Latest news with #healthplans
Associated Press
26-05-2025
- Business
- Associated Press
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. / ACCESS Newswire / 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 Management ZeOmega, HealthEdge (CareManager), EXL (CareRadius), VirtualHealth (HELIO), GuidingCare (Altruista Health) 2. Population Health Management (PHM) Platforms Innovaccer, Lumeris, Lightbeam Health Solutions, Health Catalyst, Arcadia 3. Interoperability & Data Integration Platforms InterSystems (HealthShare), Smile Digital Health, Cureatr, Redox, Moxe Health 4. Member Engagement & Communication Platforms Icario, Welltok (Virgin Pulse), mPulse Mobile, HealthCrowd, Convey Health Solutions 5. Quality Measure Management & Analytics Inovalon Quality Intelligence, SPH Analytics (Press Ganey), HealthEdge (GuidingCare), EXL CareRadius Analytics, ZeOmega Jiva 6. Audit Readiness & Compliance Management Inovalon, Veradigm, Cotiviti, Edifecs, Health Fidelity 7. Risk Adjustment & Coding Optimization Edifecs, Apixio, SCIO Health Analytics (EXL), Advantasure 8. Claims Integrity & Fraud, Waste, Abuse Detection Codoxo, Cotiviti, Change Healthcare 9. Utilization Management & Prior Authorization Cohere Health, MCG Health, eviCore 10. AI & Machine Learning in Quality & Risk Management Innovaccer, 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 InformationPress Office 8008637590 SOURCE: Black Book Research press release
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
Bloomberg
21-05-2025
- Business
- Bloomberg
US Will Expand Its Audits of Medicare Advantage Health Plans
The Trump administration plans to expand government audits of private Medicare health plans, adding more scrutiny to an industry that's been a profit driver for insurers. The Centers for Medicare and Medicaid Services intends to audit all eligible Medicare Advantage contracts each year and bolster the agency's resources to do the reviews.
Bloomberg
21-05-2025
- Health
- Bloomberg
Cigna Offers New Weight-Loss Drug Pricing Plan to Boost Use
By and John Tozzi Updated on Save Cigna Group 's drug benefit unit is offering a new way for health plans to cover expensive weight-loss drugs that it says will make the medicines available to more patients. Under the new option, patients would pay less than the cash price for Eli Lilly & Co.'s Zepbound or Novo Nordisk A/S 's Wegovy, but typically more than the normal copay. Meanwhile, health plans would spend less on the weight loss drugs than under the standard structure, an incentive to get more employers to cover them.
Yahoo
10-05-2025
- Health
- Yahoo
What you can and can't pay for with a health savings account
(NewsNation) — A health savings account, or HSA, lets those with a high-deductible health plan set pre-tax money aside to pay for medical expenses, from Band-Aids and Tylenol to doctor office visits. Contributions are made with pre-tax dollars. HSAs have an investment option, so earnings grow tax-free if you invest. They are an option for those with health insurance plans through a workplace or the government Marketplace. The tax-free savings plans help decrease the amount you pay out-of-pocket for some health care costs, such as doctor visit copays, deductibles and some prescription drugs. Maximize health savings: The tax benefits of HSAs and FSAs Here's what you can and can't pay for with an HSA. The expense must be considered 'qualified,' Qualified medical expenses range from dental to vision to family planning. Dental: Cleanings, flouride treatments, braces Vision: Eyeglasses, contact lens solution, laser eye surgery Medical: Chiropractic treatments, crutches, back braces, doctor visits, x-rays, insulin Behavioral health: Psychiatric care, psychologist, drug addiction Family planning: Abortion, birth control pills, pregnancy tests, fertility treatments Office visit copays and deductibles are usually considered qualified medical expenses. Healthcare-related travel and some insurance premiums may also qualify. Some lesser-known qualified expenses include cosmetic surgery if deemed for medical purposes, learning disabilities, lead-based paint removal, lactation and guide dogs. This is not an exhaustive list. Consult with your insurance provider first to confirm whether the cost is eligible to be covered by funds in an HSA. Most expenses related to preventing or treating an illness or disease are covered, but some things may not be. For example, nutritional supplements and weight loss programs not prescribed by a physician would not qualify. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
