Troy Ivey

Jeff Nally, Senior Vice President of Revenue Cycle Management at Dominion Diagnostics, explains how his team utilized TELCOR RCM reporting and advanced access to gain better insight into operations and future planning. Watch the full video here. ⬇ https://hubs.li/Q02wHdKH0

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💡 My latest substack on the Centene earnings from Friday morning before the market opened. Below are the highlights I took away from the earnings call. 💴 The health insurance giant reported $40.4 billion in revenue, reflecting 4% year-over-year growth, and raised its EPS guidance to $6.80 for 2023. Despite these solid numbers, the market reacted with initial volatility, with the stock dropping almost 5% at open, but rallying to close just over 2% down. For the year, Centene's stock has remained relatively stable, a noteworthy achievement given the challenges in the health insurance sector. 🔵 Medicaid: As the largest Managed Medicaid provider with 13.3 million members, Centene sees the end of redeterminations as a key milestone. With 90% completed, the final 10% is expected to wrap up in Q2 and Q3 2024. Elevated utilization has impacted their health benefit ratio (HBR) in Q1, but the company remains optimistic with their discussions with their 31 state partners on shifts in acuity. They are excited about upcoming expansions in Oklahoma, Florida, and Michigan. 🔵 Medicare: Centene/Wellcare is committed to the Medicare Advantage space despite lower reimbursements. They aim to achieve 85% of their Wellcare beneficiaries in a 3.5 STAR plan or better next year which is ambitious given the current state. Part D changes are on the horizon, with the "donut hole" phasing out, and CMS is actively engaged with them on premium adjustments. They feel the SNP/D-SNP arena is a sweet spot as they have a deep understanding of the lower income population as the leader in Managed Medicaid domestically. 🔵 ACA/Marketplace: Centene leads the ACA/Marketplace sector in the U.S., ending Q1 2023 with 4.3 million members—a significant 10% growth year-over-year. This line of business has strong margins, and the recent premium subsidies have driven substantial growth. The upcoming election could play a key role in maintaining this momentum in the ACA line of business as premium subsidies have doubled this line over the past 5 years from 11 million to 21 million people in ACA/Marketplace plans. Overall, Centene's strategic shifts, like focusing on core business and disposing of non-aligned assets, are setting them up for a promising 2025. I'm excited to see how they finish 2024 and deal with their TriCare West situation along with changes in Medicare Advantage. #healthcare #marketaccess #medicaid https://lnkd.in/g98qNHkg

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Payers are faced with a growing collection of claims, clinical, and operational data from a variety of sources, making it hard to extract the insights needed to drive transformation and value. Learn why an interconnected analytics strategy is critical to success: https://lnkd.in/eCXuTDjH

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ON-DEMAND WEBINAR: Is your RCM partner up to today’s security challenges? If you’re unsure, it’s time to find out. Watch to uncover how recent cybersecurity events have refocused vendor-selection requirements and what to evaluate during review.  #Cybersecurity #RevenueCycleSecurity #RCMSecurity

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Payers are worried about the financial and clinical impact of alternative funding programs. MMIT’s Stephen Callahan and Carly Nicholas explain their concerns, from regulatory non-compliance to patient eligibility delays to an overall lack of sustainability. Click here to read the deep dive: https://ow.ly/bzW850QI3j9. #AlternativeFundingPrograms #AFPs #Pharmacy #Payers

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Payers, it is time to rethink your exclusive clearinghouse arrangements. Having more than one data source limits your risk while keeping your providers and patients happy – Don’t jeopardize business continuity and the potential to revert to paper. Why choose SSI? ✅ Full-service offerings, including claims processing, ERA, eligibility, status checks, and attachments, simplify your operations. ✅ Advanced data editing tools preempt errors before they reach you, maintaining the integrity and efficiency of your data flow. ✅ Robust partnerships with major industry clearinghouses ensure seamless transitions. #EfficientHealthcare #NotAllClearinghousesAreEqual #SSIAdvantage #NoToPaper

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How are insurers still exploiting the #IDR process? Explore what’s behind the curtain when it comes to providers’ success. The process is not restoring payer-provider equilibrium as the #NoSurprisesAct intended. Learn how payers are applying cash flow pressures to providers through IDR on this episode of The Strain. Watch the full episode by visiting https://lnkd.in/eCs_2Mn9 #healthcareeconomics #healthcarefinance

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Payers, is it time to rethink your exclusive clearinghouse arrangements? Having more than one data source limits your risk while keeping your providers and patients happy – Don’t jeopardize business continuity and the potential to revert to paper. Why choose SSI? ✅ Full-service offerings, including claims processing, ERA, eligibility, status checks, and attachments, simplify your operations. ✅ Advanced data editing tools preempt errors before they reach you, maintaining the integrity and efficiency of your data flow. ✅ Robust partnerships with major industry clearinghouses ensure seamless transitions. #EfficientHealthcare #NotAllClearinghousesAreEqual #SSIAdvantage #NoToPaper

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Payers, is it time to rethink your exclusive clearinghouse arrangements? Having more than one data source limits your risk while keeping your providers and patients happy – Don’t jeopardize business continuity and the potential to revert to paper. Why choose SSI? ✅ Full-service offerings, including claims processing, ERA, eligibility, status checks, and attachments, simplify your operations. ✅ Advanced data editing tools preempt errors before they reach you, maintaining the integrity and efficiency of your data flow. ✅ Robust partnerships with major industry clearinghouses ensure seamless transitions. #EfficientHealthcare #NotAllClearinghousesAreEqual #SSIAdvantage #NoToPaper

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The countdown begins until the HFMA Annual Conference! Check out our ROI Calculator to see how much revenue you're leaving on the table or schedule a meeting with Gary Heeseman or Brad Skelton to learn more about our Insurance Discovery technology. You may be surprised to see your estimated monthly cash increase. #insurancediscovery #RCM #maxrte Link to ROI calculator: https://lnkd.in/eBPNny7i

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💡 In Onpoint’s new issue brief, our Director of Data Analytics Jesse Drummond, PhD, and Director of Health Analytics Amy Kinner, MS, discuss a new method for addressing the challenge of attributing #healthcare providers to practices using claims data from all-payer claims databases (APCDs). Many #APCDs are working hard to report on performance at the practice level – rather than at the provider level – and creating practice rosters is a crucial step in this process. While Onpoint has been attributing patients to their primary care providers using claims data for many years, accurately attributing providers to practices requires both experience and #innovation. Want to learn about our team’s new method for overcoming these challenges? Follow the link below! 👇 https://lnkd.in/eZajB32W

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The SCHFMA Annual Institute is here - and we're excited to be on the ground with Samantha Evans, MBA from AnMed Health! This is a don't-miss talk for RCM leaders who want to: ➡ Identify opportunities for digital engagement along the entire patient financial journey. ➡ Develop strategies to help patients better understand their options for resolving their bills, while also boosting health system finances. ➡ Learn how to execute technology-first revenue cycle strategies at from real-world examples at AnMed.

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Explained: The Benefits and Challenges of Risk Adjustment Accurately predicting patients’ future health care costs is critical in capitated payment models, which give providers a lump sum to cover each patient’s full treatment costs. Risk adjustment is a key tool that plans use to ensure providers have enough resources for patients requiring more intensive and costly care. If it’s not designed thoughtfully, however, providers could face financial risks and patients could suffer. In a new explainer, The Commonwealth Fund’s Celli Horstman, MPP and Corinne Lewis, MSW explain the basics of risk adjustment, including:   ➗ the information that goes into risk adjustment calculations 📈 why payers are considering expanding which factors are taken into account  ⛔️ potential drawbacks to risk adjustment, and more.

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Health plans across the country are recognizing the superior value of prospective risk adjustment programs. What's behind the move to prospective RA? Read our latest blog to learn more: https://hubs.li/Q02G4jn70

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