Current Trends For Payers

Sponsored by UST HealthProof
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Current Trends For Payers

Insider insights and perspectives on trending topics for healthcare professionals. We’re talking to the experts about the unique operating infrastructure necessary for business success and to improve the quality of care for members. Topics include BPaaS, technology, data security, operations, core administration, care management, member engagement, risk adjustment, HEDIS and Star quality measures, start-up and growth tactics, and regulatory and compliance. 

  1. 12월 2일

    Lessons Learned From the OIG

    Accurate coding in healthcare is critical, especially with the recent changes brought about by the RADV extrapolation rule. This regulation allows the Office of the Inspector General (OIG) to apply audit findings from a sample across an entire Medicare Advantage plan, significantly increasing the financial risks associated with coding errors. For example, a $500,000 penalty for mistakes in coding can now balloon to millions, making it essential for health plans to prioritize coding accuracy a...

    14분

  2. 11월 4일

    From Data to Action: Revolutionizing HEDIS Analytics

    This episode explores the challenges and opportunities plans face during the digital transition. The most common challenges are outdated systems, fragmented data sources, and managing data integration effectively. We discuss innovative strategies to reshape HEDIS reporting and analytics—from integrating diverse digital data into a unified platform to accelerating processing speeds for real-time insights. Plans can leverage these powerful analytical tools, flexible reporting, and actionable da...

    11분

  3. 10월 16일

    Bonus Episode: Star Rating Industry Report 2025

    The 2025 Medicare Advantage and Part D Star Ratings were released on October 10, 2024. This year brought significant shifts that will impact health plans across the industry. With new challenges in place and more stringent performance measures, it’s essential for health plans to understand how these changes have affected Star Ratings. The introduction of updated methodologies, such as the use of Electronic Clinical Data Systems (ECDS) for certain measures, and increased weight on critical per...

    8분

  4. 10월 1일

    Cyber Security Trends: Third-Party Security Assurances

    Preparation and a vigilant organizational mindset are critical to reducing the financial and reputational risk of cybersecurity incidents. Join CISO, Hans Guilbeaux for an in-depth discussion on ways health plans can ensure their vendors have implemented industry best practices and are prepared for incident response with detailed disaster recovery and business continuity processes.About Our Guest:Hans Guilbeaux is the UST HealthProof CISO and has over 25 years of experience in network a...

    20분

  5. 8월 29일

    Season 3 Trailer

    Previously, Medicare Advantage For Health Plans podcast, we're changing names in Season 3 to Current Trends For Payers podcast. In response to the growing needs of our audience, we’re expanding our topic coverage to include commercial, ACA, government-sponsored health plans, and more. You’ll be hearing from experts across all aspects of the business and learning about cutting-edge strategies and tactics used by some of the nation’s most successful health plans. Tune in monthly for exclu...

    1분

  6. 5월 8일

    Why Retrospective Risk Is Administratively Heavy—And What To Do About It

    Retrospective risk adjustment involves several administratively heavy processes, from chart retrieval to coding to supplemental data and submissions. The ever-changing regulatory environment requires continual updates in processes and technology.Join expert Greg Pastor to discover ways to streamline retrospective risk adjustment processes and develop a strategic, multi-faceted approach to addressing industry changes.About Our Guest: Greg is the Managing Director of Risk Adjustment Operat...

    12분

  7. 4월 1일

    Prior Authorization Trends & Opportunities

    While prior authorization serves as vital checks and balances, ensuring clinical quality and preventing fraud, the administrative burden it imposes on providers and payers alike has led to an industry-wide reevaluation of certain codes and an increased push towards technology for auto-approvals and Gold Carding. Now, it's up to payers to encourage provider adoption of the technology by offering platforms with user-friendly interfaces, intuitive design, and seamless workflows. Streamlining pri...

    12분

  8. 3월 4일

    Responsible AI For Payers

    As payers adopt artificial intelligence (AI) technologies in different aspects of healthcare operations, there is a need for AI governance and the careful vetting of vendor AI practices to safeguard patient welfare. AI solutions can offer valuable decision support to create efficiencies at scale, timeliness, and accuracy. However, AI solutions should not run autonomously, nor should the final result go unquestioned. It is essential that all stakeholders understand how AI solutions draw t...

    17분
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Insider insights and perspectives on trending topics for healthcare professionals. We’re talking to the experts about the unique operating infrastructure necessary for business success and to improve the quality of care for members. Topics include BPaaS, technology, data security, operations, core administration, care management, member engagement, risk adjustment, HEDIS and Star quality measures, start-up and growth tactics, and regulatory and compliance. 

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  • 제작진
    Sponsored by UST HealthProof
  • 방송 연도
    2022년 - 2024년
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    © 2024 Current Trends For Payers
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