Medicare & Medicaid: Reduce Costs Through Quality of Information Part 1 of 4

CMS does a good job in many things, and keeping an eye on quality of information disseminated is one.

Their guidelines layout four buckets of review:

1. Utility
2. Objectivity
3. Integrity
4. Transparency and Reproducibility

There are key points to each guideline. Here's a glance at Part I.

Utility

Information is consistently tested with focus groups and should be developed in a collaborative process involving providers, consumers, academicians, and policy analysts

CMS stays active by developing special reports and topical studies that address emerging information needs (email, mobile, social, PDF documentation) that comes from proposed legislative changes and policy debates.

Having these guidelines helps Insurance providers in developing their communications. Moreover, having partners and suppliers throughout the communications chain that respect and understand their intent delivers results for the Medicare and Medicaid system. 

A knowledgeable communications chain from creation to production and dissemination, will ensure that information can be utilized across media and that costs can come out of the system at every step in the process.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Measuring Health Care

At-a-glance:

From The Common Wealth Fund, an interactive map/scorecard on quality of Health care across the US (click here).

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Making Sense of 2010 Enrollment and Disenrollment Guidance from CMS

CMS recently released their updated 2010 guidance for Enrollment and Disenrollment.  A surprise awaited with a new model enrollment forms (exhibit 1 and 1a) along with new notices.

There are also NEW MA exhibits 34, 35, 36 and NEW PDP exhibits 33, 34, 35.  

Exhibit 33	NEW! PDP Model Notice to Research Potential Out of Area Status
Exhibit 34	NEW! PDP Model Notice for Disenrollment Due Out of Area Status (No Response to Request for Address Verification)
Exhibit 35	NEW! PDP Notice of Disenrollment Due to Out of Area Status (Upon New Address Verification from Member)

As with any guidance from CMS, the first step is identifying what’s new, then moving forward with an analysis of how it will change your business; what it could add, change or remove for your processes.

We’ll be providing more on these guidelines as enrollment deadlines approach.

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Health Care: Forward thinking to reduce costs

Do you know the multi-cultural dynamics of your employees, or your insured base membership? 

As an industry looking for all ways to reduce health care costs, an innovative forward thinking approach to is to better understand the multi-cultural dynamics of your members. 

Diving deeper into the demographics – categories such as ethnicity, coupled with age, sex, religious affiliation and other characteristics – can guide and aid you in understanding their needs, develop better treatment plans, and implement more effective out reach programs with the ultimate goal of producing better outcomes related to their specific health issues.  

Better outcomes with improved quality of care for each cultural sector combined with understanding a groups specific disease issues, behavioral dynamics, and family relations will provide better methods of treating our population in general, thus reducing overall health care costs. 

The Multi-cultural dynamics of employees and insured base of membership is an untapped source of analysis that can be applied in reducing overall health care costs. 

This is definitely something to think about, ponder and explore. 

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Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.