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Imagine if each time you entered an address into your GPS you only had a 50% shot that you would arrive at your correct location. You would be pretty upset if you weren’t in the 50% that made it to their destination. That is precisely what CMS has uncovered during round two of the online provider directory review. The average Medicare Advantage Organization’s inaccuracy rate by location was 48.39%.  Nearly HALF of all directory locations reviewed are inaccurate. That high rate not only produces frustration, but a significant access-to-care barrier for members.

It’s clear that healthcare payers do not have the necessary monitoring and oversight built into their system to be compliant. Sure, it would be great for a central provider database to be available, but it’s not. Which means the responsibility is on the healthcare payer to work with their providers to ensure accurate data. Payers can’t assume that every time a provider needs to update their information that they will reach out. A proactive outreach program must be put in place by the payer to obtain new data and ensure current data is correct. Using contract execution or renewal dates is a great place to start. Incorporating outreach that is triggered on an annual basis by these dates can jump start the monitoring process.

And location is only one element of a larger problem. During CMS’s review they also found a number of providers who had either retired, were deceased or relocated for a number of years. Inaccurate provider directories impact the overall adequacy of a payer’s network. After round 2 of the review, 23 plans were issued a notice of non-compliance, 19 plans were issued warning letters and 12 were issue warning letters with a request for a business plan. It’s time to be proactive and change the way you do things. Don’t become a statistic and receive a letter from CMS, instead issue a letter to your providers that contains the data you have on file and encourage a response. Work together to see better results.

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Member Communication: Less Is Not More.

There is no way to sugar coat it – Medicare Advantage plans are not meeting their customer satisfaction goals. Surveys prove it, with satisfaction having dropped from 2017 to 2018. One of the main drivers for the discouraging results is a lack of communication. Health plans are not leveraging communication strategies to engage members even though it’s the most effective […]

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You Can’t Manage What You Can’t See – Thoughts from the Optimizing Appeals & Grievances Conference

Much of the discussion last week at the Optimizing Appeals & Grievances and Improving ODAG & CDAG Outcomes Conference centered around accountability and company culture.  There was also a great deal of attention given towards the ability to pull Universes on demand.  These topics along with better ways to manage your day to day workloads are common challenges we hear from […]

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Building a Strong Network: It Takes an Empowered Team

Life is full of different experiences. Take a moment to think about the last really good experience you had. What was it about the experience that made it so positive? Now think about the last horrible experience you had. What was it that made the experience so poor? I’m betting that the factors behind why your experience was positive or […]

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The Secret to Improving Member Experience? Hint: It’s Probably Not What You Think.

Life is full of different experiences. Take a moment to think about the last really good experience you had. What was it about the experience that made it so positive? Now think about the last horrible experience you had. What was it that made the experience so poor? I’m betting the factors behind why the experience was positive or negative […]

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March 27, 2018

Bad Data Is No Different Than No Data.

Imagine if each time you entered an address into your GPS you only had a 50% shot that you would arrive at your correct location. You would be pretty upset if you weren’t in the 50% that made it to their destination. That is precisely what CMS has uncovered during round two of the online provider directory review. The average […]
February 9, 2018

Be an Olympic Athlete in the Work Place

The Winter Olympics are here! If you’re like me, you’re looking forward to the excitement and thrills of international competition! I am a snowboarder so I have a personal love for winter sports and will be glued to my TV and social media feeds watching the events and keeping medal counts. There is such an inspirational culture built at the […]
December 13, 2017

Are You Asking For A Faster Horse?

We all know the adage…you don’t know what you don’t know. Time and time again while working in the world of enterprise information software I see this first hand. We speak with managers and executives that don’t even realize how far enterprise information platforms have come or just how impactful they can be to your business process. To often we […]
August 31, 2017

Things That Are Better Together

There are many things in this world that make us happy and bring us joy. Sometimes when those great things are combined with other wonderfully, great things they become AMAZING! Simply put…they are Better Together. Here are a few of those amazing things: Peanut butter and jelly Milk and cookies – especially chocolate chip! Netflix and your couch Danny and […]