Blog: The Payer's Edge
AllMed offers an extensive library of educational resources that help our clients stay abreast of emerging clinical procedures and therapies to support improved clinical decision making.
The payer's edge:
Your plan’s star rating has a significant effect on your bottom line. It’s a key way attract new enrollees, expand market share and increase revenue. And, as you may know, the factor that has one of the largest impacts on your star rating is your Medicare Part D determinations and redeterminations. This blog outlines exactly what the star rating means and the link between the way a plan handles Part D determinations and how the plan rates.
In today's ever-changing health care landscape, the role and responsibilities of Medical Directors have been stretched beyond the traditional clinical scope. As the scope and complexity of their roles continue to evolve, payers of all types are increasingly partnering with IROs to perform medical review at all stages of the care management continuum. Learn more about how IROs are helping to streamline the utilization review process, easing pressure on medical directors while allowing organizations to work more effectively and efficiently. Read More
With the new federal healthcare reform laws, healthcare payer and medical management organizations expect to process about 32 million new enrollees during the next 10 years, dramatically increasing the volume of utilization reviews for complex and critical care services. As a result of this increased volume, the outsourcing of first-level physician review will become more important than ever. Read More
Outsourcing first-level physician review has become essential as health plans continue to face increased pressure to handle larger volumes while controlling cost. When making the decision to outsource, health plan executives must weigh both the advantages and disadvantages of moving their medical reviews to an external partner. Let’s take a look at the pros and cons of outsourcing medical reviews for payer organizations. Read More
Along with the growing incidence of mental health and substance abuse problems in the United States, the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA) are driving the growing number of behavioral/mental health determinations being dealt with by payers. Learn more about the effect these changing regulations have had and how AllMed's MedCert can help meet the needs of payers with a first-level pre-authorization solution. Read More