Latest news with #CareManager
Yahoo
25-05-2025
- Business
- Yahoo
Black Book Reveals 50 Elite Technology Vendors Driving Medicare Advantage 5-Star Ratings Amid Heightened CMS Audit Standards
Client Rankings Guide Health Plans to Advanced IT Solutions for Superior Compliance, Performance, and Member Outcomes for 2026 & Beyond WASHINGTON, D.C., WASHINGTON, D.C. / / May 25, 2025 / In response to significant challenges Medicare Advantage (MA) plans face due to intensified CMS regulations and stringent audit protocols, Black Book Research has unveiled its 2025 rankings of the top client-rated technology vendors critically enabling health plans to achieve and sustain CMS 5-Star ratings. The authoritative list showcases vendors excelling across key categories essential to meeting evolving CMS expectations, from compliance and interoperability to member engagement and advanced analytics. "The escalating complexity of CMS audits demands sophisticated technological solutions," stated Doug Brown, Founder of Black Book Research. "Our rigorous survey methodology identifies the premier technology providers empowering Medicare Advantage plans to master regulatory compliance, enhance care quality, and achieve superior member satisfaction." Black Book's comprehensive study, based on insights from 1,046 Medicare Advantage executives and IT leaders, categorizes the top-performing vendors according to 18 qualitative Key Performance Indicators (KPIs), ensuring methodological transparency. These KPIs encompass ease of integration, user-friendliness, customization capabilities, vendor responsiveness, proactive client engagement, training quality, innovation and continuous improvement, regulatory compliance, reliability, member engagement effectiveness, analytics and reporting quality, operational efficiency impact, data security, scalability, quality and risk management support, cross-functional collaboration, client-vendor partnership quality, and perceived return on investment. The top-performing vendor categories are as follows: 1. Care Management Platforms & Chronic Disease ManagementZeOmega, HealthEdge (CareManager), EXL (CareRadius), VirtualHealth (HELIO), GuidingCare (Altruista Health) 2. Population Health Management (PHM) PlatformsInnovaccer, Lumeris, Lightbeam Health Solutions, Health Catalyst, Arcadia 3. Interoperability & Data Integration PlatformsInterSystems (HealthShare), Smile Digital Health, Cureatr, Redox, Moxe Health 4. Member Engagement & Communication PlatformsIcario, Welltok (Virgin Pulse), mPulse Mobile, HealthCrowd, Convey Health Solutions 5. Quality Measure Management & AnalyticsInovalon Quality Intelligence, SPH Analytics (Press Ganey), HealthEdge (GuidingCare), EXL CareRadius Analytics, ZeOmega Jiva 6. Audit Readiness & Compliance ManagementInovalon, Veradigm, Cotiviti, Edifecs, Health Fidelity 7. Risk Adjustment & Coding OptimizationEdifecs, Apixio, SCIO Health Analytics (EXL), Advantasure 8. Claims Integrity & Fraud, Waste, Abuse DetectionCodoxo, Cotiviti, Change Healthcare 9. Utilization Management & Prior AuthorizationCohere Health, MCG Health, eviCore 10. AI & Machine Learning in Quality & Risk ManagementInnovaccer, Apixio, "By leveraging these highly-rated technology partners, health plans significantly elevate their capabilities to comply with CMS standards, manage rigorous audits efficiently, and deliver outstanding outcomes," added Brown. "These tools are essential for Medicare Advantage plans seeking to thrive in 2026 and beyond." Detailed insights and complete rankings from Black Book's "2025 Medicare Advantage 5-Star Technology Enablers Report" are now available for health plan leaders committed to strategic technological advancement without cost at About Black Book Research Black Book Research provides independent, unbiased analysis and rankings within healthcare technology, services, and managed care solutions. For over two decades, its vendor-agnostic methodologies have delivered trusted insights, free from vendor influence or sponsorship bias, guiding strategic technology decisions for thousands of healthcare executives, payer IT decision-makers, and managed care professionals. Contact Information Press Office research@ SOURCE: Black Book Research View the original press release on ACCESS Newswire Sign in to access your portfolio
Business Wire
21-05-2025
- Health
- Business Wire
AccentCare Selects Netsmart to Enhance Value-Based Care and Drive Population Health Initiatives
OVERLAND PARK, Kan.--(BUSINESS WIRE)--AccentCare, a national leader in post-acute care, has selected the Netsmart CareFabric® platform to strengthen the population health capabilities and delivery of coordinated, high-quality care for the patients of AccentCare Medical Group. AccentCare Medical Group will leverage this technology to advance value-based care models and improve outcomes for patients and families. AccentCare recognized the need for a platform that combines flexibility with innovation, making the Netsmart myUnity® platform the ideal solution for the organization. The user-friendly, ONC-certified solution features intuitive design and workflows that align to providers' unique end user experiences—all while integrating with AccentCare's existing solution portfolio. This flexibility will equip AccentCare to stay agile and adaptive during its adoption of the Guiding an Improved Dementia Experience (GUIDE) Model and palliative care programs. 'With better access to timely, actionable insights, we can anticipate patient needs earlier and respond with care that is more personalized, proactive and effective,' said Dr. Balu Natarajan, Chief Medical Officer, AccentCare. 'This investment empowers our teams to improve quality of life for patients and families.' By collaborating with Netsmart, AccentCare will leverage the CareManager ™ solution to support population health management programs with enhanced care coordination, data reporting and analytics. The CareManager population health management solution will support AccentCare's clinical programs under value-based care contracts by establishing scalable, centralized and automated workflows. Integrating demographic and risk scoring data from payers will allow for efficient assignment of care managers and automation of tasks, which is crucial for expanding health plan collaborations and scaling population health efforts. 'We're building the digital infrastructure needed to lead in value-based, home-centered care,' said Dr. Mark Grzeskowiak, Senior Medical Director, AccentCare. 'By prioritizing data and improved workflows, we're creating a smarter, more connected foundation that supports operational excellence, fuels innovation and ultimately enhances the experience for patients, care teams and partners.' AccentCare will leverage innovative features within CareManager, including a predictive analytics tool powered by VNS Health. This tool enables the assessment of mortality risks for patients over six to twelve months, supporting evidence-based care recommendations and aiming to improve the quality of life for patients and their families, particularly in end-of-life scenarios. 'AccentCare is committed to leading the way in value-based, population health management,' said Scott Green, SVP & Managing Director of CareDimensions, Netsmart. 'Our technology solutions empower organizations like AccentCare to get a full picture of their patient populations, enabling more proactive, coordinated and personalized care. Together, we can support better outcomes and sustainable models of care that meet the needs of patients and providers alike.' AccentCare will utilize a variety of solutions and services from the CareFabric portfolio, including a patient and family engagement portal, interoperability, advanced reporting capabilities and integrated revenue cycle management (RCM), to standardize operations and enhance service delivery. By teaming up with the Netsmart Outsource RCM Services team, AccentCare will have access to industry experts and state-of-the-art RCM automation and intelligence focused on creating efficiencies across the revenue cycle and advancing collection rates. The centralized Netsmart billing office will standardize essential billing and collection functions. Additionally, the integrated RevConnect ™ clearinghouse will further optimize back-office functions by centralizing claims and eligibility information. Each of these tools support the goal of improving claims processing and collections while maximizing staff efficiency, particularly while navigating complex markets through automated case rate billing. 'At Netsmart, we understand the necessity of flexible, integrated technology solutions while providing crucial services like GUIDE, hospice and palliative care,' said Hannah Patterson, General Manager & Vice President Care at Home, Netsmart. 'Our collaboration with AccentCare provides a streamlined, comprehensive, flexible technology platform they need to continue pushing forward with expansion and evolution while providing the highest quality care.' Through its relationship with Netsmart, AccentCare will leverage a secure, scalable platform to advance value-based care and optimize service delivery. This collaboration provides innovative, data-driven solutions that enhance care coordination and support population health management. Together, we are empowering AccentCare to lead in healthcare transformation and deliver high-quality, patient-centered services across the post-acute continuum. About AccentCare® AccentCare is a nationwide leader and trusted guide in post-acute health care, covering a broad continuum of services from personal, non-medical care to home health, palliative care and hospice. We provide patients and clients with the right care at the right time, wherever they call home. Guided by integrity and compassion, we are proud to set the standard for clinical and operational excellence as we shape the future of aging in place. Headquartered in Dallas, AccentCare employs 30,000 team members and cares for over 200,000 lives annually, in more than 250 locations, across 32 states and the District of Columbia. Learn more at About Netsmart Netsmart is an industry-leading healthcare technology organization empowering providers to deliver value-based care to the individuals and communities they serve. The Netsmart CareFabric ® platform serves as a unified, connected framework of solutions and services for human services, post-acute, payer and public sector communities. Together with our clients and Marketplace vendors, we develop and deliver innovative technology, including electronic health records (EHRs), interoperability, analytics, augmented intelligence (AI), population health management and telehealth solutions and services that assist organizations in transforming the care they deliver. The result has helped make a positive impact on the lives of more than 147 million individuals. For more than 55 years, Netsmart has helped provider organizations in their efforts to improve the health and wellbeing of the communities we collectively serve. 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