Who We Serve

Health Plans

Health plans are feeling the squeeze from every direction. Increased pressures on cost, quality and regulatory compliance are shifting the strategies and needs to operate a plan.

Smart Series provides many capabilities to extend the reach and results of Commercial, Medicare and Medicaid plans.  From claims administration through interconnecting your members, provider networks, brokers, and employers, health plans are supported in reducing medical loss and administrative costs.  »

Medicare Plans

In 2016, CMS estimates that the average MA premium will decrease by 1%, even though Part D and Special Needs plans are expected to increase by 8% and 3% respectively. That’s not stopping current or new entrants from offering more MA plans in 2016, including more with zero premium. Further, Star Ratings emphasizing healthy behaviors, managing chronic conditions, and measuring members’ satisfaction with the health plan services and processes remain critically important, with loss of one star costing MA plans millions of dollars. »

Medicaid Plans

In Q2 2015, CMS issued guidance to states for Medicaid MCOs to dedicate a minimum portion (85%) of rates to medical loss – the first significant Medicaid managed care regulation issued since 2002.   NCQA’s Standards for Member Connections and New York’s DSRIP program continually emphasize patient-centered care, services in health education, wellness and prevention, and improved care coordination across an expanded care team that includes community-based organizations. »

Emerging Care Systems

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The growth and evolution of care delivery systems assuming full risk continues to rise rapidly. The formations are many – ACO, DSRIP PPS, MSOs and even more traditional IPAs. Faced with new administrative challenges, population health and care coordination initiatives, the prospect of using EMRs and HIEs to resolve these issues falls flat. »

Provider Organizations

Enable the transition to value-based payment

Pay-4-Performance and value-based payments are becoming the new normal. Regulation and financial incentives are aligning to drive down cost and improve quality of care. Integration of physical and behavioral health are further driving the need for sophisticated care coordination that can’t be resolved through EMRs and HIEs alone. »

Administrators & Trusts

Achieve differentiation amidst expanding customer demands

Self-insured employers and trust constituents have evolved their expectations of plan administration. The enlightened administrator is competing beyond cost to include employee engagement, health and wellness, consumer-driven plans and medical spend reduction.

Smart Series offers comprehensive administration and communication capabilities.

Learn how HealthTrio can differentiate your administrative offerings »