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. Accompanied by General Accountability Office calling for more MA plan oversight, reduction in member access from narrow networks will likely result in more regulation.

 

HealthTrio and our partners improve Star Rating performance and premium profitability while reducing administrative costs, empowering member connectedness and satisfaction, and mitigating risk of the acute and chronically ill. These benefits are provided Smart Series capabilities that provide:

 

  • Fully-featured administration of members, networks, benefits and claims processing;
  • Integrated care coordination supported by fully-featured care management and a Shared Health Record;
  • Automated, rules-based connection of members and their care teams, supporting both administrative transactions and clinical monitoring and intervention;
  • Member Health Risk Assessments and health education, wellness and alerts, encouraging action on gaps in care and increased compliance with care regimens; and
  • Accurate and appropriate assessment of members’ clinical status, ensuring RAPS submission and associated premiums are appropriately matched to illness burden; and
  • Countless communications tailored by your innovation within your policies powered by an integrated analytics

 

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