Recent statistics from the CDC show more than 38 million people in the US have diabetes and up to 9 million of that number as...

On November 15, 2023, CMS issued a proposed rule that proposes revisions to regulations governing Medicare Advantage (MA or Part C), the Medicare Prescription Drug Benefit (Part D), Medicare cost plans and Programs of All-Inclusive Care for the Elderly (PACE), in Contract Year 2025 with a limited number of provisions to be applicable beginning with CY 2026. The proposed rule includes policies that would modify Star Ratings, marketing and communications guidance, agent/broker

When most of us think about artificial intelligence (AI) in healthcare, we don’t usually think about an algorithm determining if our 85-year-old grandmother [1] will be kicked out of the nursing home or if your father will be approved for the scan needed to determine the progression of cancer. We all agree that medical costs are out of control and rising faster than salaries and outpacing retirement savings and there is no doubt that a shortage of registered nurses, general p

Beginning in contract year 2024, there will be CMS changes mandated to Special Needs Plans (SNPs) Health Risk Assessments (HRAs) to...

Co-Authored by Anita McCreavy It is that time of year when plans evaluate their Quality Improvement Program and Model of Care successes...