A Game Changer for Dual-Eligible Plans: CMS’s Proposed HRA Integration Rule
This blog was originally published by PDHI. Navigating the healthcare landscape is becoming increasingly complex, especially for individuals eligible for both Medicare and Medicaid. As policymakers seek ways to streamline processes and improve care coordination, a new proposed rule could be a game changer for dual-eligible plans. This proposal aims to simplify health risk assessments […]
Improving HOS Scores in the Evolving Landscape of Member Experience
The Importance and Current Changes of CAHPS and HOS As the importance of CAHPS (Consumer Assessment of Healthcare Providers and Systems) and HOS (Health Outcomes Survey) have taken center stage over the last few years, health plan focus on these surveys has significantly (and understandably) increased. These surveys not only provide insight into how members […]
Centers for Medicare & Medicaid Services 2026 Final Rule & Rate Announcement
On April 4, 2025, CMS released its Final Rule for Contract Year 2026 which introduced and codified significant changes to Medicare Advantage (MA), Medicare Part D, PACE and Cost Plans and continued its commitment to enhancing beneficiary protections, reducing cost and improving care coordination across Medicare and Medicaid programs. While this rule may not have […]
Unlocking Provider Power: The Playbook for Medicare 5-Star Quality Ratings
In today’s healthcare landscape, member experience isn’t just a buzzword, it’s a key driver of Medicare Star Ratings and quality bonus payments (QBPs). While health plans have long focused on improving CAHPS and HOS scores, one critical piece of the puzzle often goes underutilized: providers. Why Provider Engagement Matters Providers play a pivotal role in […]
Talking CAHPS: Building Trust in Healthcare
In today’s healthcare landscape, trust is a cornerstone of success for health plans and providers. It’s not just about delivering care but about fostering meaningful relationships with members that lead to improved satisfaction, loyalty, and health outcomes. In our recent webinar, Talking CAHPS: Measuring & Improving Member Trust, we explored how trust directly impacts member […]
Boosting Part D CAHPS Scores: A Data-Driven Approach for Health Plans
2025 Star Ratings Retrospective
Introduction Medicare Advantage plans have had several months to review the 2025 Star Ratings as well as the recently recalculated release. Performance trends continue to highlight a competitive and rapidly evolving landscape for Medicare Advantage and Prescription Drug Plans (MA-PD) in the coming years. With new CMS policies taking effect, cut point trends, methodological changes, and a […]
Talking CAHPS: The HOS Edition
Health Outcomes Survey (HOS) fielding is finally here! HOS results and outcomes have a profound impact on health plan quality performance, and while HOS measures are important, these measures have implications and impact on other measures as well, such as CAHPS and HEIDS. What is HOS and Why is it Important? Looking Ahead: HOS & […]
Digital Strategies to Improve Medication Adherence
Medication adherence, while critical for managing chronic conditions like diabetes, high cholesterol, and cardiovascular disease, has still proven to be a struggle for many Americans.
Don’t Let the 2025 CMS Changes Get You Down: Get Ahead With These Member Engagement Best Practices
Now that we’ve had time to delve into the 1300+ pages of the 2025 Final Rule, the critical implementation phase begins. Many elements of this final rule were anticipated, and some were long overdue. This rule marks a significant shift towards expanding access, strengthening beneficiary protections, addressing social needs—not just identifying them—improving the quality of […]