to our team. 👏 If you're looking for expert guidance in Medicare Set-Aside (MSA) services, Jake from EK Health is here to help! Whether you need assistance with MSA referrals, analysis, or compliance, he's your go-to guy. Submit your next MSA referral: https://hubs.la/Q0260bw30. 📝 TOP 5 THINGS YOU NEED TO KNOW ABOUT MSAs: https://hubs.la/Q02604KF0 #MedicareSetAside #DefensibleOutcomes #25DaysofGratitude

7 additional MAPD contracts receive a 5-star rating. CMS recently recalculated 2024 star ratings (for contracts that wouldn't be harmed by the recalc). With that recalculation, an additional 7 contracts received a 5-star rating for 2024. Taking the total 5-star rating contracts from 31 to 38. [This is according to an article by Becker's (see first comment for link).] Here are the 7 new contracts moving to a 5-star: -Alignment Health Plan of North Carolina -Aetna Health of Iowa -HealthSun Health Plans -Humana Health Plans of Puerto Rico -Mount Carmel Health Plan -UnitedHealthcare of Wisconsin -UPMC For You HealthSun Health Plans is the largest to move up to 5-star. It's part of Elevance and is primarily made up of D-SNPs in Southeast Florida. ___ Give me a follow. I post Medicare Market Insights daily.

Always enjoy learning from Howard Weiss of EmblemHealth. Wonderful presentation on "Navigating the Regulatory Landscape: Updates on CMS Actions That Are Likely to Affect Medicare Advantage Plans" at #RISE #MARecon2023 Great discussion on  new regulatory initiatives of interest to Medicare Advantage plans, issues that CMS is likely to consider in the future, and that could affect your daily work. #rafaelgonzalezesq #cattiegonzalezpllc #ahigherstandardinmspcompliance