Valora Medical Group’s Post

The latest edition of APHSA -- American Public Human Services Association Catalyst includes a great article from Merative's Walt Sedlazek regarding lessons learned from the Unwinding. One of the key areas highlighted is to "expand and encourage self service." Providing systems of engagement that empower clients, improve operations and expand capacity are essential to program performance and improved outcomes. This is not nice to have, it is necessary. #SystemsofEngagement #ClientExperience https://lnkd.in/epWjB-DE

It's that time of year again - award season! 🏆 Let's take a moment to recognize the top performers from the 2024 AEP (See table below). Congratulations to CVS/Aetna, Devoted, and Alignment for crushing it and proving that innovative product design and outstanding care delivery is a winning model! 🎉 Special recognition goes to Humana for their continued growth, while other nationals struggled. So, what happened? In a word - CMS! Due to lower reimbursements, many plans increased their pricing and reduced benefits to maintain profitability. Unfortunately, this resulted in increased premiums, deductibles, and co-pays, translating into more beneficiaries shopping and switching their plans than ever before. According to Deft Research, some 40+% of beneficiaries shopped and 16% switched their MA plan to the benefit of many local plans who had a great AEP. CMS will be reducing reimbursements again next year, so it's important to start preparing now. 💪 Stay tuned for our annual AEP Retrospective report, where we'll highlight lessons learned from the last AEP to inform your 2025 AEP strategy. 😎 Quote of the week: "Chiefs 25 - 49ers 22." - CBS Sports. I guess Patrick and Travis brought it! 😫 #medicareaep #medicare #medicareagent #medicare2024 #medicareopenenrollment #medicaresales #medicareenrollment #medicareinsurance #Medicare

Let’s us know how we can make your AEP a success story!

Are you ready for Plan Preview? The Star year is zooming by! CMS is a few short months away from sharing Star score data and opening a brief window for plans to find and flag discrepancies. It takes tremendous coordination and rapidly analyzing a lot of disparate data to make the most of the Plan Preview period. Check out our latest article with best practices for planning and engaging with CMS during Plan Preview to ensure the most accurate and robust Star scores possible. https://lnkd.in/ePpVmxHP Marc S. Ryan 🇺🇦, Neetu R., Alex Schaefer #PlanPreview #MedicareAdvantage #CMS #MAstars #Medicare

Read our Lilac Software blog on the upcoming Plan Preview. Pay close attention to our recommendation on best practice data review year-round. If you are not doing now, ready for next year's Plan Preview by implementing the process for CY 2025. This is key to effectively challenge data anomalies/errors with CMS during Plan Preview. Lilac Software

On April 1st, CMS released the Final Notice of Methodological Changes for CY2025 for Medicare Advantage Capitation Rates and Part C and Part D Payment Policies. In an effort to continue our long-standing goal of sharing knowledge with clients and potential clients, Cognisight has highlighted the proposed changes affecting risk adjustments for Medicare Advantage plans and PACE programs in our latest Client Briefs. Please visit https://lnkd.in/gCfWXaPi to read them now. #Cognisight #RiskAdjustment #CMSnews #MedicareAdvantage #PACE #HealthPlanHelp

Stumbled across this really cool article from KFF highlighting the significant changes that have been happening in the Medicare space. Costs will continue to rise as more people age-in and skew older in general. Maintaining a hold on costs from customer acquisition through to Medicare spending are critical for carriers & distributors to remain on the positive side of profitability. https://lnkd.in/eat45wsp #kff #medicare #medicareadvantage

The April #NAACOS conference was incredibly insightful. It gave us a chance to better understand the strengths and weaknesses of Value-Based Care as it stands today. We also met many of the decision-makers who are working hard to address these challenges. Additionally, the feedback we received from ACOs reinforced that our solution, Florence, could play an important role in supporting patients and practices in both REACH and MSSP models. #VBC #ValueBasedCare #ACOReach #MSSP National Association of ACOs Generated Health https://lnkd.in/ekNhDsyj

On April 1st, CMS released the Final Notice of Methodological Changes for CY2025 for Medicare Advantage Capitation Rates and Part C and Part D Payment Policies. In an effort to continue our long-standing goal of sharing knowledge with clients and potential clients, Cognisight has highlighted the changes affecting risk adjustments for Medicare Advantage plans and PACE programs in our latest Client Briefs. Please visit https://lnkd.in/gCfWXaPi to read them now. #Cognisight #RiskAdjustment #CMSnews #MedicareAdvantage #PACE #HealthPlanHelp

CMS's recent recalculation of the 2024 Star Ratings is causing Medicare Advantage plans to reassess their strategies. In a recent interview with AJMC's Managed Care Cast, Cotiviti's Marge Ciancetta discusses the challenges and offers strategies to help smaller MA plans optimize their Star Ratings and quality initiatives. https://bit.ly/3z4VSt9 #HealthPlans #HEDIS