Regional health plans are navigating intense pressure right now — medical cost containment, CMS scrutiny, growth targets, member experience expectations, and operational resilience. And yet, many plans are operating under a quiet assumption: “Our call center partner is fine.” Maybe they are. But here’s the better question: If you were selecting your call center vendor today — knowing what you now know about performance, compliance risk, scalability, and cost — would you make

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

Did you know that CMS provides nearly 100 different reports to Medicare Advantage and Part D plans? These reports cover membership,...

CMS Star Ratings and Member Experience