May 17, 2022
RISE brings payers and providers together June 28-29 at Caesars Palace in Las Vegas to uncover new strategies to align financial incentives, improve patient outcomes, and better navigate the value-based care space.
May 25, 2022
Deft Research’s 2022 Medicare OEP and Disenrollment Prevention Study surveyed more than 2,400 Medicare Advantage (MA) members to better understand what causes many of them to reexamine their coverage during the 90-day rapid disenrollment period. The study provides insight so MA plans can better tackle short-term AEP prep as well as long-term AEP/OEP retention goals.
May 25, 2022
A spotlight on recent organizational efforts and partnerships that promote health equity in different ways.
May 25, 2022
RISE rounds up recent headlines that impact the Medicare Advantage industry.
May 25, 2022
The study identified inconsistencies among patients transitioning from hospitals and skilled nursing facilities due to social determinants of health (SDoH) and racial disparities.
May 25, 2022
United States Surgeon General Dr. Vivek Murthy has issued an advisory that highlights the urgent need to address the health worker burnout crisis across the country.
May 25, 2022
Overdose deaths are disproportionately affecting Native Americans due to continued underfunding of health care resources and limited access to quality care.
May 20, 2022
The world of risk adjustment is tricky–but critical to ensuring payers are fairly compensated for covering patients who are more likely to incur high health care costs. With risk adjustment, government programs such as Medicare and Medicaid will adjust the revenue provided to a health plan/payer based on the health of those covered.
May 19, 2022
RISE summarizes recent regulatory headlines.
May 19, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
May 17, 2022
Do you have a clear picture of your data, and tools that allow you to easily identify the most impactful interventions to improve patient care?
May 17, 2022
Despite the challenges, if true interoperability can be achieved it would provide granular data that can be used to improve clinical outcomes, reduce utilization, and provide support for clinical research.
May 17, 2022
RISE brings payers and providers together June 28-29 at Caesars Palace in Las Vegas to uncover new strategies to align financial incentives, improve patient outcomes, and better navigate the value-based care space.
May 17, 2022
Insurers say prior authorization requirements are intended to reduce wasteful and inappropriate health care spending. But they can baffle patients waiting for approval. And doctors say that insurers have yet to follow through on commitments to improve the process.
May 16, 2022
A year ago, the Centers for Disease Control and Prevention awarded states and local health departments $2.25 billion to help people of color and other populations at higher risk from COVID. But a KHN review shows public health agencies across the country have been slow to spend it.
May 13, 2022
Home visits help identify health risks before they become severe, preventing expensive adverse events and facilitating holistic condition management across care settings for better cost and quality outcomes.
May 12, 2022
These events cost Medicare and patients hundreds of millions of dollars for October 2018.
May 11, 2022
New research from Creighton University underscores the significant impact finances have on an individual’s health.
May 10, 2022
Kaiser Family Foundation (KFF) researchers said the biggest losses will be among children, adults who became eligible for coverage under the Affordable Care Act’s (ACA) Medicaid expansion, and adults eligible for Medicaid other than due to a disability. These groups experienced the largest increase during the pandemic.
May 10, 2022
The 7th annual event, live streamed June 7-8, will feature strategies to improve ODAG & CDAG outcomes, a review of the latest changes to Centers of Medicare & Medicaid Services (CMS) regulations, and strategies to improve member satisfaction.
May 06, 2022
Year after year, the annual event connects professionals across the health care ecosystem with industry leading executives, leadership coaches, and motivational speakers to cultivate female leadership in health care. This year, keynote speakers Mandie Kelel, M.S., marriage and family therapist, certified facilitator in Brené Brown’s Dare to Lead™ Program, and Dr. Ginny A. Baro, Ph.D., CEO, founder, Executive Bound, will pull back the curtain on what it takes to awaken the authentic leader within.
May 04, 2022
The leading “teamcentric” conference on quality of care and improving member experience will take place June 28-29 at Caesars Palace in Las Vegas. Check out the featured speakers and planned sessions.
May 04, 2022
If the Supreme Court’s conservative majority affirms the leaked decision overturning abortion rights in the U.S., the effects would be sweeping for 40 million women in more than two dozen states where Republican-led legislatures have been eagerly awaiting the repudiation of the right to terminate a pregnancy.
May 03, 2022
The Blue Cross Blue Shield Association (BCBSA) and Blue Cross Blue Shield (BCBS) companies urge the health care industry to implement national industry standards for health equity data collection.
May 03, 2022
Even the savviest Medicare drug plan shoppers can get a shock when they fill prescriptions: That great deal on medications is no bargain after prices go up.
May 02, 2022
The Centers for Medicare & Medicaid Services (CMS) late Friday released its final rule for the Medicare Advantage (MA) and Part D prescription drug programs. The final rule revises MA and Part D regulations related to marketing and communications and makes changes to quality ratings, medical loss ratio reporting, special requirements during disasters or public emergencies, and reduces out-of-pocket costs for prescription drugs under Part D.
May 02, 2022
RISE summarizes recent regulatory headlines.
April 28, 2022
The 2023 Notice of Benefits and Payment Parameters Final Rule (final 2023 Payment Notice) finalizes many of the changes announced in the proposed rule.
April 28, 2022
A new report released by the Office of Inspector General (OIG) determined Medicare Advantage Organizations (MAOs) sometimes delayed or denied MA beneficiaries’ access to services even when the requests met Medicare coverage rules.
April 28, 2022
When it comes to health policy, former Utah Republican Sen. Orrin Hatch, who died April 23 at age 88, leaves a complex legacy of major legislative achievements, changing positions, compromises, and fierce opposition. In many ways, though, Hatch’s evolution and leadership on health policy during his four decades in the U.S. Senate mirror that of the Republican Party.
April 26, 2022
The health care industry is facing a crisis, warns the chief medical officer for Inovalon. Risk and quality measurement are major contributors to the administrative burden faced by physicians, which is causing them to leave the practice of medicine. And that means reduced access to care.
April 25, 2022
The proposed rule aims to expand Medicare coverage and establishes five special enrollment periods.
April 21, 2022
The Justice Department said on Wednesday that the cases allegedly resulted in approximately $150 million in COVID-19-related false billings to federal programs and theft from federally-funded pandemic assistance.
April 21, 2022
A recent court decision that overturns one of the Centers for Disease Control and Prevention’s few pandemic rules—masks required on public transportation—spotlights how little power remains in federal hands to enforce public health protections.
April 21, 2022
A new report from The Autism Intervention Research Network on Physical Health (AIR-P) has found children with autism who are non-white or live in low-income households are more likely to face poor health outcomes and challenges with health care.
April 20, 2022
As the only non-association conference focused on special needs plans (SNP), the annual event provides key insights for operational, clinical, compliance, and marketing specialists. This year’s conference will be held live and in-person, June 22-24, at the Westin Times Square in New York City.
April 20, 2022
RISE summarizes recent regulatory news, including announcements and proposals from the U.S. Department of Health and Human Services, the Centers for Medicare & Medicaid Services, and the Centers for Disease Control and Prevention.
April 20, 2022
A 2021 survey of more than 3,500 seniors by the consulting firm McKinsey & Company found that most were dissatisfied with their onboarding experience. But health plans can use the gaps in their onboarding experience to differentiate themselves among ever increasing competition in the market.
April 19, 2022
Shannon O'Connell, senior manager, Engagys, shares the biggest takeaways after moderating the consumer focus panel, Direct Insights into Addressing Social Determinants of Health from Patients Themselves, at The RISE Summit on Social Determinants of Health in Nashville last month.
April 19, 2022
RISE is excited to announce that a panel of three representatives from the Centers for Medicare & Medicaid Services’ Consumer Information and Insurance Oversight Financial Management Group will kick off the second day of the Risk Adjustment Forum, May 11, in Chicago, with an update to the HHS-operated risk adjustment program.
April 19, 2022
A new analysis conducted by ATI Advisory for Better Medicare Alliance finds that Medicare Advantage (MA) beneficiaries report a 35 percent lower rate of cost burden compared to fee-for-service (FFS) Medicare.
April 19, 2022
Survey results show that Medicare Advantage Organizations recognize the critical need to improve communications with members and are finding new ways to create and manage the required Medicare marketing materials.
April 14, 2022
Xavier Becerra, secretary of the Department of Health and Human Services (HHS), extended the COVID-19 public health emergency (PHE) another 90 days. The extension will allow most of the emergency waivers to remain in place through July.
April 14, 2022
The last of our country’s baby boomers are reaching retirement age, making them eligible for Medicare. When this younger group of ‘trailing edge’ boomers joins the ‘leading age’ boomers (seniors approaching 80 years), Medicare enrollment will catapult to 80 million beneficiaries by 2040.
April 13, 2022
The 7th annual event will return May 22-24 at an all-new location in beautiful Asheville, N.C., to connect forward-thinking innovators and pioneering senior-level women to address the myriad of challenges women face at work and advance diversity, equity, and inclusion to cultivate female leadership in health care. All genders are welcome in this push for empowerment and innovation.
April 13, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
April 12, 2022
RISE rounds up recent news on COVID-19.
April 12, 2022
RISE summarizes recent regulatory news, including announcements and proposals from the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS).
April 11, 2022
Supercharge your plan’s sales and marketing communications and retention strategies for AEP 2023 at RISE’s live-streaming event June 13-14.
April 06, 2022
This year’s in-person event will include a focus on the impact of RADV audit strategies, compliance updates, and an entire track on ACA risk adjustment.
April 06, 2022
According to a new report released by the Commonwealth Fund, women in the United States between the ages 18-49 have the highest rate of avoidable deaths compared to other high-income countries.
April 04, 2022
The Centers for Medicare & Medicaid Services (CMS) announced Medicare Advantage (MA) plans will see an even bigger pay bump than what the agency originally proposed in February. CMS also finalized policies for risk adjustment and Star ratings for 2023.
April 04, 2022
Sens. Susan Collins (R-Maine) and Jeanne Shaheen (D-N.H.) are seeking to craft a compromise that members from both parties could accept. Their plan, still being ironed out, would not guarantee a specific limit on out-of-pocket costs but seeks to roll back insulin prices by barring rebate payments to pharmacy benefit managers.
April 04, 2022
The Centers for Medicare & Medicaid Services (CMS) has expanded access to free over-the-counter COVID-19 testing for people with Medicare Part B, including those enrolled in a Medicare Advantage (MA) plan.
April 04, 2022
The pandemic crisis has overwhelmed understaffed state Medicaid agencies, already delaying access to the insurance program in Missouri. As the public health emergency ends, low-income people nationwide could find it even harder to have coverage
April 01, 2022
RISE summarizes the latest regulatory headlines.
March 31, 2022
This year’s summit drew a record-breaking number of more than 500 attendees live in Nashville to learn and discuss actionable solutions to social determinants of health (SDoH) challenges to achieve better outcomes for vulnerable populations.
March 31, 2022
According to part one of the 2022 Survey of America’s Physicians, six in 10 physicians said they feel they have little to no time to effectively address their patients’ social determinants of health (SDoH).
March 30, 2022
To stay competitive in tomorrow’s Medicare Advantage (MA) marketplace, plans need finely tuned strategies for each of these four MA opportunities.
March 29, 2022
A new report prepared by the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary finds that despite increased demand for patient care in 2021, the growth in national health spending slowed as supplemental funding for public health activity and other federal programs associated with the pandemic declined significantly.
March 25, 2022
Sens. Robert Casey Jr. and Ron Wyden want a probe into what barriers are keeping Medicaid plans from reaching enrollees.
March 24, 2022
During an hour-long press conference late last week, Department of Health and Human Services (HHS) Secretary Xavier Becerra discussed a wide range of topics, including risk adjustment in Medicare Advantage, COVID, and telehealth.
March 23, 2022
A Kaiser Family Foundation (KFF) analysis finds that Black adults, those in poor health, and people living with disabilities are most likely to carry significant medical debt.
March 23, 2022
RISE summarizes the latest regulatory headlines.
March 22, 2022
RaeAnn Grossman, EVP, Cotiviti, who co-chaired RISE National 2022 with Kevin Healy, CEO, Allymar Health Solutions, reflects on her experience at this year’s conference, which returned to Nashville as a live, in-person event for the first time since March 2019.
March 21, 2022
The director of community health promotions at Robert Wood Johnson Barnabas Health in New Brunswick received the RISE Health Care Hero Award on Monday, March 21 at The RISE Summit on Social Determinants of Health in Nashville.
March 18, 2022
The number of children ages 3-17 years diagnosed with anxiety or depression increased nearly 30 percent from 2016 to 2020, according to the study.
March 17, 2022
RISE rounds up the latest news on COVID-19.
March 17, 2022
The data brief provides insight into the use of telehealth in both Medicare fee-for-service and Medicare Advantage (MA) during the first year of the COVID-19 pandemic from March 2020 through February 2021.
March 16, 2022
A new brief published by the Kaiser Family Foundation analyzes cost-sharing liability for Part B drugs in traditional Medicare and cost-sharing requirements in Medicare Advantage (MA) plans. Here are the key findings.
March 16, 2022
Better Medicare Alliance (BMA), a research and advocacy organization that supports Medicare Advantage, says MedPAC’s recommendations don’t consider data that shows lower per-beneficiary government spending in Medicare Advantage, even as Medicare Advantage maintains lower consumer costs and better health.
March 15, 2022
Regulatory bodies are increasingly using data analytics to guide their audit processes to great effect. In this landscape, compliance can no longer be an afterthought. Health plans must take proactive steps to address issues before they arise so they may focus their valuable time and resources on what matters most—caring for patients.
March 15, 2022
Many Medicare Advantage plans send caregivers to the homes of seniors periodically to help with housework and provide companionship. But the workers may also prod seniors into activities that boost the plans’ Medicare ratings and federal reimbursements.
March 11, 2022
As the country enters Year 3 of the pandemic emergency, people with disabilities across the U.S. are still finding it difficult to use innovations in telemedicine, teleworking, and testing.
March 11, 2022
RISE summarizes the latest regulatory headlines.
March 11, 2022
According to the study, communities with higher levels of racial prejudice experience poorer health outcomes such as heart disease and mental health problems.
March 09, 2022
The associate chief medical officer of HonorHealth Medical Group in Arizona received the Dr. Martin L. Block Award for Innovation & Excellence on Wednesday, March 9 at RISE National 2022 in Nashville.
March 09, 2022
What an incredible two days we’ve had at RISE National 2022!
March 08, 2022
More than 1,600 participants (a RISE National record) representing 562 organizations across 46 states gathered at the Gaylord Opryland Resort & Convention Center to learn the latest on Medicare Advantage, regulatory and compliance updates, risk adjustment, quality, HEDIS®, Star ratings, member experience, social determinants of health (SDoH), the latest technology advancements, and payer/provider collaboration.
March 04, 2022
The Department of Health & Human Services (HHS) will once again delay the implementation of the Trump administration’s controversial SUNSET rule, according to a notice in the Federal Register.
March 04, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
March 03, 2022
The White House has unveiled a national preparedness plan, which provides a roadmap to fight COVID-19 and return to a new normal. But execution of the plan requires congressional support and funding.
March 03, 2022
Our annual program returns April 26-27 as a virtual event and will explore the impact of COVID on vulnerable populations and the associated financial crisis related to Medicaid funding and enrollment, critical behavioral health challenges and the need for integrated care for members, and social determinants of health and associated funding issues.
March 02, 2022
The president wants to set minimum staffing levels for the beleaguered nursing home industry. But, given a lack of transparency surrounding the industry’s finances, it’s a mystery how facilities will shoulder the added costs.
March 02, 2022
Here are the health care highlights from Biden's address.
March 02, 2022
The actuarial consulting firm findings indicate that 5,311 of 5,312 Medicare Advantage (MA) plans (99.9 percent) will offer supplemental benefits unavailable in fee-for-service Medicare for 2022. The most common benefits include vision, hearing, fitness, and dental care.
February 28, 2022
Inoculation rates remain low despite massive outreach efforts and incentives from federal and state programs and Medicaid plan operators, leaving many low-income people vulnerable to the virus.
February 28, 2022
Experts tell us that we must break down silos to streamline our activities and make sure our work and investments pay off. But how do we go about actually doing it? Here are practical steps you can take.
February 25, 2022
In health care, there are long-standing and well-documented disparities in care for Black and white patients. Those disparities have carried over into who gets funding for research and health startups.
February 25, 2022
RISE summarizes the latest regulatory headlines.
February 24, 2022
Not everything that happens in Vegas, stays in Vegas! We’re back from last week’s 2022 Medicare Marketing & Sales Summit at Caesars Palace with a summary of what we learned during key conference sessions.
February 23, 2022
RISE’s annual summit will be held live in Nashville on March 20-22. This year’s event has more content than ever before with three preconference workshops, three content tracks, a record-breaking lineup of more than 80 speakers, and 28 thought-provoking sessions. Ahead of the summit, RISE spoke to a few of the esteemed speakers set to take the stage next month. Here’s a sneak peek at the push button topics they plan to address.
February 22, 2022
It’s been a long three years and we are counting down the days until we are all back together again in Nashville, Tenn. for RISE National 2022. You’ve heard about the incredible content and speakers we’ve lined up, but you may be unaware of all the fun and activities we’ve planned. Here’s a helpful guide so you can make the most out of the three-day event, March 7-9.
February 16, 2022
RISE summarizes this week’s regulatory-related headlines.
February 15, 2022
New CMS rule supports standardization of data to better understand drivers of health.
February 15, 2022
Future forecaster and game designer Jane McGonigal, Ph.D., specializes in creating simulations that help people imagine the biggest global challenges they might face in the future. In 2008, one of those simulations was a global outbreak of a fictional respiratory virus originating in China set 11 years in the future, in the fall of 2019. Sound familiar?
February 14, 2022
Contract-level RADV audits can seem daunting, but with these tips they do not need to be overwhelming.
February 14, 2022
After months of disproportionate impacts amid the pandemic, COVID testing and vaccination rates are finally improving among the Hispanic community.
February 14, 2022
HL7 Version 3 Standard: Patient administration is better known as ADT-Admission, Discharge, and Transfer. ADT feeds allow managed care organizations to see and share a patient’s medical history with other providers in the care continuum. ADT systems also securely store large amounts of patient data. But are ADT feeds the best resource for improving member outcomes?
February 14, 2022
Utilization management (UM) is commonly assumed to be a strategy payers implement to reduce health care cost. Although successful programs do result in reduced cost of claims, the focus of an effective UM program is improved quality of care.
February 14, 2022
State Medicaid agencies for months have been preparing for the end of a federal mandate that has prevented states from removing people from the safety-net program during the pandemic.
February 10, 2022
Members of the RISE Risk Adjustment Policy Committee share their thoughts on the Centers for Medicare & Medicaid Services’ (CMS) recently released proposed 2023 Medicare Advantage (MA) and Part D Advance Notice and its impact on MA plans.
February 10, 2022
The Biden administration is getting rid of several policies implemented by Trump-era appointees that restricted enrollment. Federal officials now say states can no longer charge premiums to low-income residents enrolled in Medicaid and have ruled out work requirements.
February 10, 2022
Back for its 21st meeting, The International Publication Planning Meeting (TIPPA) will be held as a virtual event on March 24-25. The conference will connect global stakeholders in biopharma, medical device/diagnostics, medical communication agencies, medical writers, and publishers for off-the-record discussion, networking, and idea exchange.
February 08, 2022
Among the 764 hospitals hit with a 1 percent reduction in Medicare payments this year for having high numbers of patient infections and avoidable complications are more than three dozen that Medicare also ranks as among the best in the country.
February 08, 2022
Don’t miss your chance to register your team and join RISE for the Medicare Marketing & Sales Summit, February 16-18, at Caesars Palace. Here’s why this year’s event is breaking attendance records.
February 04, 2022
After it became increasingly clear that the White House’s efforts to expand access to free testing didn’t make it easy for older Americans who need the tests the most, the administration has decided to rectify it.
February 03, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
February 02, 2022
Deft Research’s annual national market research report examined the shopping and switching habits of more than 3,300 Medicare beneficiaries during the most recent Annual Election Period (AEP). The insights on what triggers led seniors to shop for other plans and ultimately choose a new carrier can help Medicare Advantage (MA) plans better prepare for the 2023 AEP.
February 02, 2022
As omicron surges, more nursing homes are facing a double whammy: Lab tests are taking too long, and fast antigen tests are in short supply.
February 02, 2022
The Department of Justice (DOJ) collected more than $5.6 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal 2021 and most of that money came from health care fraud cases.
February 02, 2022
RISE summarizes this week’s regulatory-related news.
February 02, 2022
The Centers for Medicare & Medicaid Services (CMS) on Wednesday released proposed payment policy changes for Medicare Advantage (MA) and Part D drug programs in 2023. Here’s a summary of the proposed changes to risk adjustment, Star Ratings, and the agency’s plans to advance health equity.
January 28, 2022
If federal officials accept a court’s decision, some patients will get a chance to seek refunds for their nursing home and other expenses.
January 27, 2022
The Government Accountability Office (GAO) on Thursday said that for more than a decade it has found issues with how the Department of Health and Human Services’ (HHS) prepares for and responds to emergencies, including COVID-19, the H1N1 influenza pandemic, Zika, Ebola, and extreme weather events, such as hurricanes.
January 27, 2022
Don’t miss your chance to get the latest developments in mandatory insurer reporting, conditional payments, Medicare set-asides, and Medicare Secondary Payer at the 7th Annual Medicare Secondary Payer Master Class, February 23-25, at the Kimpton Hotel Monaco in Washington, D.C.
January 26, 2022
Health plans operating in the Medicare Advantage space will need to optimize their risk adjustment and quality prospective and retrospective strategies to optimally align and make provider engagement and data governance the foundation to an effective social determination of health and population health strategy.
January 26, 2022
RISE summarizes recent headlines in regulatory news.
January 26, 2022
The Racial Equity and Policy (REAP) framework serves as a tool for researchers, policymakers, and others to identify and examine racial equity implications of health policies.
January 25, 2022
These tech-led retrospective approaches can help health plans ensure the data they submit is complete and accurate—without leading to further provider abrasion.
January 24, 2022
RISE is pleased to confirm that representatives from the Centers for Medicare & Medicaid Services (CMS) and Office of Inspector General (OIG) will join our roster of more than 150 speakers at RISE National 2022, which will take place live, in-person in Nashville, Tenn. on March 7-9.
January 24, 2022
The laws governing Medicare don’t provide coverage for self-administered diagnostic tests, which is precisely what the rapid antigen tests are and why they are an important tool for containing the pandemic.
January 21, 2022
Two rapid-testing initiatives the Biden administration released in the past week are inaccessible to some residents of multifamily housing, people who don’t speak English well, or those without internet access.
January 21, 2022
The funding announcements include $103 million in American Rescue Plan funds to reduce burnout and improve retention in the health care workforce as well as $13 million in funding to increase behavioral health in rural communities.
January 20, 2022
A new study found Black patients in a remote monitoring program had higher retention rates when providers reached out to them over the telephone rather than a smartphone app.
January 20, 2022
The Department of Health and Human Services issued preliminary rules regarding health insurance marketplaces that aim to deter fraudulent sign-ups for coverage. Experts say the agency’s action indicates a problem exists.
January 20, 2022
Two new studies on Medicare Advantage (MA) supplemental benefits indicate that more and more plans are taking advantage of the ability to use non-medical incentives to differentiate themselves among the increasing competition. While one report looks at the number of plans across the country offering these new non-medical benefits, the other study uncovers member preferences when it comes to common supplemental benefits.
January 20, 2022
The annual AEP preparation is a complex, human intensive and costly process for MAOs. To handle these challenges, MAOs employ a wide variety of approaches and solutions for managing their plan materials.
January 18, 2022
The findings of the latest Engagys-RISE survey on consumer engagement practices highlight the focus health plans place on consumer health engagement, effective communication channels, and the ways they measure engagement effectiveness. The following column analyzes the key results and maps them to industry trends to illustrate the reasons behind the newer results.
January 18, 2022
Insurers that offer Medicare Part D prescription drug program plans (PDP), beware. Member use of a prescription drug discount card is associated with lower intent to stay with their plan,
January 13, 2022
The Supreme Court on Thursday blocked a key Biden administration COVID-19 initiative—putting a stop, for now, to a rule requiring businesses with more than 100 workers to either mandate that employees be vaccinated against COVID or wear masks and undergo weekly testing.
January 13, 2022
RISE summarizes this week’s regulatory news from the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), and Office of Inspector General (OIG).
January 13, 2022
RISE looks at recent headlines concerning social determinants of health (SDoH).
January 10, 2022
The annual event will be held live at The Omni in Nashville, Tenn., March 20-22. Here’s a look at what we have planned so far for preconference workshops, networking opportunities, keynote presentations, general sessions, track sessions, and our health and safety protocols.
January 07, 2022
The proposed rule would revise Medicare Advantage (MA) and Medicare Part D regulations related to marketing and communications, Star ratings, the criteria used to review applications for new or expanded plans, provider network adequacy requirements, medical loss ratio reporting, special requirements during disasters or public emergencies, and the use of pharmacy price concessions to reduce the out-of-pocket costs for prescription drugs under Part D.
January 07, 2022
The Supreme Court on Friday took up one of the most contentious issues of the COVID-19 pandemic, hearing a series of cases challenging the Biden administration’s authority to require workers to get a COVID vaccine or be tested for the virus regularly.
January 06, 2022
Jane McGonigal, Ph.D., a world-renowned designer of alternate reality games—games that are designed to improve real lives and solve real problems—will speak on the second day of the main conference about how we can apply gaming to the health care industry.
January 04, 2022
Here are our predictions for the health care industry in 2022 based on interviews with industry experts in 2021, presentations at RISE conferences, and observations from our editorial team.
December 30, 2021
Whether you want to learn more about health policy, COVID, health care costs, or the latest news, we’ve gathered our picks for health care podcasts to add to your listening library in 2022. And a shameless plug – of course RISE Radio is on the list!
December 28, 2021
The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) today issued the Notice of Benefit and Payment Parameters 2023 Proposed Rule, also known as the proposed 2023 payment notice. In addition to lowering health care costs and making coverage options more equitable, the proposal also makes changes to risk adjustment models and HHS-Risk Adjustment Data Validation.
December 28, 2021
The COVID-19 pandemic continues as we close out 2021. Here is the latest news.
December 23, 2021
The Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) issued guidance this week tied to legal standards and best practices for improving access to COVID-19 vaccine programs and ensuring nondiscrimination based on race, color, and national origin.
December 23, 2021
It’s become industry standard to code medical records to 95 percent. But would you be satisfied with receiving 95 percent of your paycheck each month? Or 95 percent of your retirement savings? Probably not. Yet many health plans currently accept a 95 percent coding accuracy rate.
December 23, 2021
Nearly 14 million Americans have enrolled in Affordable Care Act (ACA) marketplace health plans for next year—a record since the health law’s coverage expansion took effect in 2014. A boost in subsidies marketing and assistance in navigating the process increased the rolls of the insured.
December 20, 2021
Our editorial team has had the pleasure of conducting dozens of interviews during 2021. We enjoyed them all and learned so much. Here’s a look back at a few of our favorite conversations.
December 20, 2021
As we head into 2022, here’s a look back at our most viewed articles of 2021. Trending topics included fraud lawsuits, Star ratings, and federal investigations into overpayments.
December 20, 2021
Dr. Nancy Messonnier, former director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, answers questions about the pandemic. The Q&A was originally published by Participant.
December 20, 2021
Member engagement was a priority for health plans this year, but consumers proved hard to reach, according to the Sixth Annual Survey of Healthcare Consumer Engagement Practices, which is conducted each year as a joint effort between RISE and Engagys. The annual survey tracks the consumer engagement tactics, budgets, challenges, and priorities of the nation’s leading health plans.
December 20, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
December 17, 2021
RISE summarizes the latest headlines that impact Medicare, Medicaid, and Medicare Advantage (MA).
December 16, 2021
A new report from Together for Better Medicaid reveals states’ commitments to address social determinants of health (SDoH) and health equity through their partnerships with Managed Care Organizations (MCOs).
December 15, 2021
The U.S. Department of Health and Human Services (HHS) this week will release Provider Relief Fund (PRF) Phase 4 payments to health care providers who have experienced revenue losses and expenses related to the pandemic.
December 15, 2021
Starting in January, California will embark on an ambitious experiment to control asthma in its most vulnerable patients.
December 10, 2021
Ryan Avery, a world record holder, two-time best-selling author, Emmy award winning journalist, and world champion, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.
December 10, 2021
The American Medical Association and American Hospital Association are not arguing to halt the law that protects patients from unexpected bills from providers they didn’t know were outside their insurance network. Instead, they want to change the rules for the mediators who will settle the dispute between insurers and providers.
December 10, 2021
In West Virginia, older residents often go without dental care, and a quarter of people 65 and older have no natural teeth, the highest rate of any state in the country. But a powerful senator from West Virginia, Joe Manchin, has rebuffed efforts to add a dental benefit to Medicare.
December 09, 2021
In a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, the Better Medicare Alliance proposed strategies to better serve Medicare Advantage (MA) members. The letter was sent as CMS prepares its Calendar Year 2023 MA rate and policy-setting process.
December 09, 2021
Accuracy issues raise red flags because the data is used to plan and direct resources in the nation’s continuing response to the COVID-19 pandemic.
December 09, 2021
Nearly 4.6 million Americans signed up for health plan coverage through HealthCare.gov and State-based Marketplaces since the start of the 2022 Open Enrollment Period on November 1, according to the U.S. Department of Health & Human Services (HHS).
December 08, 2021
Medicare billing codes for audio-only follow-up check-ins lead to new reimbursement battles.
December 06, 2021
Was your 2022 Star rating score too close for comfort? Pay attention to these three trends as you look to the (near) future.
December 06, 2021
A new report from the U.S. Department of Health and Human Services (HHS) found that massive increases in the use of telehealth helped maintain some health care access during the COVID-19 pandemic, with specialists like behavioral health providers seeing the highest telehealth utilization compared to other providers.
December 06, 2021
RISE summarizes the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.
December 02, 2021
America’s taxpayers could see recoupment of billions of dollars in misspent Medicare, Medicaid, and other health and human services funds due to the work of the Department of Health and Human Services (HHS), Office of Inspector General (OIG), according to a new report.
December 02, 2021
A day after a federal judge blocked a vaccine mandate of staff at Medicare and Medicaid-certified facilities in 10 states, a second U.S. judge applied the ruling nationwide where the mandate was still in effect.
December 01, 2021
RISE’s Women in Health Care Leadership Summit will return for its sixth consecutive event Dec. 14-15 in San Diego to connect entry-level and top executives in health care, career coaches, and leadership gurus to share tools for women empowerment and leadership in the industry. Speaking with RISE ahead of the summit, keynote speaker Dr. Amy Nguyen, senior national physician executive, Optum, shared strategies she leveraged to position herself as a leader.
December 01, 2021
Dale Klein has a built a business helping people present themselves, become better networkers and level up their careers. She'll be speaking about active listening at the upcoming RISE Women in Health Care Leadership Summit.
November 30, 2021
A federal judge on Monday ruled that the Centers for Medicare & Medicaid Services (CMS) doesn’t have the authority to enforce a vaccine mandate of staff at Medicare and Medicaid-certified facilities in 10 states.
November 30, 2021
After launching her career as a global keynote speaker and certified leadership and success coach, Lisa Orrell realized just how many people were unhappy at work. An expert on leadership development and personal branding, she focused her efforts on helping teams and organizations around the globe enhance their workplaces to improve culture and retain employees. Orrell will kick-off the annual RISE Women in Health Care Leadership Summit, held Dec. 14-15 in San Diego, with a fun and insightful keynote presentation on how to use your personal leadership brand to manage a leadership mindset even in the most difficult times.
November 29, 2021
In California, health insurers blame long waits for therapy appointments on workforce shortages, but state lawmakers say that’s an excuse. A new law requires insurers to reduce wait times for mental health appointments to no more than 10 business days.
November 23, 2021
The Health and Human Services secretary says the administration has heard complaints from doctors and hospitals about the rules it unveiled for implementing the law to end surprise medical bills. But he says providers who have exploited a complicated system to charge exorbitant rates will have to bear their share of the cost—or close.
November 23, 2021
The 6th Annual CMS Bid Bootcamp will return as a live, in-person event, January 13-14, 2022 at the Luminary Hotel & Co. in Fort Myers, Fla. From a pre-conference workshop on bid essentials to strategies that support and improve Star ratings, here’s everything we’ve planned to help you create, update, and execute your own CMS bid roadmap to set your organization up for plan growth year after year.
November 23, 2021
The analysis measured health equity for people of different races and ethnicities within and between each state and their health system’s performance for racial and ethnic groups.
November 22, 2021
Change Healthcare has been using claims reports from its commercial health plan clients to project the increased risk to insurers of post-COVID health impacts in 2021 through 2023. The research is ongoing, but RISE interviewed Peter Colbert, director, customer success decision analytics, to find out what the health care technology company has learned so far.
November 22, 2021
Achieving health equity requires the participation of individuals, communities, businesses, government, social service agencies, and more.
November 22, 2021
The COVID-19 pandemic has suddenly presented payers with new and unexpected challenges.
November 22, 2021
Insights learned from a recent focus group Real Time Medical Systems conducted with 10 experienced health plan executives about their organization’s relationship with skilled nursing facilities (SNF) and what information they use to help drive both quality and value with their SNF partners.
November 19, 2021
A new brief commissioned by Better Medicare Alliance (BMA), and prepared by the actuarial consulting firm Milliman, finds 2022 offers more availability of home-based palliative care, in-home support services, caregiver support, and therapeutic massage.
November 19, 2021
In a Health Affairs blog post, Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure and Center for Medicaid & CHIP Services (CMCS) Director Dan Tsai described their policy agenda for Medicaid and Children’s Health Insurance Program (CHIP).
November 19, 2021
The House of Representatives on Friday voted 220-213 in favor of President Joe Biden’s Build Back Better Bill. Although it’s significantly scaled back from the originally proposed $3.5T package, it’s unclear whether it will pass the Senate, where it needs 51 votes.
November 18, 2021
The rule requires health plans, and other group health plans to submit key data to the federal government that will be used for a report on prescription drug pricing trends and rebates, as well as their impact on premiums and drug spending for patients, compared to their employers and/or group health plans/health insurance issuers.
November 18, 2021
After more than 20 years in the corporate world, Erin Hatzikostas left her role as CEO at a health care financial institution and reimagined her career as a best-selling author, TEDx speaker, executive coach, and founder of b Authentic. Hatzikostas, who will be a speaker at the RISE Women in Health Care Leadership Summit on Dec. 14-15 in San Diego and RISE National 2022 on Mar. 7-9 in Nashville, talked to RISE about strategic authenticity and how women can change the job rather than change themselves for the job.
November 17, 2021
Congress last year shielded consumers from unexpected out-of-network charges, but hospitals and doctors have decried the arbitration plan put forward by the Biden administration for negotiating these bills as favoring insurers. More than 150 members of the House agree.
November 17, 2021
Do you know someone who has made a significant impact in the lives of underserved populations through health care and/or social services interventions? If so, nominate them for the first-ever RISE Health Care Hero Award!
November 16, 2021
The Centers for Medicare & Medicaid Services (CMS) said its aggressive corrective actions led to an estimated $20.72 billion reduction of Medicare Fee-for-Service (FFS) improper payments over seven years.
November 15, 2021
As independently owned pharmacies struggle to stay open amid competition with large retail drugstores, individuals in rural communities are left without easy access to a pharmacy.
November 15, 2021
Seniors may have sticker shock when they open their Medicare monthly premium bills in January. The Centers for Medicare & Medicaid Services (CMS) has released the 2022 Medicare Part B premiums and it’s one of the largest increases ever.
November 12, 2021
Here's a list of questions you should ask any quality analytics and technology vendor, whether you are evaluating your current partner or shopping for a new one. Their answers will help you assess whether their goals, priorities, and expertise meet your individual needs.
November 12, 2021
RISE summarizes the latest regulatory headlines that impact the health care industry.
November 12, 2021
Our 12th annual conference will take place Dec. 14-15 at the Manchester Grand Hyatt San Diego. Check out the sessions and speakers we’ve planned to help you boost your Star ratings in 2022.
November 12, 2021
RISE National 2022—the #1 trusted source for all things Medicare Advantage—returns to Nashville, Tenn. on March 7-9 as a live, in-person event and will feature two blockbuster keynotes.
November 11, 2021
Researcher: Medicare Advantage plans costing billions more than they should
November 10, 2021
Medicare officials say complaints are rising from seniors lured into private plans with misleading information or enrolled without their consent.
November 10, 2021
The Office of Inspector General (OIG) audited UPMC Health Plan, Inc. to determine whether the Medicare Advantage organization appropriately submitted selected diagnoses codes to the Centers for Medicare & Medicaid Services’ (CMS) risk adjustment program.
November 09, 2021
TV ads and mailings targeting seniors tout Medicare Advantage plans this time of year, but millions choosing traditional Medicare make a costly and difficult decision about Medigap coverage, which gets much less attention.
November 08, 2021
Two new studies by the Kaiser Family Foundation (KFF) offer a comprehensive look at Medicare Advantage (MA) plans and Medicare Part D stand-alone prescription plans. Here’s what they uncovered.
November 08, 2021
Although Medicare provides older adults with significant financial protection from health care costs, many still struggle to afford needed care, according to a blog post on the Commonwealth Fund.
November 08, 2021
The research shows how capitation and faster claim payment in Medicare Advantage (MA) helped maintain cash-strapped physician practices, while risk stratification methods allowed health plans to quickly reach seniors most in need.
November 08, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
November 05, 2021
Deft Research’s 2021 Individual and Family Plan Member Experience and Engagement Study reveals the commercial health plan benefits that create and destroy member loyalty. Spoiler alert: It’s not cost.
November 04, 2021
The Centers for Medicare & Medicaid Services (CMS) has been busy. Here is a roundup of the agency’s recent news and actions.
November 04, 2021
Fueled by consumer frustration with high premiums and deductibles, two new offerings promise a means for consumers to take control of their health care costs. But experts say they pose risks.
November 03, 2021
The Centers for Medicare & Medicaid Services (CMS) on Tuesday released the 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule.
November 03, 2021
President Joe Biden and Congressional Democrats announced they reached a compromise plan for drug pricing that will reduce the costs of prescription drugs and insulin and finally allow Medicare to negotiate prices for high-cost prescription drugs.
November 03, 2021
The survey of Medicaid directors in states and the District of Columbia explored current policies or planned changes for the current fiscal year.
November 01, 2021
Former CMS Administrator Seema Verma will share insights on high value, low-cost health care at The RISE Summit on Social Determinants of Health on Monday, March 21 at The Omni Nashville.
October 29, 2021
RISE rounds up the latest regulatory headlines that impact Medicare, Medicare Advantage, and Medicaid.
October 28, 2021
Join us for the latest episode of RISE Radio, our podcast series that focuses on issues of interest to our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.
October 28, 2021
As lawmakers weigh new spending provisions to cover dental, hearing and vision services for Medicare beneficiaries, a group supporting Medicare Advantage plans is airing commercials that raise concerns about the funding for those private plans.
October 28, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
October 28, 2021
UnitedHealthcare, one of the largest health insurers in the country, filed suit this week against TeamHealth, claiming the staffing company deliberately upcoded commercial insurance claims for emergency room services, which led to overpayments of more than $100 million
October 27, 2021
Medicare plans’ ‘free’ dental, vision, hearing benefits come at a cost
October 26, 2021
Any effort to apply AI to risk adjustment in a VBC context must start with the right strategy and technology for data capture across formats, systems, and providers.
October 22, 2021
Medicare marketers are making connected TV (CTV) an integral part of their media mix during AEP (it is easy to include as a mid-AEP boost). In addition, it’s also a great low-cost channel to leverage throughout the year. So, what is CTV? And why is it important?
October 22, 2021
A recent panel of Medicare beneficiaries revealed that every beneficiary wanted and welcomed communications from their health plan. Here's how to make communications the most effective in driving action.
October 21, 2021
RISE rounds up the latest news involving Medicare Advantage (MA) plans.
October 21, 2021
The Commission’s recommendations aim to modernize current data systems to address structural racism and advance health equity.
October 21, 2021
The sixth consecutive event will return to San Diego December 14-15 to connect pioneering senior-level women inspired to advance diversity and inclusion and cultivate female leadership in health care.
October 20, 2021
Licensed Medicare agents, or brokers, can help beneficiaries choose the right coverage, but financial incentives also can influence which plans they highlight, according to a Commonwealth Fund blog post.
October 20, 2021
A new survey released by Medicare Advantage.com prior to the Annual Election Period finds a widespread lack of knowledge among beneficiaries about Medicare enrollment and basic health insurance terms.
October 19, 2021
Digital health startup nirvanaHealth this week launched Aria Medicare, a Medicare Advantage-in-a-box solution that runs on Amazon Web Services.
October 18, 2021
The use of analytics for the proactive review of and oversight into coding and submission processes has become more critical than ever. But instead of only looking for undercoding or gaps, health care organizations need to look for overcoding as well. In this landscape, even plans that did not think they were on the radar for RADV may now be at risk—and all plans should prepare for some kind of audit each year.
October 18, 2021
The Centers for Medicare & Medicaid Services (CMS) issued a long-awaited memo outlining best practices for Medicare marketing campaigns conducted by third parties. But does it go far enough? RISE weighs in.
October 15, 2021
The hospital has implemented several programs targeting food insecurity, education attainment, health literacy, and health care access.
October 15, 2021
RISE summarizes recent regulatory headlines.
October 15, 2021
New, often lower-cost plans capitalize on the convenience of telemedicine—and patients’ growing familiarity with it. But consumers should weigh costs and care options before enrolling in a “virtual-first” plan.
October 14, 2021
The new Kaiser Family Foundation (KFF) analysis examines how many seniors compared different health plans during the 2018 Medicare open enrollment period for coverage in 2019 (the most recent year available).
October 14, 2021
RISE will return to Caesars Palace, Las Vegas, Feb. 16 to 18, 2022 for the 15th annual Medicare Marketing & Sales Summit. Here’s what you need to know about planned preconference workshops, networking opportunities, keynote presentations, general sessions, track sessions, roundtables, and our health and safety protocols.
October 14, 2021
Patients soon will not have to worry about the prospect of these often-costly unexpected bills, a federal law promises. Some experts say the new policy could also slow the growth of health insurance premiums.
October 12, 2021
But Americans generally have little confidence that the White House or Congress will recommend the right thing, a new poll shows.
October 11, 2021
Ashby Wolfe, M.D, regional chief medical officer, Centers for Medicare & Medicaid Services (CMS), will kick off the second day of the 18th Risk Adjustment Forum, Nov. 15-17, with a keynote address that includes an industry update on risk adjustment and a review of CMS policy changes in 2021.
October 08, 2021
The Centers for Medicare & Medicaid Services (CMS) on Friday released Star ratings ahead of Medicare open enrollment. Seventy-four Medicare Advantage plans received the highest rating of 5 stars.
October 08, 2021
Laura Cooley, Ph.D., senior director of education and outreach, Academy of Communication in Healthcare, will kick off RISE’s 18th Risk Adjustment Forum on November 16. In this article Cooley shares time-effective steps health care leaders can take to manage complex change.
October 07, 2021
The Department of Health and Human Services and Better Medicare Alliance released separate reports this week that show promising findings about COVID-19 vaccinations and seniors, and hospitalization and mortality rates for Medicare Advantage members.
October 07, 2021
RISE summarizes this week’s regulatory headlines.
October 07, 2021
RISE is excited to return to in-person conferences. To ensure the health and safety of attendees, speakers, exhibitors, and staff, RISE will require proof of full COVID-19 vaccination status to attend the events. Here’s everything you need to know before you make your travel arrangements.
October 06, 2021
Blue Cross Blue Shield of Massachusetts plans to incorporate equity measures into its payment models to address racial disparities identified through its recent health equity analysis.
October 06, 2021
Patients are caught in the middle as insurers clamp down on paying for treatments or force prior authorizations for care.
October 05, 2021
A recent review of persistent gaps in preterm birth rates between Black and white women underscores racism as a key factor.
October 04, 2021
RISE looks at current trends and challenges related to social determinants of health (SDoH) with Melissa Quick, co-chair, Aligning for Health, a coalition advocating to Congress for solutions to address SDoH across the country.
October 01, 2021
The attorneys general in Illinois and Arkansas on Thursday separately announced settlements with Centene Corporation, the largest Medicaid managed care organization in the United States, over inaccurate billing practices.
October 01, 2021
A new interim rule outlines a process that will take patients out of the middle of payment disputes, explains how payers and providers can settle out-of-network payment disagreements, and details a process for self-paying and uninsured individuals to resolve issues over bills.
September 30, 2021
More than 2 million low-income adults are uninsured because their states have not accepted Medicaid expansion under the Affordable Care Act. Congressional Democrats want to offer them coverage in the massive spending bill being debated, but competition to get into that package is fierce.
September 30, 2021
The Centers for Medicare & Medicaid Services (CMS) announced Wednesday that the average premium for Medicare Advantage (MA) plans will be $19 per month in 2022. The agency also projects enrollment in MA plans to spike to 29.5 million people in the upcoming year.
September 30, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
September 28, 2021
The ad, advanced by a right-leaning seniors advocacy organization, mischaracterizes proposals to bargain on drug prices, regarding both the effects on the Medicare program and on beneficiaries.
September 28, 2021
Daniel “Rudy” Ruettiger will share his message on how to “dream big” and the importance of building relationships at the RISE Medicare Marketing & Sales Summit, February 16-18, 2022, at Caesars Palace.
September 28, 2021
Nominations are now open for RISE’s annual Martin L. Block Award for Innovation & Excellence. RISE’s highest honor recognizes excellence and clinical leaders’ passion to improve patient care.
September 24, 2021
For the third year in a row, health plans striving to improve population health efforts will convene to hear more than 20 industry experts’ and thought leaders’ expertise on the actionable strategies that take initiatives to the next level. The live-streaming virtual event, November 16-17, will spotlight critical issues in the population health space; from the dramatic increase in hospital readmissions post-pandemic to maternal health care among vulnerable populations to the mental health crisis, we’re covering it all.
September 23, 2021
RISE summarizes the latest regulatory headlines that impact Medicare, Medicare Advantage (MA), and Medicaid.
September 22, 2021
The Department of Justice (DOJ) said 42 doctors, nurses, and other licensed medical professionals are among the 138 defendants facing criminal charges for their alleged involvement in health care fraud schemes that resulted in nearly $1.4 billion in alleged losses.
September 22, 2021
A new Office of Inspector General (OIG) report found that 20 of 162 Medicare Advantage (MA) companies studied drove a disproportionate share of the $9.2 billion in payments from diagnoses that were reported only on chart reviews and health risk assessments (HRA) and on no other service records.
September 22, 2021
A new Kaiser Family Foundation (KFF) analysis provides context about existing coverage and costs as Congress debates adding dental, hearing, and vision benefits to Medicare.
September 21, 2021
Sixteen states have an adult obesity prevalence at or above 35 percent, an increase from nine states in 2018, according to new data from the Centers for Disease Control and Prevention (CDC), which notes social determinants of health (SDoH) play an influential role.
September 20, 2021
The plans are designed for people who don’t get dental coverage through their jobs and can’t afford an individual plan. For about $300 to $400 a year, patients receive certain preventive services at no charge and other procedures at a discount.
September 17, 2021
RISE summarizes recent headlines that impact the U.S. health system, Medicare, Medicare Advantage, and Medicaid.
September 17, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
September 15, 2021
The Census Bureau on Tuesday released its 2020 findings regarding Americans’ income, poverty, and health insurance coverage.
September 15, 2021
According to the report, COVID-19 and the subsequent economic downturn has reversed progress on eliminating poverty by four years, with 31 million more people around the world living in extreme poverty.
September 14, 2021
The feds’ civil suit links exaggerated patient bills to “tens of millions” in overcharges.
September 13, 2021
It’s not easy to get the necessary resources to ensure your organization is able to prevent and properly respond to ransomware attacks. But as the number of attacks increase in the health care industry, it’s vital that organizations put the right people and resources in place. Here’s how Integra Managed Care has responded to the growing threats and why your organization may want to follow the managed long-term care plan’s lead.
September 10, 2021
Two years ago, RISE West had the honor of having Richard Picciotto, retired NYC fire department chief, present an amazing story of his survival and heroics during 9/11. As the nation commemorates the 20th anniversary of our darkest day, we look back on his inspiring keynote.
September 09, 2021
In a new blog post, Chiquita Brooks-LaSure, administrator, Centers for Medicare & Medicaid Services (CMS), reflects on her first 100 days in office and her vision for the future.
September 09, 2021
The Centers for Medicare & Medicaid Services (CMS) said the new action will protect patients, providers, and health care workers in Medicare and Medicaid settings.
September 09, 2021
RISE summarizes recent headlines that impact Medicare and Medicare Advantage.
September 09, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
September 08, 2021
Although Medicaid traditionally doesn’t fund clinics to supply legal assistance, Colorado is one of several states that have been given permission to use some of their Medicaid money to help pay for such programs.
September 02, 2021
The learning continued at our hybrid-event with two keynotes, a Medicare Advantage member focus group, legal insights, and a panel discussion on member engagement and experience. Here are a few highlights from our favorite sessions.
September 01, 2021
Our 2021 hybrid event kicked off on Wednesday with 400 attendees gathering in-person at The Broadmoor in Colorado Springs, while 200 others participated in the event via their home offices.
September 01, 2021
The Office of Inspector General (OIG) said the findings may help hospitals and health officials better prepare for and address the wide-ranging and extensive needs of COVID-19 patients, particularly when local communities experience a surge in cases.
August 31, 2021
2023 Stars is around the corner. Here's an action plan to design your CAHPS® improvement strategy.
August 31, 2021
RISE summarizes the latest regulatory headlines that impact Medicare, Medicare Advantage (MA), and Medicaid.
August 30, 2021
Older adults who live in disadvantaged neighborhoods become disabled two years earlier than those living in more affluent areas, according to researchers from Yale School of Medicine.
August 26, 2021
RISE summarizes recent headlines that have an impact on Medicare, Medicare Advantage, and Medicaid.
August 25, 2021
A new study by Deft Research uncovers how Medicare members use digital health tools provided by their insurers, their providers, and other third parties to manage their health and navigate their coverage.
August 25, 2021
A new analysis from Wakely Consulting Group, funded by AHIP, finds that adding dental, hearing, and vision benefits to traditional Medicare without adjusting the benchmark for Medicare Advantage (MA) could result in fewer benefit dollars for MA plans to pay for supplemental benefits, including those that address social determinants of health.
August 24, 2021
In this white paper, we explore the opportunities, as well as the technical and strategic challenges that payers face on the path to achieve complete digital transformation in health data access, interoperability, and data-driven health care.
August 23, 2021
Outsourcing clinical workflows to offshore partners is becoming increasingly popular and is highly cost effective. But there are challenges that come with outsourcing,
August 23, 2021
Scripps Health recently revealed it was the victim of a significant cyberattack, which forced the organization to shut down its systems and initiate emergency manual down-time procedures until it could restore all its systems 25 days later. The massive attack cost the San Diego-based health system nearly $113 million. The organization is far from alone. Ransomware attacks on the health care industry are increasing in number and severity.
August 23, 2021
Though overall suicide rates have decreased in the U.S. in recent years, rates continue to rise in communities of color.
August 20, 2021
For a health care payer to ensure its population’s risk burden is accurately represented, optimal technology tools must be used to monitor encounter data, isolate aberrancies, and quickly and efficiently address any errors.
August 20, 2021
RISE reviews recent headlines that have an impact on Medicare, Medicare Advantage, and Medicaid.
August 20, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
August 19, 2021
The pandemic has had a disproportionate impact on racial/ethnic groups, low-income earners, and women, according to a new review from Public Health Nursing (PHN).
August 17, 2021
Our guide to hot-topic sessions, keynotes, and networking opportunities at RISE West, a hybrid event that will take place August 30-Sept. 2.
August 17, 2021
Vaccines are one of the best tools to promote better health outcomes.
August 11, 2021
RISE reviews the latest headlines, including the Office of Inspector General (OIG) reports, trending telehealth diagnoses, and the introduction of a new bill to improve the oversight of nursing homes.
August 11, 2021
When the program began half a century ago, backers believed the benefits would expand over time, but politics and concerns about money have stymied most efforts. Now congressional Democrats are looking to add vision, dental, and hearing care.
August 09, 2021
In an August 5 memo to all Medicare Advantage (MA) plans, the agency announced that the COVID-19 public health emergency significantly impacted the validity of measures related to physical and mental health currently used in the Star Ratings.
August 09, 2021
Learning will take place at RISE West even before the main conference begins.
August 06, 2021
How behavioral science, segmentation, and hyper-personalization helps health plans activate their members.
August 05, 2021
While federal Medicaid rules prohibit costs related to non-medical services, such as social determinants of health (SDoH), there are opportunities for state Medicaid programs to address enrollees’ social needs both within and outside of managed care, according to a new report by the Kaiser Family Foundation (KFF). In the brief, KFF discusses the options and federal Medicaid authorities that states can leverage to address enrollees’ SDoH, as well as examples of initiatives launched in response to the COVID-19 pandemic.
August 05, 2021
A new report conducted by NORC at the University of Chicago on behalf of Better Medicare Alliance’s Center for Innovation in Medicare Advantage (MA) highlights innovative approaches that MA plans are doing to address social determinants of health (SDoH) for beneficiaries. However, researchers acknowledge that barriers remain.
August 04, 2021
RISE summarizes the latest health care news from the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and the Commonwealth Fund.
August 03, 2021
A recent study from the American Journal of Preventive Medicine (AJPM) found socioeconomic and racial/ethnic disparities in vaccine uptake have persisted over the last decade in adults. As COVID-19 vaccine roll-out continues throughout the United States, efforts to promote health equity among racial/ethnic minority and low-income populations are critical to improve population health.
August 02, 2021
Medicare Advantage (MA) beneficiaries in the last year of life dropped their coverage to join traditional Medicare at more than twice the rate of all other MA beneficiaries, according to a new Government Accountability Office (GAO) report.
August 02, 2021
The government has intervened in False Claims Act lawsuits against Kaiser Permanente affiliates for submitting inaccurate diagnosis codes for risk-adjusted payments to the Medicare Advantage (MA) program. Mary A. Inman, a partner in the whistleblower practice group at Constantine Cannon, which is representing one of the whistleblowers, will take a deeper look at the case as part of a RISE West session on lessons learned from whistleblower-litigated False Claims Act cases.
July 29, 2021
Pharmaceutical companies routinely cover the cost of patient copays for expensive drugs under private insurance. A federal judge could make the practice legal for millions on Medicare as well.
July 29, 2021
Many people enrolled in Medicare go without dental care, especially beneficiaries of color, according to a new Kaiser Family Foundation analysis of dental coverage and costs for people with Medicare.
July 28, 2021
RISE rounds up the latest news on COVID-19.
July 28, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
July 28, 2021
For the second year, FRA and RISE will join forces to produce a live-streaming virtual event August 24-25 to connect health care service providers, the investment community, and leaders in the health care industry to cultivate the business partnerships needed to foster change and achieve positive financial returns. Ahead of this year’s event, Alison Rein, vice president, health and human services, Quantified Ventures, who is a presenter at this year’s summit, shared with RISE an inside look at how the outcomes-based capital firm connects organizations with innovative program models in need of capital with the right investors.
July 26, 2021
The Kaiser Family Foundation (KFF) findings come as lawmakers in Congress consider establishing a hard cap on such spending.
July 26, 2021
Patients seem to like remote visits, and health care providers now depend on them. But outages, freezing, and other glitches cost time and money, and compromise quality of care.
July 23, 2021
A recent brief from Kaiser Family Foundation (KFF) found that after years of progression in coverage across all racial/ethnic groups, uninsured rates have increased through 2019.
July 21, 2021
RISE summarizes recent regulatory news, including announcements and proposals from the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services.
July 20, 2021
Sen. Ron Wyden (D-Ore.), who is helping to negotiate the health care spending framework for the Democrats' budget plan, said lawmakers may have to settle for very basic versions of programs deployed in the package. But the key, he added, is to get the "architecture of these changes, bold changes," started and show people what is possible.
July 19, 2021
RISE West 2021 will bring together senior leaders from Medicare Advantage health plans, commercial marketplace sponsors, Part D health plans, providers groups, pharmacy benefit managers, and accountable care organizations to discuss the hot topics facing the industry. We talked to four of the 50 speakers about their sessions to learn what attendees can expect at this year’s hybrid event, which will take place live in Colorado Springs and virtually via livestream August 30-September 2.
July 18, 2021
COVID-19 accelerated the adoption of telehealth services. But what does the future hold? RISE West will explore innovative approaches to telehealth efforts during a panel discussion on Wednesday, Sept. 1, the first day of the main conference. We talked to Andy Ellner, M.D., one of the panelists ahead of the hybrid event, about Firefly Health, a virtual primary care practice established in 2016.
July 17, 2021
Provider engagement is a key theme at this year’s RISE West, a hybrid event that will take place live in Colorado Springs and via livestream August 30-Sept. 2. In this article we talk to Jeslie Jacob of Blue Cross and Blue Shield of Illinois, one of the panelists at the session on payer experiences in provider engagement.
July 16, 2021
Recommendations to help Medicare Advantage Organizations to effectively address challenges of timelines, quality, and user fatigue associated with Annual Enrollment Period update cycles.
July 15, 2021
Angela G. Huskey, PharmD, CPE, senior vice president and chief clinical officer at Millennium Health, joins us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.
July 14, 2021
The Centers for Medicare & Medicaid Services (CMS) released the proposed 2022 Physician Fee Schedule on Tuesday. In addition to proposed payment rates for Medicare next year, the agency included policy proposals to address health equity and expand patient access to comprehensive care.
July 14, 2021
The new report sheds light on the health disparities that continue to exist by gender, geography, socioeconomic status, race and ethnicity, and educational attainment.
July 14, 2021
RISE rounds up the latest health care headlines that impact Medicare, Medicaid, and the Affordable Care Act.
July 14, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
July 13, 2021
HHS Secretary Xavier Becerra says the administration is eager for Congress to make changes to Medicare that will provide more benefits and make more older adults eligible for the program.
July 09, 2021
A coalition of more than 100 organizations have expressed their support for the reintroduction of the bipartisan bill.
July 08, 2021
Learn about the innovative strategies special needs plans (SNPs) can leverage to support individuals with significant, complex social needs while advancing health equity.
July 08, 2021
The new workgroups will address issues of most concern to members of RISE’s Medicare Member Acquisition & Experience (MAE) community. Up first, the fallout from Joe Namath’s Medicare television commercials and key performance indicators (KPIs) around marketing and sales.
July 02, 2021
The new regulation is the first in a series of rules that will help shield consumers from surprise medical bills. Balance billing is already banned in Medicare and Medicaid–the rule offers similar protections to those insured through employer-sponsored and commercial health plans.
July 02, 2021
For the second year in a row, Deft Research has found a higher proportion of age-ins lean toward selecting a Medicare Advantage (MA) plan when they enter Medicare. Although the balance of interest between MA and MedSupp may have changed during the COVID-19 pandemic, it doesn’t appear to be reversing, according to an executive summary of the 2021 Age-In Study.
July 01, 2021
The Centers for Medicare & Medicaid Services (CMS) said the proposed changes mark the Innovation Center’s first direct effort to close health equity gaps.
June 30, 2021
RISE rounds up the latest regulatory headlines involving emerging infectious disease emergencies; mental health, deceitful health plan marketing practices, health care cost-related problems and racial disparities, health literacy, and the American Hospital Association’s lawsuit on site-neutral payments.
June 29, 2021
The proposed provisions are part of the third installment of the payment notice for 2022.
June 29, 2021
A new study indicates social determinants of health (SDoH) are associated with an increase in Medicare per beneficiary spending in certain geographic variations.
June 25, 2021
A look at community-based health care organizations’ proven-successful approaches to address food insecurity.
June 25, 2021
The pandemic will undermine Americans' health for years. Even those not infected by the coronavirus could suffer health problems related to poverty, job loss, eviction — or all of the above
June 24, 2021
In a sharp shift from Trump-era policies, President Joe Biden looks at expanding Medicaid eligibility to new mothers, inmates, and undocumented immigrants and adding services such as food and housing.
June 24, 2021
RISE rounds up the latest news concerning COVID-19.
June 24, 2021
The findings indicate that fewer Black patients would have died from COVID-19 if they were admitted to different hospitals.
June 22, 2021
Check out the keynotes and officials who have joined our blockbuster roster of more than 50 speakers and 30 sessions for RISE West 2021. The hybrid event will take place August 30-September 2 both live in Colorado Springs and virtually via livestream. This article spotlights four of the can’t-miss sessions.
June 21, 2021
Mary Beth Donahue has been tapped to lead the Better Medicare Alliance’s (BMA) community of 160 ally organizations and more than 500,000 grassroots advocates supporting Medicare Advantage.
June 21, 2021
The annual study, conducted by J.D. Power, measures member satisfaction with Medicare Advantage (MA) plans based on six factors: coverage and benefits; provider choice; cost; customer service; information and communication; and billing and payment.
June 21, 2021
Three Kaiser Family Foundation (KFF) analyses examine the latest data trends in Medicare Advantage (MA). Among the findings: Enrollment is way up, premiums have dropped, and more members are in plans with Star ratings of 4 or higher.
June 18, 2021
New research shows global poverty trends are on the rise amid the pandemic for the first time in decades.
June 17, 2021
RISE summarizes recent headlines that impact the health care industry.
June 17, 2021
The latest episode of our podcast series, RISE Radio, focuses on the explosion of telemedicine during COVID-19 and what the future holds.
June 17, 2021
The Supreme Court on Thursday dismissed a challenge to kill the Affordable Care Act (ACA) and saved health care coverage for millions.
June 15, 2021
What an amazing RISE Summit on Social Determinants of Health it’s been! Day two delivered another impressive lineup of compelling speakers, timely discussions, and cross-sectional connection.
June 14, 2021
It’s been a busy first day at The RISE Summit on Social Determinants of Health! After a long 16 months, many of us have experienced a thrilling return to in-person attendance in Nashville, and others joined from the comfort of their home offices thanks to our reimagined hybrid conference experience. It is great to be back and reconnect, both in-person and virtually!
June 11, 2021
Phone visits became an option for many Medicare and Medicaid patients during the pandemic. Now policymakers are deciding whether they’re worth the money.
June 11, 2021
A new analysis by researchers at Brown University reveals that the current Star rating system for Medicare Advantage (MA) plans doesn’t always mean gold-level care for racial/ethnic minorities and socioeconomically disadvantaged enrollees in the plans.
June 10, 2021
Citing the deaths of thousands of health care workers, the new rules will force employers to report fatalities or hospitalizations to the Occupational Safety and Health Administration, and provide higher-quality protective gear, among other actions.
June 09, 2021
Health care organizations and industry trade groups continue to put pressure on the Centers for Medicare & Medicaid Services (CMS) to allow audio-only encounters to be included in Medicare Advantage (MA) risk adjustment.
June 08, 2021
The latest data reveals 31 million Americans are enrolled in health coverage through the Health Insurance Marketplaces and Medicaid expansion under the Affordable Care Act (ACA).
June 07, 2021
Pressure is mounting on Congress and the Biden administration to make permanent pandemic-inspired rules that fueled telehealth growth. Some fear fraud and ballooning costs.
June 07, 2021
The new relief program aims to expand access to affordable water and assist low-income households impacted by the COVID-19 pandemic pay their water and wastewater bills, prevent shutoffs, and support water system reconnections related to non-payment.
June 07, 2021
RISE’s annual summit will be held as a hybrid event on June 14-15, with preconference workshops on Friday, June 11. Whether attending virtually via livestream or in-person in Nashville, participants will hear from cross-sectional thought leaders driving change in the transition to value-based care. Here’s an inside look at some of this year’s anticipated sessions.
June 04, 2021
Throughout the covid-19 vaccination effort, public health officials and politicians have insisted that providing shots equitably across racial and ethnic groups is a top priority.
June 03, 2021
The new head of the Centers for Medicare & Medicaid Services said the administration will focus on getting more people insured and is interested in finding a way to alleviate the gap keeping low-income families in states that haven’t expanded Medicaid from enrolling in Affordable Care Act health plans.
June 03, 2021
The latest episode of our new podcast series explores the positive aspects of working from home as well as the challenges of managing a remote workforce.
June 02, 2021
The industry trade association says its new mission and brand reflects its commitment to innovation, solutions, equity, and delivering results for every patient in every community.
June 02, 2021
A U.S. District Court judge has found the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) did not exceed their statutory authority when they suspended the collection of data on patient care and satisfaction during COVID-19.
June 01, 2021
Join us for the sixth episode of RISE Radio, our new podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.
May 26, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
May 25, 2021
Three of our biggest quality-related conferences will become hybrid events this summer. What exactly does that mean? Here’s what you can expect at Qualipalooza 2021, the 17th Risk Adjustment Forum, and RISE West–as well as future RISE hybrid events.
May 25, 2021
The Senate voted 55-44 on Tuesday to confirm President Joe Biden’s nominee to oversee the Centers for Medicare & Medicaid Services (CMS).
May 21, 2021
RISE summarizes recent news in the Medicare Advantage (MA) space.
May 21, 2021
RISE looks at the latest news from the Department of Health and Human Services as well as studies that impact Medicare.
May 21, 2021
RISE is thrilled to host this year’s Summit on Social Determinants of Health as a hybrid event to provide all attendees, whether joining in-person in Nashville or virtually via livestream, ample time to network and collaborate with professionals across the ecosystem. Ahead of this year’s event, RISE talked to conference Steering Committee member Kristen Daugherty, chief executive officer, Emergence Health Network, about what she’s gained as a past attendee of the summit and what she’s looking forward to at this year’s event.
May 20, 2021
The annual report compiles the latest data to provide a full picture of the Medicare Advantage (MA) landscape from beneficiary demographics and enrollment trends to consumer savings and improved outcomes, as well as MA’s response to COVID-19 and the continued drive to health equity.
May 18, 2021
A little-discussed, long-term toll of the pandemic is that large numbers of older adults have become physically and cognitively debilitated and less able to care for themselves after sheltering in place.
May 17, 2021
The event, held on June 22-23, is the only non-association yearly gathering for Special Needs Plan (SNP) professionals who are mid- to senior-level management to stay current in a highly regulated and evolving environment.
May 14, 2021
The investment will create tens of thousands of jobs and prepare the United States for future outbreaks.
May 14, 2021
Automation and artificial intelligence are proving to be key to the future of risk adjustment and value-based care. By combining the expertise of human coders, with the speed and efficiency of machine learning we will be able to maximize the outcomes from risk adjustment programs.
May 14, 2021
Health plans can help advance the goal of achieving health equity.
May 13, 2021
Hispanics who have yet to receive a covid shot are about twice as likely as non-Hispanic whites or Blacks to say they’d like to get vaccinated as soon as possible, according to a survey released Thursday. The findings hint at fixable, though difficult, vaccine access problems for the population.
May 12, 2021
RISE summarizes the latest headlines that impact the health care industry.
May 11, 2021
Join RISE for a special presentation with Jim Loehr, Ed.D., co-founder of Johnson & Johnson Human Performance Institute, who will offer insights into his 30-plus years of propriety research and training of elite performers, including Olympic gold medalists, military Special Forces, hostage rescue teams, surgeons, and Fortune 500 CEOs to achieve sustained high performance.
May 10, 2021
The event will take place live in Orlando and via livestream June 30 and July 1, with pre-conference virtual workshops on June 25.
May 10, 2021
The program addresses social determinants of health (SDoH) needs among members by making the most of its partnerships with health care provider organizations, community health workers, and a community referral platform.
May 09, 2021
For risk adjustment and HEDIS® programs, most payers will agree that more data, and not less, is critical to ensuring fair and accurate reimbursement.
May 06, 2021
RISE examines the latest research news on Medicare, Medicare Advantage, and Medicaid.
May 05, 2021
The Centers for Medicare & Medicaid Services (CMS) on Friday released the second final payment notice, finalizing risk adjustment changes and cost-sharing limits for the Affordable Care Act (ACA) marketplace in 2022.
May 04, 2021
RISE is pleased to announce two keynote speakers for Qualipalooza 2021, which will take place June 28-29, 2021 in-person in Orlando and virtually via livestream for those unable to travel.
May 03, 2021
A report from the Government Accountability Office paints a picture of an already strained behavioral health system struggling after the pandemic struck to meet the treatment needs of millions of Americans with conditions like alcohol use disorder and post-traumatic stress disorder.
April 29, 2021
Without certification, health insurers will no longer be able to run advertisements on Google’s platform after June 2.
April 29, 2021
RISE summarizes recent headlines that impact Medicare, Medicare Advantage, and Medicaid.
April 28, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
April 27, 2021
For the third year in a row, RISE will bring together payers and providers for open dialogue and idea exchange to deliver quality value-based care, align financial incentives, and improve patient outcomes. The live-streaming virtual event, held on May 20-21, will feature critical topics and insights relating to the current health care landscape.
April 23, 2021
The health plan’s programs aim to equip individuals and communities struggling with food insecurity with equitable access to healthy foods.
April 23, 2021
This year’s Women in Health Care Leadership Summit will be a live-streaming virtual event on June 14-15.
April 23, 2021
New research from the Commonwealth Fund explores the role agents play in influencing Medicare beneficiary plan choices. But without financial incentives, agents don’t’ necessarily offer information on Medicare Advantage plans not in their contracts.
April 22, 2021
The $80 million is the largest allocation the government has made to the Navigator program and is an eight-fold increase in funding from the previous year.
April 21, 2021
Master the essentials of membership and revenue reconciliation at the live-streaming virtual conference June 16-17.
April 20, 2021
Health providers are seeing the consequences of pandemic-delayed preventive and emergency care, from longer hospital stays to more root canals.
April 20, 2021
Here’s how three organizations targeted social determinants of health (SDoH) and accomplished improved health outcomes beyond the clinical walls.
April 20, 2021
Medicare Advantage company may face record penalty over alleged billing errors.
April 20, 2021
RISE summarizes the latest headlines that impact the Department of Health & Human Services, Medicare, and Medicare Advantage.
April 16, 2021
Get your sales, marketing, member communications and enrollment teams ready for a successful AEP! This year’s annual conference will run June 21-22 as a live-streaming virtual event and will feature sessions that address strategies for member acquisition and retention and best practices for onboarding.
April 15, 2021
RISE summarizes the latest headlines that impact Medicare and Medicare Advantage.
April 14, 2021
Join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.
April 14, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
April 08, 2021
It’s been a digital year like no other due to COVID-19, causing Americans to rely on telehealth, virtual learning, and video chats as their new normal for health care, education, and social interaction. But the heightened reliance on digital tools has increased disparities and inequities among individuals without digital skills and access to internet, computers, or mobile devices.
April 08, 2021
RISE reviews recent headlines in the news that impact Medicare and Medicare Advantage.
April 08, 2021
A national survey conducted by the Kaiser Family Foundation and The Washington Post reveals worry and stress related to COVID-19 has negatively affected the mental health of most frontline health care workers.
April 08, 2021
Members diagnosed with depression tend to have comorbidities and often report more access issues and show less satisfaction with their health plan than other members.
April 06, 2021
Join us for the latest episode of RISE Radio, our podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.
April 05, 2021
Here’s how UnitedHealthcare, a health insurance plan with benefit programs for individuals and families, employers, and Medicare and Medicaid beneficiaries, leveraged social determinants of health (SDoH) programs to better meet member needs, improve Star ratings, and close quality and HEDIS® gaps.
April 05, 2021
Social risk analytics hold immense potential in achieving business goals, reducing costs and improving the lives of consumers, patients and members. As organizations recognize socioeconomic data’s value, they can capitalize on its full potential with the right mechanism and collaboration.
April 02, 2021
This growing market segment represents a big opportunity for Medicare Advantage Organizations.
March 31, 2021
A new analysis released by the Better Medicare Alliance finds that Medicare Advantage (MA) beneficiaries report more savings each year than those in original Medicare.
March 30, 2021
Heather O’Toole, M.D., chief medical officer at Innovation Care Partners, a clinically integrated network and an accountable care organization in Arizona, received RISE’s highest quality award at this year’s RISE National.
March 30, 2021
It’s been an amazing three days of RISE National 2021!
March 29, 2021
RISE National was in full swing today, filled with timely updates for 2021 and 2022, an insightful keynote address, collaborative panel discussions, and so much more.
March 26, 2021
A Texas federal judge, who previously ruled the Affordable Care Act unconstitutional, has signaled his openness to ending the law’s popular coverage requirement for preventive services.
March 26, 2021
Bipartisan legislation introduced this week would expand telehealth services for seniors during the COVID-19 pandemic.
March 26, 2021
RISE National is finally here! Our 2021 virtual summit kicked off Friday with pre-conference workshops, an inspiring family-friendly keynote, and virtual networking. If you missed it, we’ve got you covered. We’ve summarized the day below—and there’s still time to register for the main conference, which begins on Monday.
March 25, 2021
RISE rounds up the latest headlines from the White House and the Centers for Medicare & Medicaid Services (CMS).
March 25, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
March 24, 2021
This year’s hybrid event on June 14-15 will bring together cross-sectional thought leaders who aim to drive change in the transition to value-based care. Whether attending in-person in Nashville or virtually via livestream, community-based organizations (CBOs), payers, hospitals/health systems, funders, and manufacturers or government entities will have two jam-packed days to discuss actionable and scalable solutions to address social determinants of health (SDoH) and achieve better outcomes for the most vulnerable populations.
March 23, 2021
Progressive and conservative Democratic lawmakers, as well as President Joe Biden, are in favor of authorizing federal officials to negotiate with drugmakers over what Medicare pays for at least some of the most expensive brand-name drugs and to base those prices on the drugs’ clinical benefits. Such a measure could put Republicans in the uncomfortable position of opposing an idea that most voters from both parties generally support.
March 22, 2021
RISE summarizes the latest regulatory news that impacts Medicare and Medicare Advantage.
March 19, 2021
What exactly does a hybrid event entail? Here’s your one-stop guide for what to expect at the June 2021 event.
March 19, 2021
Blue Cross Blue Shield Association (BCBSA) announced this week it has partnered with Feeding America® and its network of 200 food banks to educate Americans about the safety and the effectiveness of the COVID-19 vaccine.
March 19, 2021
Xavier Becerra was narrowly confirmed as secretary of the Department of Health and Human Services (HHS) on Thursday but health care organizations across the country applauded the move.
March 18, 2021
RISE reviews the latest headlines that have an impact on Medicare and Medicare Advantage.
March 16, 2021
RISE National is right around the corner. Check out the interactive virtual sessions and activities planned for our live-streamed event, which will take place March 26, 29, and 30.
March 15, 2021
Health provider conflicts, fraud, and access disparity temper the COVID telehealth revolution.
March 11, 2021
RISE reviews the latest headlines that impact Medicare and Medicare Advantage.
March 09, 2021
Experts say the two-year expansion of subsidies for most people who buy insurance through the government exchanges would be among the most significant changes to the affordability of private insurance since the passage of the Affordable Care Act.
March 08, 2021
This benefit season, more than any other, it’s critical to address medical services that target complex medical needs and non-medical services that target social factors, to stay competitive.
March 08, 2021
Luciana Borio, M.D., who warned the public in an opinion piece published in the Wall Street Journal in late January 2020 about the pending COVID-19 pandemic, will be a keynote speaker at RISE National, a virtual live-streaming event, later this month. In this interview, Dr. Borio talks to RISE about COVID, what’s on the horizon, and what health plans can do to support their members.
March 08, 2021
Join us for the third episode of RISE Radio, our new podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.
March 05, 2021
RISE summarizes the latest news involving Medicare, Medicare Advantage, and the Affordable Care Act.
March 05, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
March 02, 2021
Four representatives from the Centers for Medicare & Medicaid Services (CMS) will kick off the RISE National main conference with a policy update on Monday, March 29. The virtual live-streamed event will include preconference workshops on Friday, March 26 and the main conference March 29-30.
March 02, 2021
Health care policy expert Ezekiel J. Emanuel, M.D., will present a keynote on the future direction of the American health care system on Monday, March 29, the first day of RISE National. Dr. Emanuel, former advisor to President Joe Biden’s transition team on COVID-19, talked to RISE ahead of the virtual conference about the current health care landscape and potential changes that could improve it.
March 01, 2021
A new whitepaper explores how the COVID-19 pandemic has impacted beneficiaries and how a comprehensive health assessment can bridge care gaps for high-risk members.
February 26, 2021
RISE looks at recent headlines that impact Medicare and Medicare Advantage.
February 25, 2021
If you missed this year’s virtual summit, we’ve got you covered. Here’s a recap of what we learned during each day of the jam-packed conference.
February 25, 2021
A recent analysis from Kaiser Family Foundation (KFF) found continued disparities based on state-reported data of COVID-19 vaccinations by race and ethnicity.
February 25, 2021
Engagys and RISE presented results, insights from fifth annual survey of health care consumer engagement practices during this week’s virtual RISE Medicare Marketing & Sales Summit.
February 25, 2021
Stakeholders across the spectrum convened for a state of the industry address during RISE’s virtual Medicare Marketing & Sales Summit this week to discuss their strategies to stand-out from the crowd, increase members’ accessibility to products and services, and ensure a friendly user experience. Here are the key takeaways from their conversation.
February 24, 2021
Wendy Sue Swanson, M.D., a pediatrician, author of Mama Doc Medicine, and a pioneer in the use of the digital space to provide humanistic doctor-patient information, will be one of five keynote speakers at RISE National, a virtual live-streamed event March 26, 29, and 30. In this interview, Dr. Swanson previews her talk and offers insight into the current landscape as well as the potential for even more innovation to transform the health care system into one that is both patient-centered and provider-centered.
February 24, 2021
Now that 2021 has arrived, a national election recently completed, and significant changes to the health care landscape in America continuing to unfold amidst a pandemic, the time for health data preparation is here.
February 19, 2021
Renowned medical centers are among the quarter of general hospitals that will lose 1 percent of Medicare payments for one year because their patients have high rates of bedsores, sepsis, and other preventable complications.
February 18, 2021
RISE summarizes the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.
February 18, 2021
Representatives from the U.S. Department of Health & Human Services’ Office of Inspector General (OIG) will join our roster of more than 50 speakers at RISE National, which will be live-streamed March 26, 29, and 30.
February 17, 2021
Join us for the second episode of RISE Radio, our new podcast series that focuses on issues that impact our three communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health.
February 16, 2021
RISE’s Social Determinants of Health (SDoH) Community held its first Across the Ecosystem User Group meeting last week, led by Jessica Kahn, senior expert, McKinsey & Company, and Denise Harlow, CEO, National Community Action Partnership. The user group connects cross-sectional stakeholders (payers, providers, community-based organizations, government, and funders) to discuss actionable and scalable solutions to SDoH challenges and drive social good. Here are key takeaways from the initial discussion on executive orders from the new administration and the interactive McKinsey & Company dashboard.
February 10, 2021
The live-streaming virtual event will be a one-stop shop for state and federal legislators, health plans, providers, and community-based organizations (CBOs) to gain tactics to navigate a changing environment, move forward amid the pandemic, and further the drive for value-based care.
February 10, 2021
RISE summarizes recent research on the impact COVID-19 has had on outpatient Medicare fee-for-service claims, mental health, and patients with dementia.
February 10, 2021
Success in the COVID-19 world requires critical considerations and new approaches.
February 09, 2021
With the introduction of HIPAA in 1996, interoperability has often taken center stage in the health care arena. Amid new federal regulatory requirements and an unprecedented global pandemic, the importance of the industry’s journey to achieve a truly interoperable and connected health care delivery system that supports improved patient care and quality outcomes has never been clearer.
February 08, 2021
The new report notes a dramatic increase in the number of Medicare Advantage (MA) beneficiaries who have access to additional supplemental benefits to individuals with chronic illnesses in 2021. Last year a little more than one million MA members were enrolled in plans offering the chronic care benefits. That number grew to more than three million in 2021.
February 08, 2021
A recent Department of Health and Human Services’ Office of Inspector General (OIG) report examines opioid use in Medicare Part D during the first eight months of 2020, the beginning of the COVID-19 outbreak. Here are the key takeaways from the report.
February 08, 2021
Tara Lipinski, internationally acclaimed figure skater and Olympic gold medalist, will share her inspirational life lessons about how she overcame adversity to achieve her storied career in figure skating, at 4 p.m. EST Friday, March 26 during a presentation to kick off RISE National, a live-streaming virtual event.
February 08, 2021
Most of us can appreciate the beauty and splendor of a beautiful sunset and all that it represents, such as the completion of a day's work and the passage of time. There is a sunset of a different type about to occur in the Medicare Advantage space, and although it may not be as spectacular as an actual sunset, there are things to consider to ensure that there are no dark clouds on the horizon that diminish the ability to see it clearly and have a positive experience.
February 05, 2021
RISE is pleased to introduce the launch of RISE Radio, a series of podcast episodes that will focus on issues that impact our three RISE communities: Quality & Revenue; Member Acquisition & Experience; and Social Determinants of Health. Joining us for our inaugural episode of RISE Radio are the members of the RISE Risk Adjustment Policy Committee.
February 04, 2021
RISE summarizes recent research of interest to our RISE Quality & Revenue community.
February 03, 2021
In a recent survey conducted by The Root Cause Coalition (TRCC), researchers found the general population considers economic stability and access to health care the most impactful social determinants of health (SDoH).
February 01, 2021
Deft Research surveyed more than 3,000 seniors to better understand their shopping and switching behavior during the most recent Annual Enrollment Period (AEP). RISE looks at three of the findings that indicate reasons members may shop around and switch carriers.
February 01, 2021
In a recent webinar for the RISE Association, FOX Rehabilitation offered an inside look at its geriatric house calls model to provide outpatient therapy to vulnerable seniors in the comfort of their homes. As an alternative option to the traditional models of post-acute rehabilitation, the program improves patient satisfaction while reducing total cost of care.
January 29, 2021
Black Americans are still receiving covid vaccinations at dramatically lower rates than white Americans even as the chaotic rollout reaches more people, according to a new KHN analysis.
January 28, 2021
RISE reviews the latest headlines that impact Medicare, Medicare Advantage, and the Affordable Care Act marketplace.
January 27, 2021
The Better Medicare Alliance’s Center for Innovation in Medicare Advantage today released new research that examines the current limitations of measuring patient experience in the Medicare Advantage and Prescription Drug (MA-PD) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Based on those findings, the advocacy group proposes changes to modernize the measurement tool.
January 26, 2021
A San Francisco-based hospital’s emergency department social medicine (EDSM) team has improved care delivery to patients with psychosocial needs. Here’s what the team has accomplished so far since it formed in October 2017.
January 26, 2021
Customer experience expert Dean Lindsay will present the opening keynote at the virtual Medicare Marketing & Sales Summit 2021 on Monday, Feb. 22, the first day of the main conference. In this exclusive Q & A, Lindsay answers questions about the common mistakes marketing professionals make when it comes to member engagement and what they can do to inspire loyalty.
January 22, 2021
RISE summarizes the latest headlines that impact Medicare and Medicaid.
January 21, 2021
On health care, President Joe Biden made it clear that combating the COVID-19 pandemic will be his top priority. “We must set aside politics and finally face this pandemic as one nation,” he said. “We will get through this together.”
January 20, 2021
For the first time, RISE will offer pre-conference workshops at the Medicare Marketing & Sales Summit. Two three-hour virtual workshops will be offered the afternoon of Friday, Feb. 19, followed by a welcome reception and a keynote address by former Disney executive Louie Gravance.
January 19, 2021
On the day before the inauguration of a new president, the country marks a once unthinkable milestone of 400,000 deaths. The winter surge of the pandemic claimed 100,000 Americans in just five weeks.
January 19, 2021
The report sheds light on the U.S. health disadvantage and the role business leaders can play in improving community health through engagement and investment.
January 16, 2021
The Centers for Medicare & Medicaid Services late Friday announced it released Medicare Advantage (MA) and Part D payment information due to COVID-19. The Rate Announcement includes final policies on risk adjustment for 2022.
January 15, 2021
The Centers for Medicare & Medicaid Services (CMS) Thursday issued a rule that finalizes several of the proposed provisions for the annual Notice of Benefit and Payment Parameters for 2022 (the 2022 payment notice). The rule makes changes to reduce consumer costs in the Affordable Care Act (ACA) marketplace, empowers states to develop their own health care program, accelerates innovation, and clarifies program requirements.
January 15, 2021
Engagys and RISE have collaborated once again to release our 5th annual State of Healthcare Engagement Survey. Here’s a sneak peek on what the 2020 findings revealed. Engagys Managing Director Kathleen Ellmore will review the full survey findings during the RISE 2021 Medicare Marketing & Sales Summit, a live-streaming virtual event, Feb. 22-23.
January 15, 2021
The Centers for Medicare & Medicaid Services (CMS) on Friday finalized the “CMS Interoperability and Prior Authorization” to improve the electronic exchange of health care data and streamline processes related to prior authorization.
January 15, 2021
The Centers for Medicare & Medicaid Services (CMS) Friday issued a final rule that aims to advance the agency’s efforts to strengthen and modernize the Medicare Advantage and Part D prescription drug programs. Most of the changes are effective for the 2022 plan year and could lower enrollee cost sharing on some of the most expensive prescription drugs.
January 15, 2021
2020 was truly a year for the ages. The COVID-19 pandemic caused tragic illness, lockdowns, and untold economic consequences. Simultaneously, it also spurred technology adoption like telemedicine, and life-changing realizations, such as work-from-home works. And Medicare plans were affected too—with marketing experiencing a shift to digital strategies, data insights, and more that are likely to continue into 2021, and beyond.
January 14, 2021
The American Health Information Management Association (AHIMA) has released the results from its 2020 social determinants of health (SDoH) survey.
January 14, 2021
A former Disney executive, an award-winning business author, and a Hall of Fame motivational speaker will present keynote addresses at the 2021 Medicare Marketing & Sales Summit, a live-streamed virtual event, which includes pre-conference workshops and a member reception on Feb. 19 and the main event. Feb. 22-23.
January 13, 2021
The Centers for Medicare & Medicaid Services (CMS) issued a final rule Tuesday that will speed Medicare beneficiaries’ access to the latest advanced devices.
January 13, 2021
RISE looks at recent headlines concerning social determinants of health (SDoH).
January 12, 2021
RISE reviews the latest from the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS).
January 11, 2021
Dr. Emanuel, a member of President-elect Joe Biden’s transition COVID-19 advisory board, will kick off the first day of RISE National on Monday, March 29, with a keynote address on the future direction of the American health care system. Also slated to speak at the virtual conference: Tara Lipinski, internationally acclaimed figure skater and Olympic gold medalist; infection disease expert Dr. Luciana Borio, who warned the public in January 2020 about the pending COVID-19 pandemic; Dr. Wendy Sue Swanson, M.D., a leading innovator in digital health, innovation and prevention; and health care futurist Ian Morrison.
January 08, 2021
What’s in store for the RISE Association communities in 2021? We asked experts in Medicare Advantage, quality and revenue, consumer engagement, and social determinants of health for their predictions on trends that will impact the industry in the upcoming year. Spoiler alert: COVID-19 will continue to play a big role.
January 08, 2021
The Centers for Medicare & Medicaid Services (CMS) on Thursday issued new guidance for states to address social determinants of health (SDoH) in Medicaid and the Children’s Health Insurance Program (CHIP).
January 08, 2021
President Donald Trump made substantial changes to the nation’s health care system using executive branch authority. But reversing policies that Democrats oppose would take time and personnel resources, competing with other priorities of the new administration.
January 06, 2021
The International Publication Planning Meeting (TIPPA) will be held as a virtual event on February 23-24. The conference will feature more than 25 industry experts who will explore the future of scientific and medical publications, the impact and engagement of digital innovations, and data integrity.
December 30, 2020
The new bill includes $3 million in funding to establish a social determinants of health (SDoH) pilot program.
December 22, 2020
Within just a few days, the logistical barriers of the vaccine made by Pfizer and BioNTech were laid bare. Many officials now hang their hopes on Moderna, whose vaccine comes in containers of 100 doses, doesn’t require deep freezing and is good for 30 days from the time it’s shipped.
December 21, 2020
The live-streaming event will be held on February 9-10, 2021 and will feature 16 sessions and more than 20 industry leaders who will discuss critical topics and developments related to mandatory reporting, legislative updates, conditional payments, and Medicare set-asides.
December 18, 2020
AEP 2020 shopping trends and lessons learned, regulatory changes that impact sales and marketing, and strategies that small and regional plans can use to compete with national plans are just a few of the sessions planned for the live-streamed virtual event in February.
December 18, 2020
RISE reviews the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.
December 18, 2020
RISE summarizes the findings of a recent Wakely report commissioned by the America’s Health Insurance Plans (AHIP) that analyzes the information contained in the 2022 Medicare Advantage Advance Notice, including changes to the risk adjustment models, and the impact of COVID-19 on the Centers for Medicare & Medicaid Services (CMS) projections.
December 17, 2020
Industry leaders shared exclusive insights and best practices during RISE’s 11th Annual Star Ratings Master Class held virtually mid-December. Here are five actionable tips to ensure a positive member experience while improving quality scores.
December 17, 2020
New research offers insight into how high-need, high-cost beneficiaries in Medicare and Medicare Advantage fare on a broad range of quality measures, including pneumonia and flu vaccines to diabetic eye exams, post-acute care, and avoidable hospitalizations.
December 17, 2020
Persuading vulnerable low-income and ethnic communities hit hard by the coronavirus to take a new vaccine may be challenging. But established local health leaders, like a group in Rochester, Minnesota, home of the Mayo Clinic, may be one answer.
December 11, 2020
RISE’s new seminar on March 23-24 is designed for Medicare beneficiary representatives, plaintiff attorneys, paralegals, legal assistants, payee representatives, and other advocates of Medicare beneficiaries associated with workers compensation, liability, and no-fault insurance claims. The ultimate purpose of the seminar is to provide attendees with an understanding of how to protect Medicare beneficiaries compliantly. We talked to industry expert Rafael Gonzalez, Esq., about the planned sessions and why you don’t want to miss this groundbreaking seminar.
December 11, 2020
RISE examines the regulatory headlines of the week.
December 11, 2020
High stakes and big challenges await as the U.S. prepares to roll out vaccines against COVID-19, with front-line health care workers and vulnerable nursing home residents recommended as the top priority.
December 09, 2020
Manatt Health, in collaboration with the Robert Wood Johnson Foundation and the Nemours Children’s Health System, released a report outlining how organizations can drive social determinants of health (SDoH) investments for children through a Children’s Health and Wellness Fund.
December 08, 2020
Xavier Becerra, President-elect Joe Biden’s choice to head the Department of Health and Human Services, is set to be a pandemic-era secretary with no public health experience. Whether that matters depends on whom you ask.
December 08, 2020
We were looking forward to our return to Vegas, but due to uncertainty around the COVID-19 pandemic, the RISE 2021 Medicare Marketing & Sales Summit will now become a live-streaming virtual experience.
December 07, 2020
President-elect Joe Biden today announced his nominations and appointments of his health team and the names will be familiar to those in the health care industry.
December 04, 2020
Identifying risk attributes — social determinants of health (SDOH) — for populations can enhance an organization’s ability to develop sound, data-driven interventions that can influence change, enrich wellness, and improve profitability.
December 04, 2020
RISE reviews the latest headlines from the Centers for Medicare & Medicaid Services (CMS).
December 04, 2020
The live-streaming virtual event offers actuaries, product managers, and CMS bid stakeholders interactive discussions, comprehensive updates, and key strategies for the CMS bid process from start to finish.
December 03, 2020
RISE looks at the latest news regarding social determinants of health (SDoH), including recent approaches from Medicaid programs.
December 01, 2020
The Centers for Medicare & Medicaid Services (CMS) on Wednesday released its proposed annual Notice of Benefit and Payment Parameters for the 2022 benefit year. The proposal, more commonly known as the proposed 2022 Payment Notice, provides a blueprint for the changes CMS plans to make to the risk adjustment program and risk adjustment data validation (RADV) in the Affordable Care Act marketplace.
November 25, 2020
The Centers for Medicare & Medicaid Services (CMS) on Tuesday issued a final rule to amend the methodology for the U.S. Department of Health and Human Services’ risk adjustment data validation (HHS-RADV) program. The new regulation aims to provide states and payers with more stability and predictability, promote program integrity, and foster competition.
November 25, 2020
RISE rounds up recent headlines concerning social determinants of health (SDoH).
November 24, 2020
The Trump administration on Friday finalized the rebate rule, which excludes rebates on prescription drugs paid by manufacturers to pharmacy benefit managers and Part D plans from safe harbor protection under the Anti-Kickback Statute. The regulation is set to take effect Jan. 1, 2022 but is expected to face opposition.
November 23, 2020
The Centers for Medicare & Medicaid Services (CMS) on Friday finalized changes to the Physician Self-Referral Law, more commonly referred to as the Stark Law, which prohibits physicians from making referrals to providers or entities if they have a financial relationship with them. Here is a summary of the changes.
November 23, 2020
Research indicates a concerning increase in relapse, fatal and non-fatal overdose, anxiety and depression, and other mental health conditions due to the pandemic.
November 23, 2020
Morrison will address the future of the health care marketplace, trends, and implications during RISE National 2021, which will take place March 28-30, 2021.
November 19, 2020
A new data brief finds that in 2021 more and more Medicare Advantage (MA) plans will offer supplemental benefits like adult day care services, home-based palliative care, in-home support services, and career support.
November 19, 2020
In a new interview with Kaiser Health News, the nation's top infectious disease expert breaks down how to survive the coming months and describes how hard it is when people still insist the coronavirus outbreak is “fake news.”
November 18, 2020
If you’ve been tasked with championing member experience measures at your organization, consider organizing and launching an improvement team along with a well-defined game plan for how that group will work together to manage the endeavor.
November 18, 2020
RISE summarizes the latest headlines that have an impact on Medicare and Medicare Advantage.
November 17, 2020
The 11th annual RISE Star Ratings Master Class will return as a live-streamed virtual event on December 14-15. Here’s a look at the topics industry specialists will discuss to arm you with the strategies to boost your Star ratings in 2021 and beyond.
November 16, 2020
The Republican-led states are trying to prove they were harmed by the 2010 health law—and thus have “legal standing”—because their Medicaid costs increased, even though Congress eliminated the penalty for not having health coverage in 2019. At least one justice was skeptical.
November 16, 2020
While there is not a one-size-fits-all answer to social determinants or social needs, there is some basic information that can help you address the unmet needs of your member population.
November 13, 2020
The rule puts an end to overly prescriptive regulations that stakeholders have complained about since 2016, according to CMS Administrator Seema Verma.
November 13, 2020
While HEDIS® is an effective tool for measuring quality–tracking performance against these measures can be seriously challenging and time-consuming for payers.
November 13, 2020
Lessons learned from the 2021 CMS Star ratings can prepare Medicare Advantage plans for the lasting effects of COVID-19 on quality improvement initiatives.
November 11, 2020
The survey explored physicians’ perspectives on the COVID-19 pandemic and the future of the health care system. A key factor: social determinants of health (SDoH).
November 10, 2020
The U.S. Supreme Court will hear arguments today in a case that could overturn the Affordable Care Act. California Attorney General Xavier Becerra, who is defending the law with the backing of more than 20 other states, told California Healthline that he predicts the justices will uphold it.
November 09, 2020
A new analysis by the health care consulting firm uses Medicare Advantage (MA) claims data through June 2020 to estimate the impact of the reduction in claims on risk scores and payments for 2021.
November 09, 2020
The United States on Monday became the first country to surpass 10 million cases and public health experts warn numbers may continue to climb unless the Trump administration takes steps now to stop the spread of the deadly virus.
November 09, 2020
The Supreme Court on Tuesday will hear oral arguments in a case that, for the third time in eight years, could result in the justices striking down the Affordable Care Act (ACA).
November 08, 2020
Democrats had hoped not only to defeat President Donald Trump but also to capture the Senate so they could make major policy changes, such as bolstering the Affordable Care Act (ACA) and reducing the number of uninsured.
November 06, 2020
While the 2020 Interim Final Run deadline remains Feb. 01, 2021, a recent Centers for Medicare & Medicaid Services memo officially sets the 2020 Final Run deadline to Aug 02, 2021, allowing Medicare Advantage Organizations six additional months to ensure a complete and accurate data submission.
November 06, 2020
The RISE team is looking forward to seeing conference attendees live and in person when the time is right. Here are the measures RISE has taken to create a healthier and safer conference experience− let us know when you’re ready.
November 05, 2020
The American Diabetes Association (ADA) conducted a scientific review of previous research and literature on the association of social determinants of health (SDoH) and diabetes risk and outcomes as well as the impact of targeted interventions.
November 04, 2020
As the votes continue to be counted in the tight battle between President Donald Trump and former Vice President Joe Biden, the federal role in health care is at stake.
November 03, 2020
Under the plan pushed by Gov. Brian Kemp, the HealthCare.gov website will no longer provide options for Georgia starting next fall, and consumers will need to rely on private brokers, insurance companies, agents, and commercial websites.
November 03, 2020
Sexual harassment, age bias, and discrimination of race, sexual orientation, and gender all remain pervasive issues in the workplace, and the C-suite is not immune. During RISE’s virtual Women in Health Care Leadership Summit, Heather S. Sanderson of Franco Signor LLC, offered seven tactics employers can take to address and eliminate sexual harassment at the workplace, instill accountability, and improve workplace culture.
November 02, 2020
The Centers for Medicare & Medicaid Services (CMS) released the second part of its 2022 Medicare Advantage advance notice three months earlier than usual to help Medicare Advantage (MA) plans prepare their bids for 2022.
October 30, 2020
Addressing social determinants of health (SDoH) has enabled one special needs plan to improve health outcomes for members and has led to a decrease in emergency room visits, inpatient admissions, and inpatient lengths of stay.
October 30, 2020
COVID-19 cases are spreading across the United States with a new case added every second, according to the latest Johns Hopkins University data.
October 28, 2020
This year’s annual conference will take place as a live-streamed virtual event November 9-11, 2020. Take a look at just a few of the industry experts and sessions we’ve lined up.
October 28, 2020
RISE reviews the latest headlines that have an impact on Medicare and Medicare Advantage.
October 26, 2020
The Risk Adjustment Policy Committee offers policy guidelines for risk adjustment involving telehealth services.
October 21, 2020
RISE is now accepting nominations for its annual Martin L. Block Award that recognizes excellence and clinical leaders’ passion to improve patient care. For 2021, RISE has broadened the criteria beyond risk adjustment and Stars to ensure the spirit of excellence and innovation lives on.
October 21, 2020
For the first time, the National Academy of Medicine recommended vaccine prioritization be given to individuals who struggle with social determinants of health (SDoH).
October 21, 2020
RISE reviews the latest headlines that impact Medicare, Medicare Advantage, Medicaid, and the Affordable Care Act marketplace.
October 21, 2020
In this video interview recorded prior to his retirement as executive director of the RISE Association, Kevin Mowll, discusses his work with RISE over the past seven years and what the future holds for the association and its related communities.
October 20, 2020
RISE will once again take over Las Vegas in February 2021 for the can’t-miss Medicare Marketing & Sales event of the year.
October 20, 2020
Each year, Engagys and RISE partner to conduct the annual State of Consumer Health Engagement Survey. The survey is an examination of health care consumer engagement practices to further understand the rate at which health plans across the country are achieving engagement success and where they are investing in the future for better engagement and experience. Started in 2016, this survey now has four complete years of trend data.
October 16, 2020
RISE looks at recent headlines in the news that impact the health care industry.
October 16, 2020
During the second day of RISE’s live-streamed virtual conference, Gillette will share his firsthand experiences and perspective on health care accessibility.
October 14, 2020
The health system’s model will enable primary care practices to effectively screen for social determinants of health (SDoH) to improve health equity in vulnerable communities.
October 14, 2020
Learn more about one of the exciting benefits of joining the RISE Association.
October 14, 2020
Multiple versions of Interim Final Rules and Final Rules have been released in 2020, all related at least somewhat to COVID-19’s impact on Star Ratings. Health plans often interpret the rules differently. In this piece, Rex Wallace of Rex Wallace Consulting and Mick Twomey of Hyperlift, help clarify the rules.
October 14, 2020
The RISE Risk Adjustment Policy Committee looks at the implications of the Centers for Medicare & Medicaid Services’ (CMS) plans to fully phase in the CMS-HCC model in 2022.
October 12, 2020
The COVID pandemic changed the landscape of the social needs that drive health overnight. Millions of people lost their jobs; millions of people were ordered to stay home. People lost access to food for themselves and their families because they couldn’t afford it, or they couldn’t get to a grocery store. Miles of cars waiting at drive-through food pantries dominated the headlines. People became more isolated and depressed. People’s ability to pay for their housing was jeopardized.
October 09, 2020
The new network seeks to break down barriers between clinical and social care to better address member’s socioeconomic needs in the Philadelphia area.
October 08, 2020
The Centers for Medicare & Medicaid Services (CMS) released the quality ratings so that beneficiaries can compare plans before Medicare Open Enrollment begins on Oct. 15.
October 08, 2020
COVID-19 continues to dominate headlines in the wake of President Trump’s diagnosis and hospitalization. Here’s a roundup of the latest news.
October 07, 2020
William Dede, MPP, health policy associate, Special Needs Plan Alliance, will lead a session on CY21 integration requirements for FIDE-, HIDE-, and D-SNPs during RISE’s upcoming live-streamed virtual event on Oct. 27-28.
October 07, 2020
Under normal circumstances, an older adult is treated every 11 seconds in an emergency department (ED) because of a fall.
October 06, 2020
RISE’s two-day virtual event features a jam-packed agenda with keynote addresses, panel discussions, and industry leader presentations. But we’ve also planned beginner-friendly, guided meditations throughout the conference to help attendees balance their minds, bodies, emotions, and spirits.
October 02, 2020
RISE looks at the latest headlines that impact Medicare and Medicaid.
October 02, 2020
After downplaying the seriousness of the virus for months, President Donald Trump and the First Lady Melania Trump tested positive for the coronavirus. He is now under quarantine.
October 01, 2020
RISE’s two-day virtual event is the only conference in the market to bring together payers and providers to collaborate about the shift to value-based health care delivery.
October 01, 2020
The principal of EFS Supervision Strategies, LLC, will work with the RISE Association to help guide our Social Determinants of Health (SDoH) Community.
September 29, 2020
Mark your calendars! We are excited to return to Nashville, Tenn. in March for RISE National 2021. Get a first look at the new tracks we’ve already planned for you.
September 29, 2020
RISE looks at recent headlines concerning social determinants of health (SDoH), including the impact of COVID-19 on Latino, Black, and Native American communities.
September 29, 2020
President Donald Trump’s executive order says that people with preexisting conditions can get affordable insurance. But it doesn’t explain how.
September 25, 2020
The average 2021 premium for Medicare Advantage (MA) plans will be the lowest in 14 years, according to the Centers for Medicare & Medicaid Services (CMS).
September 25, 2020
RISE summarizes the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.
September 25, 2020
The two-day virtual event featured inspiring keynote presentations on how to successfully lead through crisis and how to prioritize your mental health through stress management and better sleep.
September 22, 2020
The innovative model of care saves money, improves patient satisfaction, and may boost Medicare Advantage plan enrollment.
September 21, 2020
With the death of Justice Ruth Bader Ginsburg, a lawsuit brought by Republican state officials has become the latest existential threat against the federal health law, scheduled for oral arguments at the Supreme Court a week after the general election in November.
September 16, 2020
RISE looks at the latest headlines that impact Medicare, Medicare Advantage, and Medicaid.
September 15, 2020
The Centers for Medicare & Medicaid Services (CMS) on Monday released Part 1 of its 2022 Advance Notice, which outlines changes to Part C CMS-Hierarchical Condition Categories (HCC) risk adjustment model and the use of encounter data for 2022. CMS intends to finalize the payment policies by April 5, 2021.
September 15, 2020
Learn best practices to improve outcomes for hard to reach and at-risk populations during a live-streamed virtual event on Oct. 27-28.
September 15, 2020
The live-streaming virtual event will feature two days filled with timely discussion on how to best pivot to the new landscape of population health in a post-pandemic world. The 2nd annual summit will take place November 17-18. Here’s an inside look at some of the speakers and hot topics included in this year’s event.
September 14, 2020
Paul Cotton, director of federal affairs for NCQA, will deliver a keynote presentation on the importance of quality measurement and HEDIS® measures in times of crisis.
September 14, 2020
The virtual seminar, Driving Change in Member Experience to Impact Your Bottom Line, will take place Sept. 29-30. The two-day interactive event is part of RISE’s ongoing response to COVID-19.
September 11, 2020
It’s been a busy couple of days and the virtual RISE West 2020 has officially come to a close!
September 11, 2020
RISE Managing Director Ellen Wofford made the following announcement during RISE West on Friday:
September 10, 2020
The first full day of RISE West 2020 is on the books and what a day we had!
September 10, 2020
A new study released by Better Medicare Alliance (BMA), a leading research and advocacy organization supporting Medicare Advantage, finds that MA beneficiaries have lower incomes, speak English as a second language, are more likely to rent their home, and are reliant on public transit. The findings, BMA said, show MA’s value to underserved populations.
September 04, 2020
The RISE Association’s webinar series recently featured a case study on a community-based, multi-hospital system medical respite program in Pittsburgh, Pa. that aims to provide care to people experiencing homelessness.
September 03, 2020
Learn more about the interactive virtual sessions and activities we’ve planned for RISE West 2020, which will take place Sept. 9-11.
September 03, 2020
Older Blacks are perishing quietly, out of sight, victims of the pandemic and a lifetime of racism and its attendant adverse health effects.
September 01, 2020
The Commonwealth Fund recently explored the quality of health coverage for U.S. working-age adults in the first half of 2020. Among the findings: Two in five adults do not have stable health coverage.
September 01, 2020
In this 10-minute video with RISE, Stephen Klasko, M.D., MBA, president and chief executive officer, Thomas Jefferson University and Jefferson Health, provides a glimpse into what a global pandemic would look like in 2030 based on what we’ve learned during the COVID-19 public health emergency of 2020.
August 27, 2020
RISE has once again teamed up with Engagys to find out how communications tactics have changed throughout the COVID-19 pandemic. Here are five findings from our most recent survey. Learn more when we discuss the complete results during a one-hour webinar at 1:30 p.m. EST, Wednesday, Sept. 16. The webinar is free to RISE Association members.
August 27, 2020
RISE reviews the latest headlines that impact Medicare Advantage plans.
August 26, 2020
COVID-19 has made member engagement more important than ever before. In this article, RISE talks to three of the facilitators of RISE West’s upcoming preconference workshop that tackles the need for Medicare Advantage (MA) plans to double down on member engagement in the second half of 2020.
August 25, 2020
The agency’s most recent 10-year plan aims to prioritize critical public health issues including the COVID-19 pandemic and social determinants of health (SDoH).
August 25, 2020
For the fourth consecutive year, the industry’s brightest minds, renowned leadership coaches and trainers, and motivational speakers will come together for The RISE Women in Health Care Leadership Summit, held virtually on October 29-30, to promote and advance women in the health care industry. All genders are welcome in this drive for diversity and inclusion.
August 21, 2020
For the first time, RISE’s 4th annual CompliancePalooza will be a virtual event! The October event will feature two days of high-quality content, timely updates, lively discussion, and networking.
August 21, 2020
A recent international survey found people in the United States are struggling more than people in other wealthy nations amid the global pandemic.
August 20, 2020
The High Court will hear oral arguments over the constitutionality of the Affordable Care Act (ACA) on November 10, a week after the presidential election.
August 20, 2020
Part 2 of our interview with John E. McDonough, DrPH, MPA, professor of public health practice, Harvard T.H. Chan School of Public Health, who will be a featured speaker at RISE’s upcoming virtual event, RISE West 2020, Sept. 9-11.
August 19, 2020
RISE rounds up the latest news concerning COVID-19.
August 18, 2020
A federal appeals court has ruled that the government does owe insurers unpaid cost-sharing reduction payments mandated by the Affordable Care Act (ACA) but in a separate ruling said they cannot receive the entire unpaid amount.
August 18, 2020
A New York federal judge on Monday stopped the Trump administration from enforcing a new rule that rolls back nondiscrimination protections for transgender patients.
August 14, 2020
As COVID-19 cases and deaths surge in several hot spots across the United States, many individuals and organizations continue to ask, “What else can we do to help protect ourselves, our families, our communities, and our nation?”
August 13, 2020
John E. McDonough, DrPH, MPA, professor of public health practice, Harvard T.H. Chan School of Public Health, will be a featured speaker at RISE’s upcoming virtual event, RISE West 2020, Sept. 9-11.
August 11, 2020
Consider the following framework to effectively assess the ROI of SDoH interventions.
August 11, 2020
The live-streamed virtual event, designed for those involved in Medicare Advantage product design, sales and marketing, and finance and revenue management, will take place Sept. 21-22.
August 11, 2020
Marc Milstein, Ph.D., a scientist and researcher on health and happiness, will be a keynote speaker at RISE West 2020 in September. In this article, RISE talks to Milstein about his upcoming presentation and how American adults can get a better night’s sleep amid worries of COVID-19.
August 11, 2020
The findings indicate that adults who experience one or more social determinant of health (SDoH) have an increased risk of stroke.
August 10, 2020
Health plans can use proactive telehealth and remote care strategies to help to mitigate the potential negative impact of the pandemic on risk adjustment and quality measurement programs.
August 10, 2020
Health plans have 12 months before they must have a FHIR®-Based Patient Access API built, running and easily accessible to consumers.
August 07, 2020
RISE reviews the latest headlines involving Medicare, Medicaid, and the ACA marketplace.
August 07, 2020
The death toll in the United States may reach nearly 300,000 by December 1, according to new data released Thursday from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine.
August 06, 2020
Researchers caution that a COVID-19 vaccine is likely to be less effective in obese adults.
August 06, 2020
The Center for Consumer Information & Insurance Oversight (CCIIO) at the Centers for Medicare & Medicaid Services this week issued guidance for the ACA marketplace about risk adjustment and telehealth and telephone services during COVID-19.
August 06, 2020
RISE is pleased to announce that Frank Micciche, vice president of public policy and external relations for the National Committee for Quality Assurance (NCQA), will be a featured speaker at the RISE West 2020 virtual event Sept. 9-11.
August 06, 2020
Telehealth visits have been a lifeline to patients and a financial one for health care providers during COVID-19 and may become a standard practice of care in the post-pandemic world. But health plans and providers with a financial stake in risk adjustment must press for research and medical-driven policy decisions regarding effective and appropriate use of telehealth and not allow financial motives to drive policy direction.
August 04, 2020
Chief Derek Bergsten of the Rockford, Ill. Fire Department talks to RISE ahead of the RISE West virtual summit, where he will share the success of a collaborative social determinants of health (SDoH) program that has reduced emergency department visits, ambulance runs, and hospital admissions.
August 03, 2020
Staying on top of emergency declarations and health care-related flexibilities and waivers due to the COVID-19 public health emergency is more than a full-time job.
August 03, 2020
Experts say adults 60 and up must continue to limit exposure in the years to come—even after there is a vaccine for COVID-19.
July 31, 2020
A recent study found racial and ethnic disparities beyond underlying health conditions play a significant role in the disproportionate impact of COVID-19 on communities of color.
July 31, 2020
Considering a technology vendor to support your next risk adjustment coding season? Here’s what to evaluate.
July 29, 2020
The live-streamed virtual event will take place Sept. 9-11 and features presentations from leading experts in risk adjustment, quality performance, documentation, HCC coding practices, member engagement, payer-provider collaboration, and social determinants of health. Take a look at the sessions we’ve planned.
July 28, 2020
CMS has released a summary report on issuer payments and changes under the Affordable Care Act’s risk adjustment program for insurers that sold individual and small group market plans in 2019.
July 28, 2020
FRA and RISE will join forces for the first time in a premier virtual event August 19-20 to bring together investors, health plans, and community-based organizations (CBOs) to discuss how to couple improved health outcomes with positive financial return.
July 28, 2020
The Centers for Medicare & Medicaid Services (CMS) on Tuesday released its first monthly update of data that reveals the impact of the coronavirus on the Medicare population, including American Indian/Alaskan Native Medicare beneficiaries.
July 28, 2020
For the first time since 2017, Medicaid enrollment has begun to increase, but not by as much as many analysts expected.
July 24, 2020
Recent research indicates a hotspotting approach to meet physical, behavioral, and social needs of high-cost patients is too narrow to have a lasting impact.
July 24, 2020
RISE rounds up the latest news on COVID-19.
July 22, 2020
The Court of Appeals for the District of Columbia has upheld a 2018 Trump administration rule that significantly expands the sale and renewal of short-term, limited duration insurance (STLDI), as a substitute for comprehensive health insurance.
July 22, 2020
With millions out of work because of the coronavirus pandemic, fewer payroll taxes are coming in to help keep Medicare’s trust fund intact.
July 22, 2020
The global pandemic has drastically limited in-person interactions and triggered the need for Medicare Advantage health plans to embrace a virtual world to connect with existing and prospective members. Here’s how one Florida health plan has maintained member connection, acquisition, and retention during this unsettling time.
July 21, 2020
The pandemic has given the National Institutes of Health an opportunity to show the value of its $1.5 billion “All of Us” research program. A major effort to make the platform’s database representative of America resulted in minorities making up more than half of its more than 270,000 volunteers.
July 20, 2020
Although the COVID-19 pandemic, combined with the upcoming presidential election, may limit health plans’ reach, there are still opportunities to connect with prospective members and engage with your current members.
July 20, 2020
Here are five actionable steps that organizations can take to support communities of color hit especially hard by the global pandemic.
July 20, 2020
Deft Research’s new Age-in Study takes a deep dive into how the global pandemic recession has affected consumers as they move from commercial group or Affordable Care Act coverage into Medicare.
July 17, 2020
Many variables can impact the member/patient experience—but some are more controllable than others.
July 17, 2020
RISE reviews the latest headlines that have an impact on Medicare and Medicaid.
July 16, 2020
The report, released by the Better Medicare Alliance (BMA), a research and advocacy organization that supports Medicare Advantage (MA), looks at beneficiary demographics, consumer satisfaction, health outcomes, and projections for the future.
July 16, 2020
A study from Sutter Health underscores the role race and ethnicity play in how individuals access care and the health outcomes caused by existing inequities.
July 15, 2020
The Medicare Member Acquisition & Experience Community (MMA&E) offers a multitude of member benefits including conference discounts, live webinars, user group meetings, and more. Here are some recommended tips to make the most of your online community.
July 15, 2020
Whether agents and brokers need to present Medicare Advantage (MA) insurance options to beneficiaries over the phone or online, health plans must now accommodate telephonic or telehealth videoconference presentations.
July 14, 2020
A new study by EmblemHealth, one of the largest nonprofit health insurers in the United States, reveals ownership of electronic devices, access to internet services, and overall lack of technology impinge on access to telehealth.
July 13, 2020
RISE is pleased to bring you the latest installment of Medicare Minutes, a three-part blog series by industry expert Rafael Gonzalez that features news of interest to the Medicare Secondary Payer industry. This first installment focuses on the private right of action. Learn more at RISE’s upcoming virtual event, The 4th Annual Medicare Secondary Payer Conditional Payment Forum, July 27-28.
July 12, 2020
RISE is pleased to bring you the latest Medicare Minutes blog post by industry expert Rafael Gonzalez. Medicare Minutes features news of interest to the Medicare Secondary Payer industry. Learn more at RISE’s upcoming virtual event, The 4th Annual Medicare Secondary Payer Conditional Payment Forum, July 27-28.
July 11, 2020
RISE is pleased to bring you the latest Medicare Minutes blog post by industry expert Rafael Gonzalez that features news of interest to the Medicare Secondary Payer industry. Learn more at RISE’s upcoming virtual event, The 4th Annual Medicare Secondary Payer Conditional Payment Forum, July 27-28.
July 09, 2020
Did you miss last month’s RISE National 2020 virtual conference? Here’s a summary of a few of the sessions.
July 08, 2020
Phenomenal keynote speakers took the virtual stage over two days at the annual event, RISE National 2020, and offered stories of hope and perseverance during the darkest of times.
July 08, 2020
The analysis measures member satisfaction with Medicare Advantage (MA) plans based on coverage and benefits, provider choice, cost, customer service, information and communication, and billing and payment. The result: Information and communication is a weakness for member satisfaction, which drives a general lack of engagement among consumers and increases the likelihood of health plan members switching plans.
July 07, 2020
Leading experts in the Medicare Advantage and Affordable Care Act market continue to call for collaboration between providers and payers. Take an inside-look at their tips to bridge the gap.
July 02, 2020
RISE reviews recent headlines that have an impact on Medicare and Medicaid.
July 01, 2020
RISE looks at the latest headlines on the pandemic.
June 26, 2020
Learn about the actions BlueCross BlueShield of North Carolina (Blue Cross NC) took as part of a payer-based strategy to improve behavioral health access, quality, and efficiency.
June 26, 2020
RISE examines the latest news on COVID-19. Among the many headlines: For every COVID-19 case reported, there actually are 10 other infections, according to health experts from the Centers for Disease Control and Prevention (CDC).
June 26, 2020
The National Quality Forum (NQF) this week released national recommendations to drive better health outcomes for people and communities by the end of the decade.
June 25, 2020
The U.S. Department of Health & Human Services (HHS) Office of Minority Health (OMH) will partner with Morehouse School of Medicine to help the communities hit hardest by the global pandemic.
June 25, 2020
The Administration for Community Living (ACL) and the Office of the Assistant Secretary for Health created the challenge to find an online tool to help isolated Americans connect with others and engage in the community.
June 25, 2020
RISE looks at the latest headlines involving HHS’ anti-transgender health care rule, price transparency, the impact of COVID-19 on Medicare beneficiaries, prior authorization reform, and the Affordable Care Act.
June 24, 2020
Learn about the strategies BlueCross BlueShield NC uses to build positive relationships, goal alignment, and a problem-solving approach among the three departments.
June 22, 2020
Check out the interactive learning sessions and fun activities we’ve got planned for our 14th annual event, which takes place June 26-30.
June 18, 2020
Client perspectives call for more action from plans and providers, community-based organizations (CBOs) thrive in cross-sector collaboration, and loneliness and mental wellness remain areas of concern.
June 17, 2020
RISE looks at the latest regulatory news that impacts Medicare and Medicaid.
June 17, 2020
The Supreme Court on Monday ruled 6-3 that employers cannot fire a person for being gay or transgender. The decision is a big win for the LGBTQ community. Just three days earlier the Trump administration removed discrimination protections for transgender individuals under the Affordable Care Act.
June 16, 2020
The ABC news veteran shared his inspiring story during a keynote fireside chat at last week’s virtual RISE National Summit on Social Determinants of Health.
June 12, 2020
The benchmarking survey focused on how health plans and community-based organizations define success for programs that address social determinants of health (SDoH) and measure their outcomes and impact.
June 11, 2020
The survey examined the occurrence of loneliness among Americans and the link between factors such as age, social media use, income, and occupation.
June 10, 2020
U.S. Department of Health and Human Services (HHS) announced Tuesday it would distribute relief funds to Medicaid providers following complaints from Congressional leaders about the payment delay.
June 09, 2020
Here’s how Indiana University (IU) Health Plans elevated customer service and member communications when COVID-19 hit.
June 08, 2020
The coronavirus pandemic has forced the nation’s doctors and hospitals to reevaluate how they work. At least three major changes may have a lasting impact.
June 04, 2020
RISE examines this week’s regulatory headlines.
June 04, 2020
Industry-leading experts in the AEP and Medicare Advantage space joined RISE for this week’s virtual AEP Medicare Readiness Summit 2020 to share best practices, strategies, and tips to navigate member needs amid a global pandemic. Here’s an inside-look at one Medicare sales manager’s recommended steps for annual election period (AEP) planning in such an uncertain time.
June 03, 2020
RISE looks at recent news regarding social determinants of health (SDoH), including the different impacts the global pandemic presents to children and adults.
June 01, 2020
The Centers for Medicare & Medicaid Services (CMS) on Friday proposed a rule to amend the methodology for the U.S. Departments of Health and Human Services’ risk adjustment data validation (HHS-RADV) program. The technical changes, CMS said, will provide states and payers in the Affordable Care Act market with a more stable and predictable regulatory framework, promote integrity, and increase competition. In this article, RISE looks at the proposed changes and asks J. Gabriel McGlamery, J.D., senior HCR policy consultant for Florida Blue Center for Health Policy, and a member of RISE’s Risk Adjustment Policy Committee, to weigh in.
May 28, 2020
The poll, conducted by Morning Consult and sponsored by the Better Medicare Alliance, surveyed 1,020 seniors in mid-May on Medicare Advantage. Here are the key findings.
May 28, 2020
The guidance to stay sheltered as society slowly reopens wears on older Americans, who have a growing sense of isolation and depression.
May 28, 2020
The global pandemic has exacerbated existing inequities for the black and Latino populations, putting them at heightened risk for physical and mental health issues.
May 27, 2020
RISE gathers up the latest news that impacts Medicare and Medicare Advantage (MA).
May 27, 2020
Each year RISE presents an award to an individual who exemplifies the life work of Dr. Martin L. Block, an expert in the risk adjustment industry who had a passion to improve patient care. This year RISE National will forgo the traditional criteria of the award and present it in honor of health care professionals within our affiliated provider networks who contracted and died from COVID-19.
May 22, 2020
The Centers for Medicare & Medicaid Services (CMS) has finalized requirements to increase access to telehealth for seniors in Medicare Advantage (MA) plans, expand the types of supplemental benefits for MA members with chronic diseases, increase access to MA for patients with End Stage Renal Disease (ESRD), and modify calculations for Star ratings.
May 21, 2020
Larry Baca, vice president, sales & marketing, for Inter Valley Health Plan will be a featured speaker at RISE’s upcoming virtual event, AEP Medicare Readiness Summit 2020, June 2-3.
May 21, 2020
The National Association of ACOs (NAACOS) and eight other leading health care organizations seek longer termination deadline and other changes as providers continue to combat the COVID-19 pandemic.
May 21, 2020
The annual event, formerly known as RISE Nashville, will now stream live on June 29-30 with pre-conference workshops on Friday, June 26.
May 21, 2020
The virtual event on June 4 and June 5. will bring together industry experts to examine the impacts of COVID-19 on vulnerable population and strategies for adaptation in this uncertain time.
May 21, 2020
Medicare Advantage (MA) is enrolling more low-income and medically complex beneficiaries, according to a new analysis from the Commonwealth Fund.
May 20, 2020
Leading experts from cross-sector health care organizations will share insights to address challenges related to social determinants of health (SDoH). If you’re a professional involved with community-based organizations (CBOs), payers, hospitals/health systems, funders, manufacturers or government entities, you’ll want to be a part of this drive for social good.
May 19, 2020
Learn more about the interactive dashboard that provides data-driven insights to inform COVID-19 response plans.
May 19, 2020
Employing powerful data and technologies can greatly simplify the workflow and number of chart retrievals.
May 18, 2020
While people across the country continue to experience different impacts from the global pandemic, they all have one thing in common: Stress. Here are some tips to build resiliency in these uncertain times.
May 18, 2020
Casa de Salud, a nonprofit clinic in Albuquerque, New Mexico, provides primary medical care, opioid addiction services and non-Western therapies, including acupuncture and reiki, to a largely low-income population. And, like so many other health care providers that serve as a safety net, its revenue—and its future—are threatened by the COVID-19 epidemic.
May 18, 2020
GeBBS Healthcare Solutions applies insights to encounter details that lead to appropriate risk scores and ensures compliance.
May 14, 2020
The Centers for Medicare & Medicaid Services (CMS) last week issued its final Affordable Care Act marketplace 2021 Notice of Benefit and Payment Parameters Rule, commonly known as the 2021 Payment Notice. The rule primarily includes technical changes to the risk adjustment program and risk adjustment data validation (RADV). Here are four things you need to know.
May 14, 2020
A new legal analysis prepared for the Better Medicare Alliance by the law firm Foley Hoag LLP finds that the Centers for Medicare & Medicaid Services (CMS) has the statutory authority to modify its risk adjustment calculation permitting the use of 2019 and 2020 data and/or to lower the fee-for-service normalization factor ahead of the June 1, 2020 deadline for bid submissions.
May 14, 2020
Lack of information is one of the greatest obstacles to efficient and effective health care. The data needed to save lives is available, but we must break down barriers to accessibility. A patient-centered approach can align the health care ecosystem to remove barriers.
May 13, 2020
Thousands of Medicare beneficiaries are at extreme risk for opioid use disorder. A federal report urges the Centers for Medicare & Medicaid Services (CMS) to do more to ensure they receive treatment.
May 12, 2020
Across the health care ecosystem, payers, providers, pharmacy, and life sciences organizations are leveraging data lakes, seeking to unite disparate structured and unstructured data from multiple sources such as claims data, clinical data, social determinants of health, and quality insights to name a few. But what exactly are we talking about when we talk about a data lake?
May 11, 2020
Last week’s memo that addressed the exceptional conditions that qualify for a special enrollment period (SEP) for individuals affected by a FEMA-declared major disaster caused a bit of confusion in the industry. The conflict: What are the actual start and end dates of the SEP?
May 11, 2020
Dawn R. Carter of Centauri Health Solutions, Inc. examines risk adjustment gap closure through effective Encounter Data Processing System and Risk Adjustment Payment System comparative analytics and implementation of best practices.
May 07, 2020
Two recent final rules on the way electronic health information is exchanged represent a huge step forward for interoperability and increased patient access, giving members unprecedented control over their health data.
May 06, 2020
RISE rounds up the latest news from the Centers for Medicare & Medicaid Services (CMS).
May 06, 2020
The Better Medicare Alliance is concerned that Medicare Advantage (MA) beneficiaries will face increased premiums and/or reduced plan benefits in 2021 during the upcoming open enrollment period unless the Centers for Medicare & Medicaid Services (CMS) takes action now to minimize uncertainty and instability in the 2021 bid process.
May 06, 2020
The Centers for Medicare & Medicaid Services on Tuesday issued a memorandum that clarifies the exceptional conditions that qualify for a special enrollment period (SEP) for individuals affected by a FEMA declared weather related emergency or major disaster.
May 06, 2020
Join RISE and top industry speakers for a two-day virtual event May 12-13 that examines the regulatory landscape and how to prepare for the changing delivery of health care.
May 05, 2020
A recent report from the Centers for Disease Control and Prevention (CDC) confirms homelessness is a significant contributor to virus spread.
May 04, 2020
While risk adjustment programs have faced growing challenges with accuracy, scale, and ROI over the past few years, COVID-19 has exacerbated these challenges overnight.
May 01, 2020
Community collaboration was a common theme throughout RISE’s two-day virtual event. Here are highlights from two case study sessions that offered an inside look at pilot programs that have proven partnership is key to addressing social determinants of health and improving population health outcomes.
April 30, 2020
Join Kevin Mowll, executive director, RISE Association, and Kathleen Ellmore, managing director, Engagys, for a deep dive into the results of a RISE-Engagys survey that uncovers how health plans are communicating with members during the COVID-19 pandemic. The webinar, COVID-19 Communications Response Survey: Addressing Near and Long-Term Member Communication Strategies, will take place at 1:30 p.m. EST, Tuesday, May 5.
April 29, 2020
RISE looks at the latest headlines involving Medicare Advantage.
April 28, 2020
With most nonemergency procedures shelved for now, many health insurers are expected to see profits in the near term, but the longer view of how the coronavirus will affect them is far more complicated and could well impact what people pay for coverage next year.
April 27, 2020
In an 8-1 decision, the high court ruled the federal government must pay insurers $12 billion in promised funds under the Affordable Care Act (ACA).
April 27, 2020
User group members discussed the impact of COVID-19 on Medicare sales strategies, the annual election period (AEP), and broker loyalty.
April 23, 2020
Here are five findings from the latest Kaiser Family Foundation (KFF) report.
April 23, 2020
Medicare Trustees released their annual report on Wednesday and once again predicted that the Medicare Part A trust fund will be insolvent in 2026. But the COVID-19 outbreak could cause the funds to run dry before then.
April 22, 2020
“Unscrupulous providers” could take advantage of the boom in treatment delivered via voice or video calls.
April 20, 2020
Social isolation due to COVID-19 has friends and families left to their own devices…literally. So much so, that grandparents are trying to learn new communication technologies to stay in touch.
April 20, 2020
Risk adjustment is complex, but breaking it down into three critical fundamentals helps health plans focus their efforts.
April 17, 2020
RISE’s Medicare Member Acquisition Experience Community held its first user group meeting in March. Kathleen Ellmore, managing director of Engagys, and Renee Mezzanotte, EVP of client engagement at DMW, served as co-chairs. Here are highlights from the discussion.
April 16, 2020
As the world struggles to come to grips with the global pandemic of the novel coronavirus (COVID-19) and what it means to our everyday lives, unavoidable questions arise. In the forefront, are questions related to managing unforeseen costs. Specifically, how do insurance carriers and health systems deal with the vast cost overruns associated with treating those stricken with the virus?
April 16, 2020
DMW staff offer their impressions from RISE’s 13th annual Medicare Marketing & Sales Summit in February.
April 16, 2020
The ability to offer telehealth services not only addresses a critical need at this time, it also signals to your members that you are their partner in health care and will provide support through a strenuous time.
April 15, 2020
Kenneth Persaud, M.D., CEO of Visualize Health, a Sharecare Company, and a member of the RISE Association Advisory Executive Committee, talks to RISE about the impact COVID-19 may have on value-based care, accountable care organizations, and telehealth.
April 15, 2020
The findings indicate that older adults, males, black Americans, and those with underlying health conditions are at a higher risk for hospitalization due to the virus.
April 14, 2020
A new survey by The National Association of Accountable Care Organizations (NAACOS) finds that 56 percent of health care organizations in the risk-based Medicare ACO program may drop out of the program because of fear they will have to pay massive losses as the result of the COVID-19 pandemic.
April 13, 2020
The Centers for Medicare & Medicaid Services (CMS) said the COVID-19 pandemic has created an urgency to expand the use of virtual care to reduce the risk of spreading the disease. In a memo sent on Friday to Medicare Advantage (MA) organizations, the agency explains how to submit diagnoses from telehealth visits. Here are the details.
April 13, 2020
The launch of the interactive mapping website, which curates publicly available data at the census tract level, provides an added resource to California-based researchers amidst the COVID pandemic.
April 09, 2020
The annual, two-day event will still feature the high-quality content that attendees are accustomed to but will now take place from the comfort of your home offices.
April 07, 2020
As the COVID-19 crisis unfolds, Medicare marketers across the country find themselves in a unique position to aid a group of individuals who they serve and who need their immediate help.
April 07, 2020
Medicare Advantage plans will see a 1.66 percent pay increase in 2021, according to the Centers for Medicare & Medicaid Services’ (CMS) rate announcement on Monday.
April 06, 2020
The study will focus on those who have experience in the Medicare Advantage (MA) market and influencing physician performance.
April 06, 2020
Here are the latest regulatory actions as of Monday, April 6.
April 03, 2020
The coronavirus outbreak has forced millions out of work and the federal-state health program for low-income people could face unprecedented strains as many states don’t necessarily have the resources or systems in place to meet the demand.
April 02, 2020
The National Committee for Quality Assurance (NCQA) on Thursday announced new policies concerning the collection of quality reporting for HEDIS® and CAHPS® for Health Plan Accreditation for Measurement Year (MY) 2019 to allow organizations to focus on the COVID-19 crisis.
April 01, 2020
Rex Wallace, principal of Rex Wallace Consulting, takes a closer look at the Centers for Medicare & Medicaid Services’ announcement about data collection for Star ratings in the wake of COVID-19.
April 01, 2020
Several proposals to expand the Medicare program are under consideration. Here’s a breakdown of each approach and what they could mean for those at risk of racial and ethnic health disparities.
March 31, 2020
The agency said it will temporarily allow more than 80 additional services to be provided via telehealth.
March 31, 2020
To provide health care organizations with the full ability to respond to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services has issued temporary regulatory waivers and new rules to lift administrative burdens. Those changes involve data collection for HEDIS®, CAHPS, and the Star ratings program.
March 31, 2020
The agency sent out a memo Monday stating that it is suspending non-emergency federal and State Survey Agency surveys so organizations can focus on protecting individuals from the spread of COVID-19.
March 27, 2020
Please take this short survey developed by RISE and Engagys that looks at member communication strategies in response to COVID-19.
March 27, 2020
While it’s vital that Americans hunker down at home to avoid spreading COVID-19, doing so may amplify another public health threat: loneliness. Research has shown that loneliness is as damaging to a person’s health as smoking 15 cigarettes per day.
March 26, 2020
The Department of Health and Human Services (HHS) has implemented efforts to better address social determinants of health (SDoH) for certain programs and groups of people, but others face worsened conditions, according to a Health Affairs blog post.
March 25, 2020
Until the Centers for Medicare & Medicaid Services (CMS) says otherwise, Medicare Advantage (MA) plans still must stay on top of Star rating measures during the COVID-19 outbreak. Here are three suggestions.
March 25, 2020
RISE looks at the latest actions from the Centers for Medicare & Medicaid Services to help state Medicaid agencies respond to the coronavirus outbreak.
March 25, 2020
Gaps in the social safety net have become apparent as public health leaders try to halt the spread of the virus.
March 24, 2020
The states are allowing new enrollments this month to help ease consumers’ concerns about the cost of health care so that the sick will not be deterred from seeking medical attention and inadvertently spread the virus.
March 24, 2020
Here are five pieces of advice from Health Data Decisions to help health plans respond to COVID-19.
March 24, 2020
Christi A. Grimm, the principal deputy inspector general, warns about “bad actors” preying on people’s fears over COVID-19 and perpetuating fraud schemes.
March 23, 2020
The RISE Association and CareSignal, a remote patient monitoring company, have partnered to offer a public service webinar on Friday, March 27 about COVID Companion, a free COVID-19 texting program for providers and plans to offer to their patients.
March 23, 2020
Carrot Health is offering a complimentary webinar on the use of its COVID-19 Critical Infection Risk dashboard.
March 23, 2020
The new Quality & Revenue Community focuses on the industry’s transformation to value-based care; The Social Determinants of Health community will allow cross-sectional thought leaders to share strategies to achieve better outcomes for the most vulnerable populations.
March 19, 2020
Mortality rates for low-income older adults who are dually enrolled in Medicare and Medicaid are twice as high compared to those more affluent and solely enrolled in Medicare.
March 18, 2020
RISE reviews the latest regulatory news, including the interoperability final rules and actions taken due to the coronavirus outbreak.
March 18, 2020
RISE looks at recent headlines concerning social determinants of health (SDoH), including the impact social distancing has on those already most vulnerable.
March 18, 2020
RISE looks at recent headlines concerning social determinants of health (SDoH), including the impact social distancing has on those already most vulnerable.
March 17, 2020
The coronavirus is spreading so quickly throughout the United States and the rest of the world that the response to the outbreak seems to change by the hour. Make sure your organization is in the best position to keep operations running smoothly and ensure that your members—who are among those at higher risk of becoming seriously ill from the virus—know they can rely on you for helpful, accurate, and the most up-to-date information.
March 17, 2020
The coronavirus is spreading so quickly throughout the United States and the rest of the world that the response to the outbreak seems to change by the hour. Make sure your organization is in the best position to keep operations running smoothly and ensure that your members—who are among those at higher risk of becoming seriously ill from the virus—know they can rely on you for helpful, accurate, and the most up-to-date information.
March 17, 2020
A new blog post from Deft Research looks at the link between non-medical circumstances and the use of the emergency room for non-emergency and routine medical care.
March 17, 2020
A new blog post from Deft Research looks at the link between non-medical circumstances and the use of the emergency room for non-emergency and routine medical care.
March 16, 2020
New Medicaid guidance reveals what states must do in response to the coronavirus outbreak.
March 12, 2020
A February 2020 proposed rule from the Centers for Medicare & Medicaid Services (CMS) regarding the 2021 Medicare Advantage (MA) program included an important change that could have a significant impact on plans as it could increase membership of beneficiaries who are diagnosed with end-stage renal disease (ESRD).
March 11, 2020
COVID-19, the Novel Coronavirus, has now spread to 114 countries, according to the World Health Organization (WHO). As of Wednesday, March 11, the agency reports 118,000 cases and 4,291 deaths. Thousands more are hospitalized.
March 10, 2020
RISE reschedules national conferences due to concerns over COVID-19.
March 10, 2020
RISE reschedules national conferences due to concerns over COVID-19.
March 09, 2020
The award-winning former TV news anchor and reporter broke through Hollywood, paid her dues in television, and created her own business and signature coaching program YOU, Amplified!®. Angela Chee will share life lessons and tips for leaders to own their voice and power at The RISE National Women in Health Care Leadership Summit, October 29-30, a virtual event.
February 25, 2020
Speaker update: Calder Lynch from the Center for Medicare & Medicaid Services has been added to a roster of more than 50 speakers at the annual event, March 15-17, 2020 at the Omni Nashville Hotel.
February 25, 2020
The new Medicare Member Acquisition & Experience Community will help local and regional Medicare Advantage health plans grow and retain their membership base.
February 24, 2020
The two-day conference will be a one-stop shop for Medicaid stakeholders to hear from leading experts as they share clinical best practices, first-hand experiences and insights, and how to prepare for the push toward value-based care.
February 18, 2020
Speaker update: Erin Sutton, Kelly Drury from the Center for Medicare & Medicaid Services (CMS) have been added to a roster of more than 100 speakers at RISE National, a virtual event, June 29-30.
February 18, 2020
The Centers for Medicare & Medicaid Services published a long-awaited proposed rule in the Federal Register on Tuesday that outlines when it may impose civil money penalties when a group health plan or non-group health plan entity fails to comply with Medicare Secondary Payer (MSP) reporting requirements.
February 13, 2020
Unable to attend RISE’s January webinar that examined the 2020 Annual Enrollment Period (AEP) and emerging trends in the Medicare Advantage (MA) marketplace? We have you covered. Here’s a summary of what we learned.
February 13, 2020
Leading experts in the community-based organization (CBO) space will join together for an open panel discussion about firsthand experiences, strength and constraint areas, and bridging the gap between health care partners-a necessity for continued improvement in social determinants of health (SDoH), according to Denise Harlow, chief executive officer, National Community Action Partnership. Harlow will moderate the panel on June 10, the first full day of this year’s virtual summit.
February 12, 2020
Deft Research recently surveyed more than 3,200 seniors to better understand their shopping and switching behavior during the annual election period (AEP). An executive research brief about the survey focuses on one of the findings: how the growth of $0 Preferred Provider Organizations (PPO) have permanently changed the Medicare landscape.
February 11, 2020
The Centers for Medicare & Medicaid Services (CMS) proposes updates and changes to the methodologies used to pay Medicare Advantage (MA) plans. The agency said the proposed updates will maximize competition among MA and Part D plans.
February 08, 2020
The HEDIS 2020 season is upon us and the countdown to submission has started. Every moment during this stretch is valuable and can ultimately impact your measure scores.
February 07, 2020
You can’t achieve 95 percent risk adjustment coding accuracy without getting it right from the beginning. Are you following best practices to ensure accurate code capture, or is there room for improvement? This checklist will help you find out.
February 07, 2020
Since the 21st Century Cures Act (CCA) was passed in 2016, there have been several changes to the existing risk adjustment model. Over the next few years, and until the Alternative Payment Condition Count (APCC) is fully implemented in Payment Year (PY) 2023, we expect to see even more.
February 06, 2020
The Centers for Medicare & Medicaid Services (CMS) recently released its first report on the use of diagnostic codes for social determinants of health (SDoH) in Medicare claims since the Z codes were implemented in 2016. The main finding: It’s difficult for the government to capture consistent data because providers aren’t assigning Z codes even when patients reveal their SDoH concerns.
February 06, 2020
A United States District Court won’t reconsider its decision to invalidate the Medicare Advantage (MA) 2014 Overpayment Rule. RISE Association Executive Director Kevin Mowll weighs in on what this may mean for CMS’ plans for the FFS adjuster in the RADV process, extrapolation of data, and annual audits.
February 06, 2020
The Centers for Medicare & Medicaid Services (CMS) published a proposed rule on Feb. 5 that updates the Medicare Advantage (MA) and the Medicare prescription drug benefit program. Here’s what you need to know.
February 03, 2020
Ginny Baro, Ph.D., had more than 20 years of corporate leadership experience before becoming a certified professional coach through the International Coach Federation. Now a motivational speaker, executive coach, career strategist, and #1 bestselling author, she’s teaching professionals how to become exceptional leaders. Baro will share her strategies for success in a special presentation at The RISE National Women in Health Care Leadership Summit, which will be held as a virtual event.
January 31, 2020
The broadcast journalist and host of the popular television show, What Would You Do?, will speak at RISE National Summit, a virtual event, on Monday, June 29.
January 30, 2020
An executive coach and celebrated artist, Allison Massari survived a devastating car accident that left her severely burned. She’ll share her health care experience, the importance of compassionate care, and how to transform lives through the art of person-centered care at RISE National.
January 27, 2020
Expect the Centers for Medicare & Medicaid Services (CMS) to take a closer look at retrospective chart reviews this year, says Jason Christ, a member of the health care and life sciences practice of Epstein Becker & Green.
January 24, 2020
Gov. Gavin Newsom has earmarked nearly $600 million in his 2020-21 state budget plan to provide intensive care management to high-needs, high-risk patients around the state. The programs are similar to an initiative in Camden, New Jersey, that was called into question by a recent study finding hospital readmissions dropped, but at only about the same rate as patients who didn’t receive the same kind of intensive services.
January 21, 2020
The Supreme Court has no plans to take up a pivotal case involving the Affordable Care Act (ACA) before the presidential election in November but also didn’t rule out a full review in the future.
January 15, 2020
RISE Association partners with Mossavar-Rahmani Center for Business and Government at Harvard Kennedy School senior fellow to identify the drivers of successful social determinants of health programs.
January 15, 2020
Despite the Trump Administration’s attempts to kill the Affordable Care Act (ACA), the Department of Justice (DOJ) and a coalition of Republican governors and state attorneys general told the Supreme Court last week that there is no need to fast track a case that challenges the constitutionality of the health care reform act.
January 14, 2020
Global stakeholders in biopharma, medical device/diagnostics, agencies, and publishers will convene at RISE’s 19th Annual International Publication Planning Meeting on Feb. 25-26 in San Diego.
January 13, 2020
Jacob Reider, M.D., chief executive officer, Alliance for Better Health, former deputy national coordinator for health information technology at the U.S. Department of Health and Human Services (HHS), will moderate a fireside chat on the federal government’s plans to address social determinants of health at The RISE National Summit on Social Determinants of Health, which will be held virtually on June 9-11. In this article, Reider shares his thoughts on the value of cross-sector collaboration.
January 10, 2020
What does the future hold for the Medicare market in the upcoming year? We asked Tim Brousseau, vice president client services, Deft Research, a member of the RISE Medicare Market Advisory Board, and Rachel Silva, vice president, strategy and Innovation for DMW, for their thoughts on emerging trends that will impact health plans in 2020.
January 09, 2020
The Centers for Medicare & Medicaid Services (CMS) has released Part 1 of the 2021 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. Here’s what you need to know about proposed updates to the Hierarchical Condition Categories (HCC) risk adjustment model and the use of encounter data.
January 09, 2020
RISE looks at the latest headlines that impact the health care industry.
January 06, 2020
Here is a six-point checklist for 2020 election planning throughout the year.
January 03, 2020
The United States Court of Appeals for the Tenth Circuit has reversed a district court decision that found flaws in the Department of Health & Human Services’ (HHS) risk adjustment formula. The decision is a blow to small insurers, particularly the New Mexico co-op that argued in a lawsuit that the way the federal government implemented the Affordable Care Act risk adjustment program “brutally penalizes new innovative, low-cost insurance companies and flouts Congress’ intent in enacting the ACA.”
January 03, 2020
Seema Verma, the administrator for the Centers for Medicare & Medicaid Services, sat down for a rare interview with KHN senior correspondent Sarah Varney. They discuss her views on President Donald Trump’s plan for sustaining public health insurance programs, how the administration would respond if Obamacare is struck down by the courts in the future,and her thoughts on how the latest "Medicare for All" proposals would affect innovation and access to care.
January 03, 2020
Members of RISE’s Medicare Member Acquisition & Experience Advisory Board will join Kevin Mowll, executive director of the RISE Association, during a January 30th webinar to discuss trends in the Medicare Advantage (MA) marketplace that emerged from the 2020 Annual Enrollment Period. In this article, RISE talks to Mowll about some of the factors that have changed the MA landscape in recent years.
December 30, 2019
Earlier this month the Centers for Medicare & Medicaid Services (CMS) released a white paper that outlined concerns with the Risk Adjustment Data Validation (RADV) program. The agency addressed the current process for sampling, outlier detection, error rate calculation, and risk adjustment transfer features and wants feedback to help form future RADV policy. Comments are due on Jan. 6, 2020.
December 30, 2019
RISE looks at three health care headlines in 2019 that will have implications for health plans in 2020.
December 27, 2019
In his final post of this blog series, Rafael Gonzalez, Esq., president, Optum Settlement Solutions, looks at changes made to the Workers’ Compensation Medicare Set-Aside (WCMSA) Electronic Attestation Enhancements and what it means to Medicare Secondary Payer compliance.
December 26, 2019
Part six in a series of seven blog posts related to Medicare Secondary Payer issues. In this piece, industry expert Rafael Gonzalez reviews three recent cases involving attorneys representing Medicare beneficiaries in auto, liability, no-fault, and workers’ compensation claims.
December 19, 2019
A federal appeals court panel on Wednesday struck down a key provision of the Affordable Care Act but will send the case back to the lower court to decide the fate of the rest of the law.
December 19, 2019
Medicare Advantage continues to make headlines. RISE examines the most recent news, including MedPAC’s annual status update of the MA program and what a repeal of the health insurance tax may mean for enrollment and earnings.
December 19, 2019
In his latest blog post, Rafael Gonzalez, Esq., president, Optum Settlement Solutions, looks at the possible creation of federal regulations that provide options on how to take Medicare’s future interests into account.
December 18, 2019
A new study from the Duke Margolis Center for Health Policy looks at early trends on Medicare Advantage (MA) offerings of supplemental benefits for patient populations with serious illnesses. Among the findings: Only a small number of plans have added new benefits in the first two years that the Centers for Medicare & Medicaid Services (CMS) has provided MA plans the flexibility to offer members new benefits outside of traditional medical services. The report looks at the barriers to implementation and strategies to promote greater adoption.
December 18, 2019
In the latest installment of a blog series on issues related to the Medicare Secondary Payer industry, Rafael Gonzalez, Esq., president, Optum Settlement Solutions, reviews the recent announcement that a Notice of Proposed Rulemaking related to civil money penalties will be published this month.
December 17, 2019
The results of a new Gallup poll are sobering: A record 25 percent of Americans surveyed couldn’t afford care this year and put off seeking treatment for a serious medical condition.
December 16, 2019
A new report from the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) raises concerns that Medicare Advantage (MA) plans may use chart reviews to inflate risk adjustment payments from the Centers for Medicare & Medicaid Services (CMS). But the OIG’s methodology and findings don’t add up, according to Sean Creighton, managing director, Avalere, and chair of the RISE Risk Adjustment Policy Advisory Committee.
December 13, 2019
Back by popular demand! Brain Scientist Dr. John Medina, last year’s top keynote speaker at RISE Nashville, will return for our 2020 conference to lead a half-day virtual workshop on the brain science behind delivering powerful and engaging presentations.
December 12, 2019
Find out what’s in store when marketing, sales, and product development professionals from local and regional Medicare Advantage health plans gather at The Venetian in Las Vegas for the annual Medicare Marketing & Sales Summit on Feb. 25-26, 2020.
December 12, 2019
In the third installment of his seven-part blog series on issues related to the Medicare Secondary Payer industry, Rafael Gonzalez, Esq., president, Optum Settlement Solutions, provides a detailed review of the changes in the Centers for Medicare & Medicaid Services’ Workers’ Compensation Medicare Set-Aside Arrangement Reference Guide.
December 11, 2019
Justices from the right and left ask whether Congress needs to keep its promises regarding risk-corridor payments.
December 11, 2019
In this second installment of a semiregular blog on Medicare Secondary Payer matters, industry expert Rafael Gonzalez looks at the Centers for Medicare & Medicaid Services (CMS) calculation of annual recovery thresholds for certain liability insurance, no-fault insurance, and workers’ compensation settlements, judgments, awards, or other payments.
December 11, 2019
Eliminating the Fee-for-Service Adjuster from the Risk Adjustment Data Validation methodology would likely have significant implications for plan payment and could change plan incentives and behavior, including plans’ willingness to assume the risk of participating in the program, writes Sean Creighton, managing director of Avalere, who also serves as a RISE board member and the chair of the RISE Risk Adjustment Policy Advisory Committee.
December 10, 2019
RISE is pleased to introduce Medicare Minutes, a seven-part blog series by industry expert Rafael Gonzalez that features news of interest to the Medicare Secondary Payer industry. This first installment focuses on the accessibility of open debts reports.
December 09, 2019
Cross-sector health care organizations will come together in Nashville March 15-17 to address challenges related to social determinants of health (SDoH). If you’re a professional involved with community-based organizations (CBOs), payers, hospitals/health systems, funders, manufacturers or government entities, you’ll want to be a part of this drive for social good.
December 09, 2019
The case revolves around risk corridor payments, a provision under the Affordable Care Act that was designed to help insurers recover some losses because they had an unusually high number of sick and expensive customers.
December 06, 2019
The Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) on Friday released a white paper to outline and seek feedback on issues that the agencies will use to inform future policy on HHS-Risk Adjustment Data Validation.
December 06, 2019
Members of Congress and others complain Medicare’s revamped Plan Finder had problems. Federal officials say they can help consumers who got bad information change their plans next year. But details about how switching will work are yet to come.
December 05, 2019
RISE looks at the planned sessions for this year’s CMS Bid Bootcamp and shines a spotlight on a presentation that will help attendees evaluate the financial impact of incorporating social determinants of health (SDOH) benefits into the bid process.
December 05, 2019
RISE looks at the latest headlines involving Medicare Advantage (MA), including a new poll rating beneficiaries’ satisfaction and a Kaiser Family Foundation analysis on the number of people who switch plans during Medicare’s open enrollment period.
November 26, 2019
Learn why the Medicare Secondary Payer Master Class has become the must-attend conference for those responsible for Medicare Secondary Payer compliance. Industry expert Rafael Gonzalez, Esq., the person who inspired the annual event, explains.
November 25, 2019
Well-intentioned, payer philanthropy is the wrong approach to solving the social determinants of health (SDoH) needs in American communities, writes Jacob Reider, M.D., CEO of Alliance for Better Health, and the former deputy director of the Office of the National Coordinator Health Information Technology, in a piece published by Health Payer Intelligence.
November 25, 2019
You may know him as the star of the nationally syndicated series, Flip My Food with Chef Jeff, where he prepares healthier versions of favorite family and restaurant recipes. But before he discovered his passion for culinary arts, Jeff Henderson was a drug dealer and spent nearly a decade incarcerated in federal prison. He’ll tell his emotional story of how he overcame all odds during a virtual keynote presentation at RISE National (formerly known as RISE Nashville) on June 30th.
November 19, 2019
The annual event will take place March 15-17, 2020 at the Omni Nashville Hotel and will feature cross-sectional collaboration as thought leaders discuss actionable, tactical, and scalable solutions to social determinants of health (SDoH). Virtual attendance option is also available for those unable to travel.
November 15, 2019
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on Friday that would require health insurers to make pricing and cost-sharing information available to the public.
November 12, 2019
One of the mistakes that Medicare Advantage plans make when prioritizing efforts to improve their star ratings is focusing only on quality measures, says Malik Abdur-Razzaq, MPH, the chair of this year’s RISE’s Star Ratings Master Class in December.
November 07, 2019
A new independent study finds that Medicare Advantage plans are incorporating new benefits in 2020 to care for the whole person and address social determinants of health.
November 07, 2019
This is the final article of a three-part blog series that highlights the crucial capabilities required for encounter submission and reconciliation success. This post focuses on how to ensure continuous compliance.
November 04, 2019
RISE and Engagys, a health care consumer engagement consultancy, are set to launch their fourth annual survey on the state of health care consumer engagement and need your input. Results will be revealed at 10th annual Star Ratings Master Class, December 12-13 in Carlsbad, Calif.
November 01, 2019
Federal officials unveil new ratings for the Affordable Care Act’s marketplace plans. Missouri is one of eight states that has no plans earning at least three stars on a five-star scale.
October 30, 2019
RISE looks at the latest regulatory news related to health plans on HealthCare.gov, Medicare Advantage, fraud and abuse, and cost-sharing reduction subsidies.
October 29, 2019
Early bird registration is now open for RISE Nashville 2020, the mega-conference for professionals of all levels in the Medicare Advantage and Affordable Care Act market. Read on to find out why people return year after year and why you don’t want to miss the 2020 event at Music City Center, March 15-17.
October 28, 2019
This is the second of a three-part blog series that highlights the crucial capabilities required for encounter submission and reconciliation success. This post will focus on how to reduce encounter submission cost and complexity.
October 22, 2019
This is the first of a three-part blog series that highlights the crucial capabilities required for encounter submission and reconciliation success. Upcoming posts will focus on reducing encounter submission cost and complexity; and ensuring continuous compliance.
October 15, 2019
RISE is now accepting nominations for the 2020 Dr. Martin L. Block Award for Excellence and Innovation. The prestigious award is given to an individual who has advanced the lives of America’s seniors through clinical leadership, policy vision, and by superior example.
October 15, 2019
SAN DIEGO—More than 450 attendees gathered at the Loews Coronado Bay Resort in San Diego for RISE West 2019 to learn about payer/provider collaboration, leadership, and the member experience. Below are takeaways from select sessions:
October 14, 2019
SAN DIEGO —Among the highlights of RISE West 2019: An amazing story of survival and heroics during our nation’s darkest day; a new way of thinking about health care innovation; and tips to change behavior to enrich the member experience. Here’s a sampling of the keynote presentations.
October 14, 2019
Fifty-two percent of Medicare Advantage plans with prescription drug coverage (MA-PD) offered in 2020 will boast 4 stars or higher, according to new data released by the Centers for Medicare & Medicaid Services.
October 11, 2019
For the latest installment of our semi-regular series that recommends articles, white papers, or issue briefs of importance to RISE members, we turn to a recent blog post by Deft Research’s Richard Hamer, Steve Runfeldt, and Adam Johnson about some of the conclusions from the firm’s survey to measure social determinants of health (SDoH) and intervening factors. These factors, known as “frames of reference” are defined as “internalized concepts and experiences that predict health behavior” and may depend on the person’s upbringing, circle of friends, education, and experiences with health care.
October 08, 2019
Steven R. Peskin, M.D., executive medical director of population health, Horizon Blue Cross Blue Shield of New Jersey, talks to RISE about the key takeaways from the health plan’s secret shopper pilot and the lessons learned on member engagement. Peskin will present a case study on the program at RISE’s 9th annual HEDIS® & Quality Improvement Summit, Oct. 23-25, in Miami.
October 04, 2019
With 70 percent of a person’s health attributed to environmental factors and lifestyle choices, it’s crucial to understand what social determinants are and how to apply them to support your population at an individual level.
October 04, 2019
It’s a time of rapid transformation for risk adjustment. Newly announced payment models are expanding opportunities in providers’ value-based care strategies all the time. These models could make it easier than ever for hospitals and practices to recognize the benefits of risk-sharing arrangements. However, providers must incorporate new tools and practices that work within, rather than against, existing care and revenue cycle workflows.
October 03, 2019
Pulse8's Scott Fries looks at why CFOs have started to take the lead within their organizations to control pharmacy spend and why this is the right approach to achieve a more efficient and effective pharmacy benefit program.
October 02, 2019
The federal government's proposed interoperability rule with major new requirements for payers and could create true data interoperability, opening the way to more efficient processes, enhanced quality of care—and new business models and competition.
October 01, 2019
The past decade has been one of significant evolution for the health care industry, shifting from a disparate and transactional environment to a more value-based model where patients are at the center. With untold amounts of health and medical information at their fingertips, patients now are in the driver’s seat as a consumer–playing a more active role in selecting their provider, demanding better quality of care, and requiring greater transparency for health care costs.
September 30, 2019
SS&C's Theresa Lane looks at the HEDIS® 2020 guidelines and the preventive measures plans can take under the pharmacy benefit to manage opioid overuse.
September 26, 2019
One of the most anticipated sessions at RISE’s upcoming CompliancePalooza is an in-depth look at recent CMS audits featuring a panel of four health plan compliance experts who will talk about their experiences. RISE interviewed two of the panelists ahead of the conference to find out what they would suggest that health plans do to improve audit preparation.
September 19, 2019
Rhonda Glover spent 34 years working for the Federal Bureau of Investigation before retiring last year from a career she loved. She had no choice–the age cut off for agents in federal law enforcement is 57. But she had far too much energy and ambition to leave the working world behind. RISE talked to Glover ahead of CompliancePalooza about what she has learned about leadership and her own career reset as founder and CEO of a training, development, and career coaching firm.
September 06, 2019
There is no need to panic if your health plan receives a notification from the Centers for Medicare & Medicaid Services (CMS) that your organization has been selected for a workplace audit— that is, if you're prepared, according to Heather Metz, manager of government compliance for Gateway Health Plan, one of the country’s leading managed care organizations that currently serves Medicare and Medicaid enrollees across five states. RISE got a chance to interview Metz about her strategies for successful workplace audits, one of two topics that she will discuss at CompliancePalooza, Oct. 21-22, in Washington, D.C.
September 03, 2019
This year’s conference will focus on the effective monitoring of departments and data, and the latest regulatory updates to mitigate compliance risks and ensure a successful Centers for Medicare & Medicaid Services (CMS) audit. Here’s a look at what compliance professionals can expect when RISE gathers on Oct. 21-22 at a brand-new venue—the elegant and historic Omni Shoreham Hotel in Washington D.C.
August 28, 2019
RISE is headed to San Diego Sept. 9-11 for our annual leadership conference. Here’s everything you need to know about the event, as well as fun things to do after hours at the Loews Coronado Bay Resort in San Diego.
August 28, 2019
For the fifth installment of our semi-regular series that recommends articles, white papers, or issue briefs of importance to RISE members, we suggest United Hospital Fund of New York’s white paper Complex Construction: A Framework for Building Clinical-Community Partnerships to Address Social Determinants of Health. The paper provides an insightful look into the hurdles that organizations face when they try to leverage the resources of community-based organizations to meet the social determinants of health needs of their patients in a medical setting.