With consumer-experience related metrics now determining more the 57% of overall Star ratings by 2023, it is important for MA plans to not only focus on quality and closing HEDIS care gaps but to also prioritize member experience and engagement. Moreover, the pandemic has underscored the need for plans to strengthen their outreach efforts and reengage their members to ensure they receive timely access to care. To positively impact an individua...

The National Health Care Anti-Fraud Association estimates that the U.S. health care system loses tens of billions of dollars every year to fraud, waste and abuse (FWA). A large portion of these costs are attributed to pharmacy spend, including duplicate claims, data entry errors, forged prescriptions, and intentional overcharging. Understanding how you can work with your pharmacy benefits partners will bring you the maximum benefit in discover...

Welcome to the 10th Annual Observation Management Summit! We at World Congress are very excited to celebrate a decade of holding this conference. 2012’s conference was met with great success and leave unbounded potential for 2013. We will continue to develop and advance the program with NEW innovative topics and NEW case studies. The concept of observation units are spreading far and wide across the health care industry. With most hospit...