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Fraud in Value-Based Care Programs

Fraud in managed care programs increases costs for the government – sometimes substantially.  As the amount of taxpayer money spent on managed care increases, so

Rx Utilization Factors

Utilization has become a key factor when we talk about reducing cost of healthcare and prescription drug expenses is big part of it. Overutilization leads

Convert Data into Knowledge

Physicians have always recognized that data collection is important in healthcare. But a lot about data collection has changed the amount of it, the electronic

The importance of Value-based Care

Medical care can be costly, particularly for patients with chronic diseases, such as high blood pressure, diabetes, heart disease, or cancer. Value-based care places an

The importance of provider engagement

Enhancing provider engagement can have a dramatic impact on health plan performance. Recent studies show that health plans find that involving providers leads to improved

What is Medicare Risk Adjustment (MRA)

The Center for Medicare & Medicaid Services (CMS) Risk Adjustment Model ensures adequate resources to care for our high-risk Medicare Advantage members. Mandated by the

Medicare Advantage plan changes coming for 2022

The greatest uncertainty is members’ health status, which could impact MA organizations’ bidding submission process for 2022. Fortunately, fully vaccinated members are likely to resume

Medicare Risk Contracts

In 2008, Congress passed the Medicare Improvements for Patients and Providers Act (MIPPA). This legislation started the trend for value-based care programs (also known as value-based contracts or

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What is Healthcare Tech?

Healthcare tech refers to technology-enabled products and services in healthcare. Distinct from medical devices and diagnostics, healthcare tech focuses on facilitating and enabling healthcare functions.