The Star Ratings Ground Is Moving. Your Strategy Shouldn’t Depend on Where It Settles.
As CMS sets a 30-day clock for member outreach, the line between members who keep their coverage and those who lose it will come down to communication clarity. Learn what the Interim Final Rule requires, who it applies to, and how plans can deploy compliant, plain-language outreach before the mandatory window closes June 30, 2026.
Meeting Medicaid’s New Community Engagement Requirements
As CMS sets a 30-day clock for member outreach, the line between members who keep their coverage and those who lose it will come down to communication clarity. Learn what the Interim Final Rule requires, who it applies to, and how plans can deploy compliant, plain-language outreach before the mandatory window closes June 30, 2026.
Modernizing Utilization Management Communications to Meet CMS Prior Authorization Requirements
Learn how health plans can modernize utilization management communications to meet CMS prior authorization timelines, improve notification compliance, and reduce operational strain.
Improving CAHPS, HOS, and Retention through Scalable, Personalized Engagement Strategies
Quality improvement teams, fresh off the latest Star Ratings release, are again feeling pressure to improve member experience, reduce abrasion, and strengthen Stars performance. Many of the plans we partner with lean on AI and advanced engagement technology to do this successfully—and their results offer valuable lessons for what works. What’s changing in CAHPS, HOS, […]
How to Improve CAHPS Performance: An Action Plan for 2026
CAHPS surveys have long been central to measuring health plan performance, but their influence has grown significantly. With member experience now carrying greater weight in Star Ratings, plans must move beyond treating CAHPS as a compliance exercise. It is no longer enough to simply measure member experience — the challenge is to improve it in […]
Activate2025: Key Themes and Takeaways
Key Insights for Advancing Trust, Innovation, and Member-Centricity in Healthcare In recent years, trust has taken center stage in healthcare, forming the foundation for effective relationships among patients, members, providers, and health plans. However, the increasing complexity of healthcare creates barriers between constituents and makes it harder to establish and maintain trusting relationships. AI presents […]
CMS is Sunsetting Standard Direct Enrollment (SDE): What Does This Mean for Carriers?
On August 25, the Centers for Medicare and Medicaid Services (CMS) announced that it is discontinuing Direct Enrollment for performance year (PY) 2026. Here’s an overview of what carriers should know: When does this update take effect? CMS’ SDE service will be disabled on October 31, 2025. What should carriers do to prepare? Carriers who […]
CMS-0057F Compliance Guide for Health Plans: Step-by-Step Roadmap to Interoperability & Prior Authorization
Webinar CMS Interoperability Rules: Why Health Plans Shouldn’t Wait to Prepare 2 Sep 2025 | 9 min read Read Blog The Centers for Medicare & Medicaid Services’ CMS-0057F interoperability and prior authorization rule marks a major shift in how health plans manage compliance and member care. While the most complex requirements don’t take effect until […]
ACA Open Enrollment 2026: 5 Key Steps for Success
The 2025 ACA Open Enrollment Period marked a significant milestone, with over 24 million consumers selecting affordable health coverage through the Marketplace. This record-breaking participation highlights the increasing demand for accessible, consumer-friendly health insurance options. As carriers prepare for Open Enrollment Period (OEP) 2026, success will depend on more than just meeting deadlines—it requires strategic […]
Enhanced Direct Enrollment (EDE): What Health Plans Should Know
You may have been hearing a buzz around Enhanced Directed Enrollment (EDE). Let us break down what it is, why it’s valuable for health plans, and how it’s different from direct enrollment. We’ll also share some information about mPulse’s EDE solution to give you an idea of how a software vendor can help. What is […]