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Insider insights and perspectives on trending topics for healthcare professionals. We’re talking to the experts about the unique operating infrastructure necessary for business success and to improve the quality of care for members. Topics include operating models, technology infrastructure, data security, operations, core administration, care management, member engagement, risk adjustment, HEDIS and Star quality measures, start-up and growth tactics, and regulatory and compliance.
Frecuencia de actualización:
monthly
Duración media del audio:
14 minutes
Entrevistas a invitados
Tiene patrocinadores
Inglés
Estados Unidos
46 episodios
desde 6 de junio de 2022
episodic
ÚLTIMO EPISODIO 🔗
The 2027 Star Ratings are out, and the headline numbers tell only part of the story. For Medicare Advantage plans, this year’s results raise important questions about performance, financial exposure, and how to prepare for a changing quality program. What do shifts across rating tiers reveal that a…
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EPISODIOS ANTERIORES 🔗
Rising margin pressure, regulatory demands, and fragmented operations are forcing health plans to confront a difficult question: when does maintaining the current model become more expensive than changing it? This episode examines the often-overlooked cost of inaction—where financial strain, delaye…
Administrative costs are climbing across the payer industry, but many plans still rely on high-level expense views that mask the true drivers of operational spend. Beneath the surface, fragmented systems, manual processes, and vendor complexity may be shaping financial outcomes more than leaders re…
Medicare Advantage organizations are facing a significant policy year as CMS releases updates that signal a recalibration of the Stars program and broader regulatory framework. Recent rule-making and guidance point to changes in measurement priorities, simplification efforts, and evolving expectati…
Enrollment for 2026 brought major shifts for health plans, driven by new CMS rules, rising consumer expectations, and the growing pressure to modernize operations. This episode explores how plans are rethinking enrollment integrity, broker oversight, digital shopping, data quality, and how emerging…
Is managing multiple vendors slowing your health plan down? Disconnected systems, rising costs, and scattered data often stand in the way of efficiency and better member experiences.
This episode explores the challenge of managing multiple vendors and how health plans can escape this antiquated op…
Whistleblower lawsuits are pulling back the curtain on risky coding practices and costly compliance gaps in risk adjustment. From inflated RAF scores to vendor oversight failures, the consequences are real and growing. This episode unpacks several DOJ cases that reveal how coding shortcuts, unsuppo…
The 2026 Medicare Advantage and Part D Star Ratings are out—and they reveal more than just who earned 5 stars. Beneath the numbers lies a clear message: CMS is reshaping what quality means, shifting the balance from member satisfaction to measurable outcomes and data precision. Plans that once thri…
Navigating risk adjustment across multiple lines of business isn’t just complex, it’s a balancing act of shifting regulations, diverse populations, and evolving models. In this episode, we break down the key differences between Medicare Advantage, Medicaid, and ACA, and explain why understanding th…
What if your contact center could do more than answer questions? What if it could predict needs, detect fraud, translate languages in real time, and coach agents as they speak to members?
In this episode, explore how AI is transforming call centers into strategic experience hubs. From agent assist…
Descargo de responsabilidad: El podcast y el arte incluidos en esta página son de Sponsored by HealthEdge, que es propiedad de su propietario y no está afiliado ni respaldado por Listen Notes, Inc.
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