ESRD Enrollment Creates Cost, Network Unknowns for MAOs
Reprinted with AIS Health permission from the July 2, 2020, issue of RADAR on Medicare Advantage. As Medicare Advantage plans prepare to enroll patients with end-stage renal disease (ESRD) this fall, a recent change to network adequacy measurement will give them some flexibility in how they include dialysis care in their networks. Meanwhile, a new lawsuit […]
Pressure Mounts on MA Plans to Address Racial Disparities
Reprinted with AIS Health permission from the June 18, 2020, issue of RADAR on Medicare Advantage As protests erupt across the U.S. calling for racial justice and police reforms, the COVID-19 pandemic continues to bring to light many of the racial disparities in health care, putting pressure on policymakers and the industry to take a hard […]
Quest Analytics Launches Quest Enterprise Services
First to launch platform enabling health plans to simultaneously measure, manage and monitor network adequacy AND directory accuracy. OVERLAND PARK, Kan., June 16, 2020 – Quest Analytics, the leader in measuring, managing and monitoring health plan network performance, today announced the release of Quest Enterprise Services (QES), the first and only platform to enable the health plan community to […]
Health Plan Best Practices to Comply with SB-137
When we say the strictest provider compliance law in the country, we’re not kidding. Although other state and federal regulators, the Centers for Medicare & Medicaid Services (CMS) for example, are starting to incorporate rules around provider directory data, SB-137 requires health plans to reach out to all contracted providers on a quarterly basis to […]
Though Agency Released No New Policy, CMS Says Inaccurate MA Provider Directories Raise Network Adequacy Issues
Reprinted from the April 3, 2019, article in Inside Health Policy. CMS emphasized the importance of accurate provider directories for Medicare Advantage plans, saying that inaccuracies can bring plans’ network adequacy into question, but did not finalize new policy to improve the directories as part of the MA and Part D call letter for next year. […]
The Health 202: Trump Administration Lets Medicare Plans Off the Hook
Reprinted from the December 4, 2018, article in The Washington Post THE PROGNOSIS The Trump administration is holding off on punishing Medicare Advantage plans for error-ridden doctor directories — further evidence the conservative-led Centers for Medicare and Medicaid Services is showing special favor to the alternative program over traditional Medicare offerings. In an audit quietly released late […]
Quest Analytics Presents New Combined Network Adequacy and Accuracy Solution at AHIP Institute 2018
Last week, Quest Analytics’ CEO Ari Tulla and President and Co-Founder John Weis presented a newly combined network adequacy and accuracy solution for health plans during a session at AHIP Institute 2018. This conference brought together key healthcare industry players including health plans, health groups, policymakers, and providers in San Diego. The combination of Quest Analytics’ network decision-support tools […]
Blockchain in Healthcare: Separating Hype from Reality
Is blockchain the biggest innovation since the internet? The hype and buzz about blockchain technology is just beginning in multiple industries. What will this new technology offer the healthcare industry? How will it change the industry manages data? We dive into the basics of blockchain, what the applications can be, and what challenges the industry […]
