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Article | August 2022

ACO REACH Model Program Updates – ‘Do Nothing’ is Not a Strategy

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The Centers for Medicare and Medicaid Services (CMS) Innovation Center recently introduced the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model as a redesign of the Global Professional Direct Contracting Model (GPDC). The move represents the…

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Executive Briefing | May 6, 2022

2022 Medicare Advantage Dental Benefits in Review

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Medicare Advantage (MA)—the alternative to traditional Medicare which allows seniors to receive Part A and B benefits through private insurance—continues to rise in popularity. As of April 2022, almost half (46%)¹ of all Medicare beneficiaries are enrolled in an MA plan.…

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Article | March 7, 2022

ACO REACH Model: Implications for Providers and Plans

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The Centers for Medicare and Medicaid Services (CMS) Innovation Center recently provided long- awaited clarification on the status of the Direct Contracting program. CMS has formally canceled the Geographic Direct Contracting Model (Geo) and is phasing out the Global and…

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Article | January 6, 2022

2022 Outlook: Plethora of ‘Granular’ Changes Will Drive MAOs’ Stars Strategy

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Reprinted with AIS Health permission from the January 6, 2022, issue of RADAR on Medicare Advantage With continued emphasis on member experience, several new Part C measures and a directional shift to closing health care inequities, 2022 stands to be…

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Article | January 6, 2022

2022 Outlook: MAOs Face Payment-Related Unknowns, Increased Competition

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Reprinted with AIS Health permission from the January 6, 2022, issue of RADAR on Medicare Advantage For the Medicare Advantage industry, change wasn’t a major outcome of the Biden administration’s first year in office. But for 2022, MA organizations face…

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Executive Briefing | January 13, 2022

Health Plan Success Drivers in 2022 (A Renewed Focus on Performance and Execution)

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Every January, we provide our perspective on areas of increasing importance and value for health plans for the upcoming year. Our prospective view of 2021 focused on the need for health plans to strike a balance between innovation and investment…

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Executive Briefing | November 30, 2021

Data to the People, by the People, for the People

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Health plans are undergoing a transformation as they evolve their capabilities and business models to not only use data in new and innovative ways, but also cope with the increasing volume, variety and velocity of data. Given the impact COVID-19…

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Executive Briefing | November 16, 2021

OTC – A Missed Opportunity for Member Engagement

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Over-the-counter (OTC) benefits have historically been used by health plans primarily as a marketing tool as well as a benefit for Medicare Advantage (MA) offerings, with value focused on member acquisition. However, as competitive dynamics in the MA market abound,…

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Executive Briefing | November 2, 2021

Value Transformation in Specialty Care

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Section I: Introduction Over the past decade, the value movement in healthcare has grown and evolved. Driven by the development and adoption of primary care-led models (e.g., patient-centered medical homes, accountable care organizations or ACOs), payers have experienced a significant…

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Executive Briefing | February 9, 2021

Racial Disparities in Healthcare: A Call to Action

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Reflecting on the significant events of 2020, most notably, heightened racial unrest and the unequal impact of COVID-19, we have a unique and time-sensitive opportunity to address the reality that racial disparities exist in our country. Racial disparities permeate across…

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