Bridging Silos: How Quality and Risk Adjustment Teams Can Drive Shared Outcomes in Medicare Advantage

Bridging Silos: How Quality and Risk Adjustment Teams Can DriveShared Outcomes in Medicare Advantage

Bridging Silos: How Quality and Risk Adjustment Teams Can Drive Shared Outcomes in Medicare Advantage In the evolving Medicare Advantage landscape, plans are under unprecedented pressure to do more with less. They must demonstrate superior clinical outcomes, deliver exceptional member experiences, and maintain precise, compliant documentation all while navigating complex regulatory changes. Yet, despite shared goals, […]

CMS 2027 Medicare Advantage Proposed Rule Explained

CMS 2027 Medicare Advantage Proposed Rule Explained: What Health Plans Need to Know and Why It Matters

In the evolving Medicare Advantage landscape, plans are under unprecedented pressure to do more with less. They must demonstrate superior clinical outcomes, deliver exceptional member experiences, and maintain precise, compliant documentation all while navigating complex regulatory changes. Yet, despite shared goals, Risk Adjustment and Quality Improvement teams often operate in parallel universes. This organizational separation creates […]

The See-Saw of Telehealth Encounters in Risk Adjustment

The See-Saw of Telehealth Encounters in Risk Adjustment

The federal government’s recent 43-day shutdown impacted many facets of everyday life in the United States, including Americans’ health, wellbeing, and access to care. One increasingly vital (yet uniquely vulnerable) component of our healthcare delivery system was adversely affected during the shutdown, yet it received little attention: telehealth. Since the beginning of the COVID pandemic […]