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Coronavirus and the SIU

By HMS
Apr. 2, 2020

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Coronavirus and the SIUApr. 2, 2020

Preparing for “novel strains” of healthcare fraud and other COVID-19 related issues To be effective, Special Investigation Units (SIUs) must…

COVID-19: Propelling Telehealth into the FutureMar. 27, 2020

A global health crisis has thrust us into a scenario in which lives quite literally depend on our ability to…

Five Strategies to Maintain, Yet Balance, Program Integrity During the COVID-19 PandemicMar. 26, 2020

Amid the chaos of a global health crisis, program integrity is vital to maintaining the healthcare safety net, while protecting…

How These 2020 Healthcare Trends Are Playing Out Amid the COVID-19 CrisisMar. 25, 2020

As tends to happen at the turn of a new year, a number of insights recently emerged about the state…

The Future of Healthcare is RetailMar. 19, 2020

If you received the same consumer experience at Amazon as you do at some healthcare providers, the home page would…

The 3 Es of COVID-19 Communication: Best Practices for Keeping People InformedMar. 6, 2020

Coronavirus disease 2019 (COVID-19) is on everyone’s mind these days and with good reason. The situation is continually evolving and…

Get Out — A Prescription for Nature?Mar. 6, 2020

Do you smoke? Are you currently taking any medications? How much time do you spend in nature? With the prevalence…

Embracing Our Irrational Side: How Behavioral Economics Can Improve Member EngagementMar. 5, 2020

Traditional economists believe that humans behave in logical, rational ways and will always act in their own best interest. Experience…

Primary Care Visits Decrease by 25%: How Health Plans Should RespondFeb. 26, 2020

As Primary Care Visits Decrease, Can Member Engagement Help Adults Avoid Serious Health Problems? A recent study published in the…

Member Segmentation: The Key to Effective Care ManagementFeb. 24, 2020

Health plans are discovering that care management is an effective way to improve member outcomes and reduce costs. The unfortunate…

Are Your Medicare Patients Missing Post-Surgical Appointments?Feb. 19, 2020

The RAND Corporation recently released a study, which found that a minority of Medicare patients are attending postoperative appointments. Yet,…

Human-Animal Interaction — A Social Determinant of Health?Feb. 18, 2020

Animals make us happy — but could they also help us live longer? New research focusing on the correlation between…

Engaging with Hispanic Members: Why Cultural Adaptation of Content Wins Over Direct Translation Every TimeFeb. 13, 2020

Hispanics are the largest minority in the United States, accounting for 18.1% of the U.S. overall population and 25% of…

Global Healthcare ConcernsFeb. 11, 2020

It’s impossible to address US health without looking at issues affecting the entire world. Healthcare issues transcend international borders, pathogens…

Best Practices for Reducing Provider Abrasion in Payment AccuracyFeb. 10, 2020

Payment accuracy helps to ensure the appropriate allocation of healthcare dollars — a goal that is in the interest of…

Millennial Healthcare Needs and Engagement StrategiesFeb. 7, 2020

Millennials get called all sorts of things: cynical, entitled, savvy, inventive. Whatever your thoughts about this generation, you can’t ignore…

Applying Patient-Centered Care Principles in the Payer MarketFeb. 6, 2020

In the healthcare sector, the patient is at the center in hospitals, clinics and physicians’ offices. Many of the principles…

Does Your Care Management Team Focus Solely on “Superutilizers”?Jan. 30, 2020

It may be time to take a different approach… When healthcare professionals think about care management services, they typically direct…

Smart Health Communities: How Care Management Can Improve Efficiency and Reduce CostsJan. 21, 2020

As the year 2020 begins, we are embarking on a new decade filled with new possibilities. This is a great…

When Worlds Collide: The Intersection of Culture, Language and Health LiteracyJan. 16, 2020

Health plans are continually searching for ways to engage with members, in hopes of closing gaps in care, improving outcomes…

Connecting the SDoH Dots Using a Journey Mapping ApproachJan. 14, 2020

Marketers have long used journey mapping to understand how consumers interact with a brand, using that intel to inspire a…

How Virtual Care Can Maximize Healthcare Resources in Vulnerable CommunitiesJan. 10, 2020

A growing and aging population is placing the U.S. on the brink of a severe physician shortage. Recent data from…

Five Essentials for Healthcare Payment Accuracy in 2020 and BeyondJan. 9, 2020

It’s 2020, and healthcare is costlier and more complex than ever. Constantly-changing policies, payment rules and quality measures are further…

The Impact of Poor Health on IQJan. 8, 2020

On a chilly, cloudy and windy June 1st in Edinburgh, 1932, almost every 11-year-old child in Scotland was given an…

Exploring Public Option as an Alternative to Single-Payer ModelJan. 6, 2020

Although the Single-Payer model has dominated the healthcare reform spotlight this past year to be sure, public option has seen…

Four Guiding Principles to Influence Consumer Health BehaviorsJan. 3, 2020

Mastering the Art and Science of Health Engagement Do either of these statements sound like something you would say? “Smoking…

Medicare Chart Reviews: Should You Be Concerned About Fraud?Dec. 20, 2019

Medicare Advantage (MA) plans are privately run health solutions that differ from traditional Medicare in a variety of ways. They…

Year-End Quality Initiatives: How Member Activation Can Generate Better Health OutcomesDec. 12, 2019

After the first half of the year, health plans typically know which member cohorts need additional attention. The second half…

How Shifting the Focus from Claim to Member Is Improving Payment AccuracyDec. 5, 2019

A medical claim can tell us a lot about a patient’s encounter with the healthcare system — from diagnosis and…

Five Things to Consider When Launching Health Risk AssessmentsDec. 3, 2019

Health risk assessments encourage health promotion — the process of enabling people to increase control over their health and its determinants, and…

Preventing Hospital Readmissions Through Post-Discharge Care ManagementNov. 26, 2019

Prior to the establishment of the Hospital Readmissions Reduction Program (HRRP) as part of the Affordable Care Act, a study…

Appropriately and Effectively Engaging Diverse Member and Patient PopulationsNov. 20, 2019

When it comes to engaging with members, health plans must take culture into account. Culture isn’t just about a person’s…

How Snail Mail Is Contributing to Medicaid Member ChurnNov. 19, 2019

A recent article in Kaiser Health News highlighted a growing problem – some states are canceling Medicaid members’ benefits based…

Prompt Payment Policies Could Protect Medicaid and Ensure Recovery EffortsNov. 19, 2019

As Medicaid continues to serve as our nation’s primary healthcare safety net, it is critical that the program safeguards itself…

Reimagining Medicaid’s Health Insurance Premium Payment ProgramNov. 15, 2019

Medicaid Health Insurance Premium Payment (HIPP) programs helps maintain Medicaid as payer of last resort by using federal and state…

Four Best Practices to Prevent Rapid DisenrollmentNov. 13, 2019

Medicare Advantage Annual Enrollment Period (AEP) is in full swing. With less than a month to complete enrollment for 2020,…

Engaging Healthcare Consumers in the Age of CrowdsourcingNov. 8, 2019

At a time when 93% of consumers claim their purchasing decisions are influenced by online reviews, organizations across all industry…

It’s Time to Accelerate Healthcare InteroperabilityNov. 7, 2019

Healthcare is an industry rife with nebulous buzzwords. But if CMS’ recently-proposed policy changes are any indication, interoperability isn’t one…

Prevention Improves Quality & Revenue, But Have Your Members Gotten the Message?Oct. 30, 2019

While Benjamin Franklin’s famous quote, “An ounce of prevention is worth a pound of cure” was actually referring to fire…

Healthcare’s Biggest Drivers: Momentum InsightsOct. 24, 2019

It’s a wrap on Momentum 2019, our annual conference uniting stakeholders from across the care continuum with the collective goal of…

4 Must-Haves Before Implementing a Value-Based Care ModelOct. 24, 2019

Shifting to a Value-Based Care Model Fee-for-service healthcare has been in place for decades; by some measures, even centuries. It’s…

Using Predictive Analytics to Avoid Unmanaged RiskOct. 16, 2019

According to the Centers for Disease Control and Prevention, the United States spends $3.3 trillion a year on healthcare and…

Four New Tech Applications Improving Payment Accuracy, InteroperabilityOct. 15, 2019

Artificial intelligence, machine learning, robotics — all terms we hear a lot in 21st-century healthcare, but often in a forward-looking…

Wellness Isn’t Just the Absence of DiseaseOct. 11, 2019

Wellness & Social Determinants of Health A few decades ago, being “healthy” meant not having diseases or other physical problems….

flu shot immunization

Overcoming Negative Attitudes Toward the Flu VaccineOct. 7, 2019

The First Step In Fighting the Flu An annual flu vaccination is the best way to prevent the flu and…

Five Questions to Ask When Evaluating Member Incentives for Your PlanOct. 4, 2019

In recent years, consumer-directed healthcare has gained significant traction in the United States. One way that health plans have embraced…

What a Popular Meme Can Teach Us About Healthcare AIOct. 3, 2019

One of These Things Is Not Like the Other: Sheepdog or mop? Puppies or food? Carcinoma or keratosis? Big data,…

Fewer Care Gaps and Healthier Choices: How Incentive Programs Can HelpOct. 2, 2019

Financial incentives have been making inroads into the healthcare arena for several years. These programs are popular with health plan…

The Impact of Natural Disasters on Behavioral HealthSep. 27, 2019

When natural disasters strike, physical safety is top of mind. The healthcare system mobilizes to assist individuals who have suffered…

COBManager®

Screening for Fraud, Waste and Abuse Within the Realm of Pediatric AutismSep. 23, 2019

According to the Centers for Disease Control, 1 in 59 children are diagnosed as being on the Autism Spectrum. Applied…

Impact for Payers in a Single-Payer SystemSep. 18, 2019

The Cascading Effects of a Single-Payer System Any discussion on groups impacted by a single-payer healthcare system must include payers….

It’s Time Payers & Providers Work Together to Coordinate Health BenefitsSep. 13, 2019

We’re at a pivotal moment in healthcare. Advancements in data, analytics and technology are creating unprecedented opportunities to improve the…

Provider Instability in a Single-Payer SystemSep. 6, 2019

The Effects of a Single-Payer System To many people, a single-payer healthcare system seems like an easy way to increase…

The Vital Role of Coordination of Benefits in Coordination of CareSep. 4, 2019

The concept of care coordination is inherently broad — so much so, that a review by the Agency for Healthcare…

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How to Effectively Engage Your Members in the Age of DataAug. 30, 2019

Best Practices for 21st-Century Health Plan Member Engagement At a time when technology has given us one-touch control over everything…

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How Innovation in Patient Matching Can Improve Coordination of BenefitsAug. 29, 2019

The healthcare revenue cycle relies heavily on patient identity management (PIM) — broadly, the ability to match patients with their…

The Patient Consequences of a Single-Payer SystemAug. 28, 2019

What’s at stake in a single-payer healthcare system? Patients have a lot at stake when it comes to changing our…

Man Receives Personal Message from Healthcare Payer

5 Ways to Reach, Engage and Empower High-Risk MembersAug. 20, 2019

Engaging the Modern Healthcare Consumer Reaching and engaging the modern healthcare consumer is often easier said than done — especially…

Generative AI: Healthcare’s Newest Disruptor?Aug. 19, 2019

The Continued Evolution of Artificial Intelligence The field of artificial intelligence is broad and rapidly evolving by nature — a…

How to Improve Consumer Perceptions of Care Quality and Experience

The Connected Healthcare ConsumerAug. 13, 2019

The ‘Who-What-Where’ of the Connected Healthcare Consumer At the beginning of the year, we forecasted some of the top healthcare…

Preventing Opioid DependenceAug. 12, 2019

The Value of Proactive Opioid Prevention When it comes to healthcare, proactive prevention of conditions is preferable to reactive treatment…

Long-term Care Financial Reviews 1

Identifying and Addressing Social Determinants of Health in Low-Income PopulationsAug. 9, 2019

Know Your Members According to a report from the Kaiser Family Foundation, social determinants of health are “the structural determinants…

The Health Effects of Natural DisastersAug. 7, 2019

It Goes Beyond Disaster-Related Injuries… It’s not a surprise that natural disasters put stress on the healthcare system. Events like…

Don’t let HOS and CAHPS results break your Star Rating improvement strategyAug. 6, 2019

Star Ratings are critical to Medicare Advantage (MA) health plans. Achieving a 4-star rating or better ensures a five percent…

How Physicians Can Help Prevent Opioid DependenceAug. 5, 2019

America’s opioid epidemic hasn’t been fueled by illegal street drugs. Sadly, one major contributor that has led patients to drug…

Six Factors Holding Payers Back from Improving Star RatingsJul. 31, 2019

We all know how important Star Ratings are for Medicare Advantage (MA) health plans. Yet, many payers often overlook key…

Exploring the Single-Payer ModelJul. 29, 2019

Healthcare remains a key issue in politics, capturing top spots on political campaigns, and seeing significant state and federal legislative…

Natural Disasters & Crisis CommunicationsJul. 24, 2019

Health Engagement During Crises In the United States, hurricane season is upon us. From the beginning of June through the…

The Cost of Not Taking Our MedicineJul. 12, 2019

The Complex Causes and Effects of Low Medication Adherence Whether it is for a short-term illness or to manage a…

older man receives mail incentive

Using Incentives to Manage High-Cost Conditions & Reduce CostsJul. 12, 2019

An ongoing challenge facing health plans today is controlling healthcare costs. This issue is also a concern for employers. A…

5 Steps for Identifying, Assessing, and Addressing Opioid MisuseJul. 9, 2019

AI, Analytics, and the Opioid Epidemic Opioids are ravaging the United States. The National Institute on Drug Abuse estimates that…

Generational Healthcare MarketingJun. 26, 2019

Shifting Trends Among Generations There’s an arms race underway. You are in it—do you know if you’re winning or losing?…

The Keys to Seamless Care Management Across PopulationsJun. 26, 2019

The Growing Complexity of Healthcare The complexity of care management is growing. Chronic medical conditions reduce quality of life for…

Reducing Medicaid ChurnJun. 21, 2019

The Medicaid Retention Journey – Ensuring Continuity of Coverage Reducing the amount of unnecessary churn inflicted on the U.S. healthcare…

Enhancing Quality Through Member EngagementJun. 21, 2019

Continue the Quality Journey with HOS/CAHPS As we head into the second half of the year, however, there’s no need…

How to Improve Consumer Perceptions of Care Quality and Experience

Treating the Whole PersonJun. 14, 2019

Addressing Medical, Behavioral and Socioeconomic Conditions to Improve Health Outcomes There are so many elements that make up who we…

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America’s Opioid Epidemic: Clues and Potential Answers Reside in Member & Provider DataMay. 17, 2019

According to the CDC [i], every day around 130 Americans die daily from an opioid overdose. That translates to 47,450 people…

Ten Considerations When Purchasing Care Management SoftwareMay. 14, 2019

Implementing a care management system can deliver significant benefits to an organization, but first you must find the right solution…

We're passionate about payment integrity. 1

How to Reduce Costs & Improve Care Delivery with Analytics and ReportingMay. 9, 2019

Care managers are constantly striving to deliver the right care to the right patients at the right time. In the…

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Social Influencers & PharmaMay. 3, 2019

Selling Pharmaceuticals Through Social Media In 2015 Kim Kardashian caused quite a stir when she touted a morning sickness drug…

Countries Winning at HealthcareMay. 1, 2019

Take a look at this map and see if you can guess what the highlighted territories have in common. They…

How Engaging Members Throughout Their Lifecycle Improves Health Outcomes and the Bottom LineApr. 23, 2019

Chalk it up to human nature. We love the action and drama of fast, focused and expert care, the kind…

80 Percent of People Want Monthly Reminder to Attest Medicaid Work RequirementsApr. 12, 2019

Work requirements are conditions on Medicaid eligibility for certain adults to work or participate in community engagement activities in order…

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Best Practices in COBApr. 8, 2019

Coordination of Benefits (COB) A member files a claim, your COB vendor checks to see if the member has primary…

Get to Know Health Plan Members

Four Ways to Empower Your Care Managers to Focus on Results, Not PaperworkApr. 5, 2019

Today’s care managers face a variety of challenges with many handling a higher volume of complex patient cases than ever…

HMS Elli - Population Risk Intelligence

The RISE of Population HealthMar. 28, 2019

Earlier this month, HMS joined over 1,200 participants at the 13th Annual RISE Conference in Nashville to discuss Supporting Risk…

Man Receives Personal Message from Healthcare Payer

For Payers, Going Local Means Being Personal and PreciseMar. 25, 2019

Going Local Dale, age 43, loves his Bit-O-Honey. But not today. His first bite ended up ripping out an old…

Doctor provides Value-Based Care

Examining the Shift Toward Value-Based CareMar. 25, 2019

From Fee-for-Service to Fee-for-Value When we get sick, or when something is bothering us enough to warrant medical attention, we…

Healthcare Consumers

Patient Power: The Consumerization of HealthcareMar. 14, 2019

The healthcare industry is ailing. And unless it makes some big lifestyle changes, the prognosis is worrisome. We’re witnessing huge…

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How to Improve Consumer Perceptions of Care Quality and ExperienceDec. 10, 2018

‘Quality of care’ means different things to different people based on their perspective. As a result, defining and delivering quality…

AI’s New Healthcare Applications

AI’s New Healthcare ApplicationsNov. 16, 2018

Artificial intelligence (AI) was conceived by Alan Turing in his 1950 paper “Computing Machinery and Intelligence,” in which he introduced…

Protecting Employer Sponsored Health Plans by Controlling CostsNov. 8, 2018

Annual benefits enrollment has become something employees dread. Employers faced with increasing health plan costs are passing on a larger…

Addressing the Opioid Epidemic with Healthcare DataOct. 12, 2018

These days you cannot have a comprehensive discussion about the U.S. healthcare system without mentioning the opioid crisis — and…

Health Plan Member Engagement Natural Disasters

Member Engagement in the Face of DisasterOct. 4, 2018

In September we watched Hurricane Florence bear down on the U.S. east coast with dread. We collectively braced ourselves for…

Strategic Member Engagement Solution for Employers

Four Medicaid Trends to Watch in the Next Twelve MonthsSep. 26, 2018

If you work with Medicaid you know it’s always been a moving target, and the last year has not brought…

The Robots are HereJul. 19, 2018

This is the blog you are looking for. Learn more from Doug Williams about how “not far from now business and quite possibly individuals will have their own R2D2 and C-3PO”. I Bitley

The High Tech Behind Coordination of BenefitsJul. 13, 2018

When most people think of coordination of benefits, they envision those annoying letters from their health insurance company asking if…

Get to Know Health Plan Members

Get to Know Health Plan MembersMay. 31, 2018

Being a healthcare consumer can be so frustrating.  I don’t know about you, but I’m tired of interfacing with a…

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Can Healthcare Organizations Make the Switch to Digital Consumerism?Apr. 18, 2018

Earlier this month we learned that Walmart may be making a bid for Humana, one of the nation’s leading Medicare…

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Using Data, Analytics, and Technology to Combat the Opioid EpidemicApr. 5, 2018

There has been extensive documentation of the current opioid epidemic in the United States.

Life-transforming Therapeutic Recreation and Technology Offer Veterans New Opportunities

Life-transforming Therapeutic Recreation Technology Offer Veterans New OpportunitiesApr. 2, 2018

Over 400 veterans will convene this week in Snowmass Village, Colo. for the National Disabled…

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The Children’s Health Insurance Program: Congress’ Bipartisan MomentMar. 29, 2018

Over the past few months there has been a lot of political debate around the future of the Children’s Health Insurance Program or CHIP. Most of the discussion centered around whether Congress…

We Need Data and Technology to Fight the Opioid EpidemicMar. 21, 2018

The Senate Health, Education, Labor and Pension Committee recently held a congressional hearing on the opioid crisis. Unlike past hearings however, this…

Short-term Health Insurance Plans: Obamacare Foil or Real Consumer Choice Solution? 1

Short-term Health Insurance Plans: Obamacare Foil or Real Consumer Choice Solution?Mar. 14, 2018

Last month, the Trump administration proposed new rules that would make it easier for consumers to buy and keep short-term…

It's Flu Season! What's Up with the Vaccine Controversy? 3

Blockchain’s Emerging Healthcare ApplicationsJan. 29, 2018

While bitcoin and cryptocurrencies seem to go in and out of fashion on a monthly basis, the blockchain—the distributed system…

How Will Medicaid Work Requirements Impact Churn and Member Retention?Jan. 26, 2018

CMS’ recent guidance to State Medicaid Directors on work requirements for non-disabled, non-pregnant adults was anticipated to those of us…

It's Flu Season! What's Up with the Vaccine Controversy? 3

It’s Flu Season! What’s Up with the Vaccine Controversy?Jan. 18, 2018

It’s 2017. New controversies abound in America, but one that has persisted over time, even after being scientifically debunked over…

It’s Time to Re-think Healthcare Data Security 2

It’s Time to Re-think Healthcare Data SecurityJan. 8, 2018

2017 was not a banner year for healthcare data security. The U.S. Department of Health and Human Services Office for…

Six Things the Healthcare Industry Needs in 2018

Six Things the Healthcare Industry Needs in 2018Jan. 2, 2018

The start of a new year always brings promise; and as we enter 2018, we do so with the hope…

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