CMS is investing heavily in state-led redesigns of Medicaid delivery and payment policies, indeed banking on them. But there are still large needs that need to be filled for meaningful, sustained transformation.
Today, as states struggle with budget pressures and brace for the national reform, interest in various managed care strategies continues to grow. A well-executed managed care effort can help control costs while improving access and quality of care. This paper addresses how to evaluate, deploy, and administer managed care systems in the Medicaid environment.
Medicare Advantage (MA) plans are private health plans that have contracted with Medicare to receive a fixed monthly fee in exchange for providing comprehensive healthcare to plan members. In order to provide appropriate care to beneficiaries with varying medical conditions, plans are paid according to the Risk Adjustment Factor (RAF) score of each patient. Insufficient documentation of chronic conditions can be an obstacle to MA reimbursement. However, even when a condition has been properly documented by the provider, it is often not coded and submitted to Medicare. Read this white paper to learn how to take the complexity out of MA reimbursement.
In this solution brief we recommend a reference architecture that can be implemented with Intel® Expressway Service Gateway for Healthcare (Intel® ESG for Healthcare) – reflecting the unique legacy protocols in healthcare, the services required for the exchanges, and the impact of strict security laws on the overall architecture. This paper is intended for healthcare solution specialists, technology architects, business analysts in the healthcare industry, Healthcare SMEs, executives, state level health and human services implementers, system integrators who are looking to build state HBE systems, and other potential customers.
Understanding illness and poverty is the first step to creating better solutions. One state health department is turning to data, a new ways of using it, to help researchers, policymakers and citizens address health problems.