Improving Network Adequacy and Access For Mental Health
Federal and state policymakers are taking a variety of measures to improve access to mental health services and substance use disorder treatments. Network adequacy and access are prominent areas of such a response directly affecting health plans. This blog post informs stakeholders about the increased emphasis on behavioral health networks and tips on how to […]
Key Application Dates: Unpacking The CMS Medicare Advantage Calendar
Centers of Medicare & Medicaid Services (CMS) Key Application Dates for CY 2022 Medicare Parts C and D Annual Calendar Our CMS calendar is one of the easiest ways to stay up-to-date with important dates and timelines for CY 2022 Medicare Advantage (MA) plans, Medicare Advantage-Prescription Drug (MA-PD) plans, Prescription Drug Plans (PDPs), Medicare-Medicaid Plans […]
Top 3 Things the “No Surprises Act” Means for Health Plans
It’s staggering to think that, according to researchers, one in five emergency room visits result in an individual receiving a bill for treatment or services they expected to be covered by their health plan, but weren’t. These unexpected, costly, and often frustrating charges are aptly called Surprise Medical Bills. While surprise medical bills impact consumers financially, […]
Designing and Building Clinician Networks That Address Social Determinants of Health
FIVE TAKEAWAYS FROM OUR WEBINAR Watch: Designing and Building Clinician Networks That Address Social Determinants of Health As clinicians and payers take on increasing risk for patient outcomes, it is essential that leaders consider the effectiveness of their networks as well as the accuracy of their clinician directories to ensure they are adequately serving their members. Modern […]
New Metrics are Critical to Addressing Mental Health Access Concerns
Our new normal is far from normal. There is this level of incredible, nonstop uncertainty around our current situation, and none of us are immune. CDC data, collected in late June, noted an increase month-over-month in mental health issues. It showed that 40 percent of adults struggled with anxiety, depression, suicidal thoughts and substance abuse1. […]
The Rebirth of Network Adequacy: Modernizing Health Plan Practice
Reprinted from The URAC Report. Nearly two months ago now CMS finalized changes to Medicare Advantage (MA) and Part D for 2021 and while I previously covered the new telehealth network adequacy provisions, I’ve been meaning to do a deeper dive into how network adequacy as a whole has changed in recent years. To do this, I reached out to Cari […]
Preparing for the Era of Provider Network Transparency
Copyright 2020 Compliance Today, a publication of the Health Care Compliance Association (HCCA). Transparency is one of the top buzzwords in healthcare today. In the last few years, we have seen the rollout of significant healthcare transparency initiatives focused on portable health records, hospital costs, drug costs, quality data, and many other things (e.g., Executive […]
Rule Raises Questions About Telehealth, Directory Accuracy
Reprinted with AIS Health permission from the July 2, 2020, issue of RADAR on Medicare Advantage. As Medicare Advantage and other insurers report increasing use of telehealth during the COVID-19 pandemic and consider the larger role that virtual visits could play on a more permanent basis, CMS recently finalized a set of policies for 2021 […]
ESRD Enrollment Creates Cost, Network Unknowns for MAOs
Reprinted with AIS Health permission from the July 2, 2020, issue of RADAR on Medicare Advantage. As Medicare Advantage plans prepare to enroll patients with end-stage renal disease (ESRD) this fall, a recent change to network adequacy measurement will give them some flexibility in how they include dialysis care in their networks. Meanwhile, a new lawsuit […]
Pressure Mounts on MA Plans to Address Racial Disparities
Reprinted with AIS Health permission from the June 18, 2020, issue of RADAR on Medicare Advantage As protests erupt across the U.S. calling for racial justice and police reforms, the COVID-19 pandemic continues to bring to light many of the racial disparities in health care, putting pressure on policymakers and the industry to take a hard […]
