Braly departs, Amerigroup acquisition pending

Larger payers have plenty of cash on hand to do deals but will look for “adjacencies” rather than merger and acquisition with other payers because of the regulatory environment, say Bain experts.

In this week's episode, Editor of Managed Healthcare Executive, Briana Contreras, had the pleasure of speaking with Chief Clinical Officer of WellSky, Tim Ashe, about the issue of Centers for Medicare and Medicaid Services cutting rates for Medicare home health. Tim addressed the solutions that are either underway or those that can potentially preserve access to these services.

What’s more valuable than the ability to identify problems within your business plan or strategy? The ability to find solutions to those problems before they arise.

In this week's episode, MHE Editor Briana Contreras and Managing Editor Peter Wehrwein met with CIO of Prime Therapeutics, Jim Graham to discuss the process of an organization’s digital transformation from a traditional Pharmacy Benefit Manager to a complete data-driven drug management system. Graham addressed the risks an organization may come across to successfully transition to this system, but also mentioned the benefits to come.

If virtual care is achieve meaningful health outcomes in a primary care setting, it must be practiced within a bona fide hybrid approach.

This year, health plans need to focus on the following smart, “no regret” investments in the enrollment process that have low risk, high reward, and ultimately deliver an exceptional member experience while simultaneously reducing costs and improving data quality.