Medicare

Our Perspective

As the Medicare market continues to expand, pressure to maximize top line revenue while bending the cost curve downward will remain a priority. Improving star ratings and claims processing efficiency requires payer-provider partnerships.  Payers and providers continue to move toward value-based care payment models to meet Medicare Access and CHIP Reauthorization Act (MACRA) criteria.  For most plans, the techniques and tools employed thus far will be insufficient for implementation and to ensure ongoing sustainability of Medicare programs.

With downward pressure on premium rates, it becomes even more critical to ensure that the evidence to support appropriate Hierarchical Condition Category (HCC) risk scores is correctly captured and reported. In addition to solid internal systems and processes to support risk score analysis and reconciliation, a highly functioning communication and feedback mechanism with the plan’s provider network is crucial.

T2C believes that to navigate these challenges and to be successful in this marketplace, Medicare plans and providers need to achieve operational competence. By operational competence, we mean having the right infrastructure, technology and processes in place to provide health plans with the ability to grow and operate the business without being weighed down by compliance and cost issues.

Stethoscope and red heart on a white backgroundMedicare Access and CHIP Reauthorization Act (MACRA)

The Quality Payment Program (QPP) instituted under MACRA changes the way Medicare pays providers for patient care services. MACRA focuses on quality, advancing care information,  improvements, and cost.  T2C works with clients to successfully design and implement ongoing improvements and innovative clinical practice re-engineering initiatives to support MACRA requirements and develop value-based payment models.

Information Technology

Many clients will need IT platforms that are capable of integrating data from multiple sources and systems to demonstrate performance measurements.  T2C evaluates administration, claims, and care management platforms and works closely with clients to select or develop technology solutions that meet business needs.  We will help define requirements, create RFPs, and develop business case documents to support your initiatives.

Five–Star Quality Rating Improvement

Obtaining high scores on the 55 measures covered by the Five–Star Quality Rating Program is essential for health plans looking to maximize their revenue.  T2C can work with you to assess your scores, metric by metric, and develop a prioritized plan to improve your rating. For the short term, we will identify quick hit, high impact areas of focus as we help build capabilities to improve and maintain your score for the long term.

Care Coordination

There needs to be proper incentive alignment between Medicare plans and providers to ensure that everyone is on board to give the best care possible. The Hierarchical Condition Category (HCC) Risk Adjustment Model reduces costs for dual eligible patients, and correctly interpreting and implementing the annual changes to the guidelines requires the right subject matter experts.  T2C will work with you to develop and implement an effective coordinated care management strategy.

Member Enrollment/Acquisition Process

Acquiring members is a highly regulated process which means Medicare/Medicaid plans need to always have compliance at the front of their minds or risk facing damaging penalties. T2C can work with you to implement comprehensive CRM capabilities to ensure compliance while capitalizing on the growing number of potential enrollees.

ARE YOU MAXIMIZING YOUR REVENUES AND BENDING THE COST CURVE?

We can help. Partner with T2C today.