Maximizing Patient Lifetime Value: A Data-Driven Approach for Modern Practices
Every day, patients are identified as needing care (a preventive screening, a specialist referral, a follow-up visit) but never make it to the appointment. This is healthcare’s missing middle: the gap between knowing a patient needs care and actually getting them to a kept appointment. Patient Lifetime Value (PLV) puts a measurable number on exactly how much that gap costs, and how much is gained when it closes.
Build or Buy? Choosing the Right Path for Effective Member Outreach
Health plans know that closing care gaps start with one thing: reaching members. But deciding how to reach them, by building an in-house outreach program or partnering with a specialized vendor, can determine whether you meet your engagement goals or fall behind.
The CMS TEAM Mandate: What Hospital Leaders Must Know to Be Ready for the 2026 Performance Year
For many Medicare patients, having surgery, whether in the hospital or an outpatient setting, can feel like navigating a maze of disconnected appointments and providers.
Streamlining Referral Management: How Real-Time Booking Transforms Provider Operations
Explore how real-time slot visibility and automated scheduling can reduce referral leakage and enhance revenue for providers. Did you know that almost half of all specialist referrals never get completed?¹ When this happens, your patients are left without the care they need, and your clinicians are left without the insights they need to make informed […]
Turning Policy Change into Member Action: How MA Plans Can Lead in the New CMS Era
The Centers for Medicare & Medicaid Services (CMS) is ushering in a new phase of Medicare Advantage (MA), one that places stronger emphasis on data integrity, outcomes, value-based care, and genuine member engagement. In this environment, success hinges less on benefit design and more on a plan’s ability to activate its members to utilize available supplemental benefits, […]
Why Your Member Outreach Strategy is Falling Short and How to Fix It
In today’s data-rich healthcare landscape, true improvement in Star Ratings and quality measures requires more than analytics—it demands decisive, targeted action that bridges insight and impact. The biggest obstacle lies not in acquiring predictive analytics but in applying these insights to effectively connect with members at the right moment. Health plans have either advanced data […]
5 Ways Improving Care Access for Members Is a Force Multiplier for Engagement and Outcomes
Access to care is one of the most critical factors influencing member health outcomes and satisfaction. When members struggle to navigate the healthcare system, it can lead to delayed treatment, unmet health needs, and poor overall experiences. Challenges such as scheduling difficulties, disjointed provider interactions, and a lack of understanding of benefits and costs compound […]
CMS Cracks Down on Medicare Advantage Audits: $43 Billion in Estimated Overpayments Leads to Increased Oversight
CMS’s recent announcement to audit every Medicare Advantage (MA) plan annually marks a major shift in oversight, with a clear focus on ensuring that diagnoses, especially those identified during In Home Assessments (IHA), are fully supported by medical records and documented care. This expansion, which represents a shift from auditing about 60 plans a year to all […]
What the 2× Weight Drop Means for CAHPS and How to Stay Ahead
After years of CAHPS being weighted at 4×, the Centers for Medicare & Medicaid Services (CMS) announced in late 2024 that CAHPS measures would be rolled back to 2× starting in 2026.
Phone Calls for Member Engagement Work! Here’s Why
The consumerization of healthcare is transforming how individuals access and manage their health. Mobile apps, health plan portals, and AI-powered chatbots are at the forefront of this shift, offering personalized, on-demand tools that mirror the convenience of industries like retail and banking. These solutions empower members to take control of their healthcare journey—whether it’s scheduling […]