HealthPayerIntel

Some states have already cut in-person interviews and limited renewals to once a year, aligning with Medicaid and CHIP final rule policies. - bit.ly/4asGsfN

Payers should implement vendor management programs, incident response plans, and training processes to prepare for third-party security incidents. - bit.ly/4cwdAVc

Payers can use the next couple of years to establish a solid technology strategy to ensure compliance with the prior authorization final rule. bit.ly/3OIAoqN

Health systems do not invest in the infrastructure needed to support Medicare Advantage, while health plans offer low reimbursement, leading to contract terminations. bit.ly/3w8pWCr

In addition to an increase in Medicare Advantage plan payments, CMS proposed updates to the Part D risk adjustment model and star ratings. bit.ly/3OuFczJ

In 2024, payers must comply with Medicare Advantage marketing requirements, price transparency regulations, and prior authorization policies. bit.ly/3TG3cDj

Healthcare coverage for the LGBTQ+ population differs depending on a member’s state, health plan, and service needed. bit.ly/3SoCiPW

Data-sharing, value-based contracts, and standardized quality measures are critical to improving payer-provider alignment. bit.ly/3QyF6J0

Per its settlement, Cigna must conduct annual risk assessments, but all Medicare Advantage plans should be proactively monitoring their compliance actions. bit.ly/48YmhpA

Around 42 percent of Medicare Advantage plans received 2024 star ratings of four or higher, down from 51 percent in 2023. bit.ly/3M4VM8i

[New Article] API marketplaces are pivotal for enhancing innovation by streamlining operations, improving #memberexperiences, and strengthening #provider relationships. Sponsored by @ZelisHealthcare bit.ly/3PXhoWr

[New Article] #APIs are reshaping healthcare by improving member and provider interactions, driving digital maturity in health plans, and offering real-time information access, cost #transparency, and streamlined processes. Sponsored by @ZelisHealthcare bit.ly/3ES7AGT

With new Medicare Advantage marketing regulations in place for 2024, payers must work with their marketing teams and establish proactive oversight programs to ensure compliance. bit.ly/3rnJTTG

[New Article] Healthcare payers are harnessing the power of #APIs to create seamless member experiences, streamline operations, and stay competitive in the digital #healthcare landscape. Sponsored by @ZelisHealthcare bit.ly/3sYRzw6

[New Article] #Payers need a proven framework for #paymentintegrity to create financial value, handle change, and engage at the highest levels of organizational strategy. Sponsored by @ClarisHealthUS bit.ly/3sFwZR9

The Blue Cross Blue Shield Association boasts 34 independent companies that provide healthcare coverage to people across the United States. bit.ly/489IQXW

Following through on the Inflation Reduction Act provisions, the Biden-Harris Administration will begin Medicare price negotiations with the drug companies this fall. bit.ly/3KYPgz6

Mental health issues were the most commonly cited impact of COVID-19 and mental health initiatives were the highest priority for employers looking toward 2024. bit.ly/45JC2yr

To reduce emergency department admission rates, payers can implement virtual care, machine learning, and value-based care strategies. - bit.ly/47n28ZB

The projected decrease in Medicare Part D premiums reflects premium stabilization and improved Part D benefits, both tied to the Inflation Reduction Act. - bit.ly/3YkzP9Z