How Will Utilization Change After COVID-19?

For healthcare systems that operate in a fee-for-service model, drops in utilization have resulted in significant financial strain and created even more uncertainty amidst the pandemic. How can…

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Healthcare worker helping elderly man out of bed.

The Value in Shifting to a Value-Based Care Model

The pandemic has shown us that the fee-for-service model was just as fragile as we thought it was. There is now a tremendous sense of urgency to change the way in which care is provided, and making…

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Elderly woman and man sitting on couch with computer.

Why the OEP is So Important This Year

A global pandemic and Presidential election year have created uncertainty surrounding this year's AEP. However, there are a few things we know for certain and this year, health plans should be…

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CMS Network Adequacy Changes & the Impact to Medicare Advantage Plans

CMS' recent network adequacy updates will open doors for plans to provide services in counties that would have otherwise proven difficult to meet network adequacy requirements.

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CMS’ Proposed Addendum to Part C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance

On July 7, 2020, CMS distributed a draft addendum to address changes required for Integrated DSNPs for Unified Appeal and Grievance processing in the Parts C & D Enrollee Grievances,…

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Building a Successful Social Determinants of Health Strategy

In the midst of a viral pandemic and evolving social movements, developing a robust SDOH strategy is more important now than ever before.

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