Medicare Advantage Resources
Take deep dives into medicare advantage news, best practices, and technology with expert members of the andros team.
Provider Network Adequacy: The Waiting Game
It’s no secret that access to healthcare services is a pivotal issue for many. Provider network adequacy, which ensures that health plans have enough providers to meet their members’ needs, serves as a cornerstone for healthcare access. However, the current network adequacy standards fall short in addressing how long patients may have to wait to get an appointment with their
The Misconception of Provider Network Adequacy
When it comes to health plans, provider network adequacy is crucial. For most health insurance products, it is mandated by law that health insurers ensure that their networks are sufficient in size and scope to offer a defined set of covered services to their members. However, provider network adequacy does not always equate to actual member access. Fact or Myth?
The Importance of Member Experience in Provider Network Adequacy
When it comes to healthcare, ensuring the satisfaction and positive experience of patients or members should be a priority of networks. However, this seems not to be the case for some, particularly those that have inadequate provider networks. Contrary to what many people think, having a sufficient number of healthcare providers in a network does not necessarily mean that members
Surpassing Network Adequacy: A New Approach to Health Equity
In the ever-evolving landscape of healthcare, it’s not enough to just meet standards – you need to surpass them. As a health plan looking to outshine competitors, it’s crucial to understand that being merely ‘adequate’ won’t cut it. Your aim should be to offer an exceptional service that not only meets but exceeds the expectations of your consumers. That’s where
Breaking Through Provider Fatigue: How andros Uses Data and Analytics to Build Better Medicare Advantage Networks
Since its launch by CMS, Medicare Advantage (MA) has transformed healthcare in the United States. As a result, Medicare beneficiaries now have more options and insurers are competing on price and quality, which has led to lower healthcare costs and better healthcare outcomes. It seems like a win-win scenario for health plans and consumers… until you recognize which group is
Is Adequacy Enough? Moving Beyond CMS Standards for Provider Networks
Meet Grace Meet Grace. She’s a 70 year-old immunocompromised woman living in a rural area. She owns a car but doesn’t drive anymore, so she relies on her son for transportation. When she’s able to schedule her medical appointments well in advance, he’s able to take time off to drive her to them. But what happens when she comes down
Q3 Primary Care Provider Market Study
“ Primary care providers are more interested in acquiring new patients with their existing health plan contracts then they are in signing contracts with additional health plans ” andros executed our Q3 Provider Market Study to better understand primary care provider sentiment around network contracting and access to specialist providers for their patients. Part of what compelled us to focus
More Than Adequate: Paving the Road to Health Equity with Next-Gen Provider Networks
Download Our Whitepaper “ Of all forms of inequality, inequality in health is the most inhumane ” There are three main contributing factors for health inequality in the U.S.² — not to mention how we structure them to serve the needs of communities. Although provider network adequacy standards exist at the federal level and are one of the ways that
Becoming a Medicare Advantage Plan of Choice for Providers
Effective, high-performing providers are the lifeblood of a successful healthcare network. When they’re not worried about things like paperwork and reimbursements, providers can focus on their patients and deliver quality care. On the flip side, providers who spend too much time behind a desk, dealing with administrative headaches rather than treating patients, struggle to do so. In the increasingly competitive
Improving the Patient Experience Using NCQA Report Cards
NCQA, the National Committee for Quality Assurance, is very clear about its mission: “We work for better health care, better choices and better health.” One tool they use to improve care is the NCQA report card program. NCQA report cards evaluate clinicians, practices, and health plans on a simple five star grading system. Since NCQA issues report cards for health
Solving the Top Provider Data Challenges in Network Development
Organizations of all sizes have struggled to solve the challenges of building healthcare provider networks, especially for Medicare Advantage, on schedule and on budget. Healthcare organizations have to analyze patient demographics and local geography, then make wise choices where to invest. They need to comply with complex regulatory requirements and demanding timelines. But despite these geographic and regulatory challenges, provider
10 Reasons Why Provider Network Development is Broken
The process of building a provider network is challenging. There is constant change in government regulations, a fast-paced competitive environment, and various information sources. Building a solid and profitable network requires the right strategy. The best network to build will depend on such things as your goals and member population, but network development strategy mistakes will prevent you from building
Medicare Advantage is the Future of Medicare
Introduction Introduced in 1997 as Medicare+Choice, Medicare Advantage plans have three goals: Reduce costs Enhance quality of care Increase choice And they have. Leveraging the power of the healthcare market, Medicare Advantage has reduced costs to its members by about 40% a year compared to fee-for-service beneficiaries. Because it works, Medicare Advantage has grown consistently–and now its growth is accelerating.
Keep your Medicare Advantage network build on track with these tips
As fall settles in, and you’re sitting at your (home office) desk with a pumpkin spice latte, chances are your organization is well into its Medicare Advantage provider network builds. Network builds are such large projects, with so many moving parts, that it can be difficult to truly understand how well a project is progressing. If you’re not able to
Turning an Early “No” in a Medicare Advantage Network to Your Advantage
No one starts a Medicare Advantage (MA) network development project with the idea of pulling the plug before it’s approved by CMS. With the continued growth of Medicare Advantage, abandoning a build that’s in-progress could easily feel like a fruitless exercise. But that doesn’t have to be the case. Health Plans, and specifically their network development teams, can often learn
Infusing Digital Innovation into Network Development to Boost Efficiency and Improve Experiences
View PDF version High-performing provider networks are at the core of a health plan’s success. Embracing digital innovation during the network development process will allow Medicare Advantage plans to secure the best possible partners in an extremely competitive environment. The Medicare Advantage (MA) marketplace has never been more vibrant. More Americans than ever are opting for the affordable coverage and
Why a holistic approach to Medicare Advantage makes all the difference
The facts and figures behind the growth of Medicare Advantage (MA) are clear – Medicare Advantage patients pay 40% less out-of-pocket on healthcare compared to patients in traditional fee-for-service Medicare plans. Combine that with ancillary benefits like hearing aids, vision care, and dental care, it’s no surprise that patients find MA plans appealing. And that appeal is resulting in substantial
Gaining an Edge in Contracting and Credentialing with Best Practices for Medicare Advantage Plans
The Medicare Advantage landscape offers attractive opportunities for health plans looking to enter the market or expand their presence into new territories. In order to succeed, plan sponsors will need to embrace innovative technologies and proactive strategies that help them stay ahead of the competition. Introduction The Medicare Advantage (MA) market is one of the most dynamic and
