Topic: Compliance

Innovating in 2014

Regan Pennypacker

CMS has developed an Innovation Center to address health care payment and service delivery models. It is a great site to find information about current Innovation Model Partners, and a place to share your ideas on how care can be delivered and paid for in ways that will lower care cost and improve quality of care. As always, the service to beneficiaries is at the heart of these initiatives, and for the program to continue, partners must be innovative.

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Navigators and Agents Gone Wild

John Gorman

Since the October 1 launch of the ObamaCare health insurance exchanges/marketplaces, there’s been a growing din over the field conduct of navigators and insurance agents, in the process of enrolling eligibles on behalf of the exchanges or the health plans participating in them.  Meanwhile, the associations backing brokers are putting pressure on the Obama administration, insisting that brokers should be more involved in the enrollment process.  Add a regulatory infrastructure that is lax – at best – when it comes to training and enforcement … does anyone else have a sense of déjà vu?  It’s the market conduct growing pains of the Part D inception all over again.  There is no doubt that some of the “navigators and agents gone wild” stories out there are simply anecdotal rumor mill reports coming from enterprising local reporters, or are “stings” by conservative bloggers and activists scoring cheap anti-reform points.

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Much Progress on Healthcare.gov, But “Back End” Fixes Will Determine Success

John Gorman

Of the many, many things I gave thanks for last week, there was Jeffrey Zients, the White House management guru brought in to sort out the mess that is the launch of ObamaCare, and for his geek squad working feverishly on the fixes.  His long-awaited progress report was released on Sunday, and it’s amazingly sanguine for a government document.  Knowing big IT projects as we do, it’s impressive how far the fix team has gotten in a matter of weeks, much of it in consumer-facing functionality on the “front end” of the website and the enrollment process.  What remains to be seen is what can be done this month on the crucial “back end” functions that connect to insurance companies participating in the exchanges — the functions for which ObamaCare will ultimately be judged when coverage kicks off on January 1, and the true test for Mr. Zients and his geeks.

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Consultant Assessment in the Headlines

Regan Pennypacker

Consultants were in the news this week; that doesn’t happen often. In this scenario which I will not deeply dive into, a private consulting team was brought on to independently assess the status of a certain federal health insurance enrollment system. Their assessment, after reviewing hundreds of documents and conducting scores of interviews, includes a number of risks with some detailed root cause drivers.

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Pay me now or pay me later: Things to keep in mind when you set your 2014 budget

William MacBain

Back in the ’80’s Fram Oil Filters had an advertising campaign that featured an actor dressed as a mechanic, admonishing viewers to get their oil changed and get a new oil filter, to prevent costly engine damage.  “Pay me now or pay me later,” he said. 

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Reading the Stars in Medicare in 2014-2015

John Gorman

Whatever you may think of healthcare.gov, CMS is killing it on the Medicare Star Ratings Quality Demonstration.

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Innovation and Quality must go hand-in-hand

Regan Pennypacker

Plan sponsors are waiting with anticipation for their 2014 Medicare Star Ratings to be released. Just yesterday, Tufts Health Plan in Watertown, Massachusetts released the news that their Medicare Preferred HMO plan was awarded 4.5 out of a possible five stars. It reminds me of the old Ford commercial jingle where they said “Quality is Job 1″. No truer words apply when it comes to maintaining high quality plan options for our nation’s Medicare beneficiaries.

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