androsInsights

Take deep dives into credentialing, provider network management, and healthcare administration news, best practices, and technology with expert members of the andros team.

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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

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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

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White Paper

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.

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White Paper

Creating a Better Provider Experience: andros Survey Insights

Introduction Building strong, healthy provider networks is anything but easy and absolutely critical to the success of every health plan. The healthcare industry continues to accelerate investments in digital healthcare tools and platforms (e.g., telehealth, remote patient monitoring, remote meetings, etc.) that disrupt traditional payment and communication barriers. M&A activity is accelerating at a breakneck pace, leading to consolidation that

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Top 100 Under 50

Each quarter, I try to send out one of these CEO letters. Not only do I think it’s important for me to really break down my thoughts and excitement about current trends and opportunities, but I get a chance to shed the business layer and sit down as a person. So, person-to-person, here’s what’s happening at andros lately.

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Summer 2022 Newsletter: Note from Mike Simmons

Each quarter, I try to send out one of these CEO letters. Not only do I think it’s important for me to really break down my thoughts and excitement about current trends and opportunities, but I get a chance to shed the business layer and sit down as a person. So, person-to-person, here’s what’s happening at andros lately.

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Celebrating #OneTeam: andros Summer MVPs

Celebrating #OneTeam: andros Summer MVPs Each quarter we acknowledge the team members who went above and beyond in their role and who exemplified the andros values. All MVP winners are nominated by their peers or manager and the People Team identifies the MVPs (and some honorable mentions!) for the quarter based on these nominations. We love this opportunity to recognize

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What Does CMS’ Final Rule for 2023 Mean for You?

What Does CMS’ Final Rule for 2023 Mean for You? https://youtu.be/gUEZLcW84aY In late April 2022, CMS announced the changes to the Medicare Advantage (MA) program for 2023, and the implications for health care organizations submitting provider networks for approval for plan year 2024 are major, to say the least. If, like most, your organization finds itself scrambling to complete your

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White Paper

From Direct Contracting Model to ACO REACH: Navigating the Continued Evolution of Value-Based Care in Traditional Medicare

With a speedy makeover for the Global and Professional Direct Contracting Model, CMS is making sure to incorporate lessons learned from previous value-based care programs. The revamped ACO REACH initiative aims to make it easier and more rewarding to embrace value-driven principles in traditional Medicare. Introduction Ever since the Affordable Care Act (ACA) became the law of the land in

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Case Studies

Humana Chooses andros as CVO Partner

When Humana began searching for a new CVO partner, they had clear criteria – their next vendor had to be a long-term solution to their problems. Our unique approach enabled Humana to proactively identify potential compliance issues and mitigate them before consequences arose.

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Delegated Credentialing: Easing the pain of credentialing your providers

Delegated Credentialing: Easing the pain of credentialing your providers Credentialing in house can be painful for health plans and other types of payors, adding the time and administrative stress of continually tracking and updating new providers, locations, and information. It can be burdensome for provider organizations too, submitting new documents with each provider, location and information changes, not to mention

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White Paper

Top 4 Challenges Facing Health Plans in 2022 and How to Overcome Them

From network development and staffing shortages to managing relationships in an increasingly digital world, health plans have a lot on their plates in 2022. How can leaders effectively navigate this difficult environment while continuing to provide exceptional services to members?   Introduction   Since the beginning of this tumultuous decade, health plans have been confronted with an unprecedented array of

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The lesser-known process affecting healthcare quality: Credentialing

Board of Directors Investor Portal The lesser-known process affecting healthcare quality: Credentialing By Mark Hirschhorn Over the last two years, we’ve gained more insight into the inner workings—and over-burdening—of the healthcare system than ever before. However, most people are still unaware of how much time-intensive administrative work is involved in the healthcare they receive. This work which takes countless hours

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White Paper

Roadmap to Innovation: What Payers Need to Compete in the Digital-First Healthcare Environment

Innovation is no longer optional for established health payers and digital native startups. Without revamping inefficient processes, payers risk falling behind in the race for provider participating providers and market share.Here are the first steps payers can take on the path toward sustainable, successful innovation.   Introduction   The health plan marketplace is evolving quickly as changing demographics, new regulations,

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The Future of Value-Based Care: Making the Most of the New Direct Contracting Model for Traditional Medicare Populations

CMS introduced the Global and Professional Direct Contracting (GPDC) Model in 2020 to build on previous successes and continue transforming the world of value-based care.  What does the new program entail and how can participants maximize their opportunities to succeed? A decade after the launch of the first accountable care organizations (ACOs), the healthcare industry has come a long way—but

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White Paper

Top 4 Steps for Getting Started with Delegated Credentialing

FREE EBOOK Delegated credentialing can save time, money, and effort for health plans and provider groups. But it’s not for everyone.  Providers need to fully understand what’s involved and assess their readiness to take on enhanced credentialing responsibilities.  Here’s how.     Introduction   Credentialing is a key part of the provider enrollment process with significant implications for patient safety, care

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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

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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

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White Paper

Infusing Digital Innovation into Network Development to Boost Efficiency and Improve Experiences

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.   Introduction The Medicare Advantage (MA) marketplace has never been more vibrant. More Americans than ever are opting for the affordable coverage and enhanced

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