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Health Plan Operations

Client-Focused Leadership Skills

  • Has Your Medicare Advantage Plan Taken These 3 Steps to Prepare For 2024 HCC Risk Adjustment Changes?

    Published On: January 27, 2025

    CMS announced the final rule for Medicare Plans for the HCC Risk Adjustment Model for the payment year 2024.Health Chain discusses the notable changes in HCC codes.

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  • nguy-n

    Risk Adjustment: A Data-Driven Approach with Health Chain

    Published On: September 10, 2024

    Boost Medicare reimbursement with accurate risk adjustment! Discover how Health Chain and Gartner’s data-driven CDI unlocks complete data & optimizes coding for maximized revenue.

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  • Payer-Provider-Collaboration

    Unlocking Insights, Empowering Action: How Payers Can Push Value Back to Providers

    Published On: May 2, 2024

    Boost Payer-Provider Collaboration! This blog explores how Payers can use healthcare data analytics & CMS initiatives to leverage interoperability and deliver actionable insights to Providers. Empower population health management through data-driven collaboration!

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  • Demystifying the Maze: A Deep Dive into the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) for Health Plans

    Published On: April 26, 2024

    The Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) in January 2024.

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  • TEFCA

    Beyond the Buzzwords: Putting Interoperability to Work in Healthcare – A TEFCA-Powered Future

    Published On: April 17, 2024

    HEALTH CHAIN INSIGHTS | 10-minute read The healthcare industry throws around terms like "interoperability" a lot, but for senior leaders in risk adjustment, quality improvement and data & analytics at Health Plans, understanding its practical implications is crucial. [...]

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  • Interoperability-in-Healthcare

    Making Data Sing: Understanding Semantic vs. Syntactic Interoperability in Healthcare

    Published On: April 11, 2024

    HEALTH CHAIN INSIGHTS | 5-minute read For health plans, data is king. But the true value lies in unlocking its meaning – a challenge that can be addressed with effective interoperability. This blog dives into two key [...]

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  • Digital-Transformation

    Revolutionizing Payer Operations: Real-Time Health Systems and the Digital Transformation Journey

    Published On: April 1, 2024

    Explore how Health Data Management Platforms drive Payer Operations' digital transformation journey, focusing on Real-Time Health Systems and meeting CMS mandates efficiently

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  • Healthcare-Delivery-Excellence

    Unleashing the Power of Health Data Management Platforms for Healthcare Delivery Excellence

    Published On: February 17, 2024

    Health Data Management Platforms can help Payers digest patient data from all sources to improve STAR ratings, enhance Member care with AI and analytics, and more

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  • Medicare-Advantage-Members

    Removing the #1 Roadblock to Delivering Better Quality Care to Medicare Advantage Members

    Published On: January 10, 2024

    Health Chain highlights roadblocks for Medicare Advantage Plans when trying to optimize risk adjustment, member engagement and care quality processes.

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  • PersonalizationinHealthInsurance

    The Power of Data-Driven Personalization in Health Insurance

    Published On: November 20, 2023

    Medicare Health Plans can boost CMS Star ratings with personalized member experiences with clinical interventions and tailored interactions

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Mid-Western BCBS Health Plan Takes a FHIR-First Approach to Clinical Data Exchange with Health Chain

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