DST RADIO

CMS added the MTM CMR completion rate measure to Star Ratings for Medicare plans in 2016. Since then, plans have struggled to reach the cut point to achieve 5 stars. Further changes to the measure create new challenges, but they may also open new doors. By transitioning the MTM CMR measure from process-based to outcomes-based, CMS is setting the stage for plans to consider MTM program as part of the larger strategy.

A Readmission or re-hospitilization is when a patient returns to inpatient hospital care shortly after discharge, typically within 30 days of discharge. There are many reasons why readmissions are important; one of which is that they are exspensive. Preventing avoidable hospital readmissions is considered by many to be the most important opportunitiy for reducing waste in health care.

Achieving value in the management of chronic HCV infection is one of the most complex challenges facing health plans today. Listen as AJ Ally, R.Ph, MBA, Vice President of Clinical Programs at DST’s Argus Health, talks about the balancing act between treating to cure and cost-effective management with a strategic focus on identifying and eliminating waste by using a Center of Excellence model to coordinate efforts of physicians, pharmacists and patients.  Sources CDC https://www.cdc.gov/hepatitis/hcv/hcvfaq.htmAASLD and IDSA Guidelines http://www.hcvguidelines.org/Kaiser Health News http://khn.org/news/medicaid-private-insurers-begin-to-lift-curbs-on-pricey-hepatitis-c-drugs/CDC https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm

MCOL, an industry leading publisher of healthcare news, interviewed DST’s risk adjustment expert Michael Nemeth about the challenges health plans face managing risk adjustment and quality performance and how integrating these two complex processes using an analytics platform can provide opportunities to impact health outcomes and optimize revenue.  Download DST's latest white paper for more on how an advanced analytics platform can provide you with the transparency and continuous insights needed to understand member health, accurately document risk and make strategic decisions.

As value-based care gains prominence, payers are developing new models that better align cost effective, consumer-focused, and value-based strategies for paying for medical services. Listen as DST’s Argus Health President Marc Palmer shares insights for integrating value into pharmacy benefit management, ways of balancing care with costs and his vision for how Argus has and will continue to meet the demands and challenges brought forth by this new model and under a new administration.

Listen as Dr. Rayvelle Stallings, Vice President of Government Programs at DST's Argus Health offers her unique perspective on patient impact, particularly children, from the point of view of a family physician, government programs expert and mother of a son required to carry an EpiPen®.

Preventing prescription drug abuse remains a top health priority for state and federal policy makers, and one that requires a comprehensive approach. In early 2016, the Centers for Disease Control and Prevention (CDC) announced several new opioid abuse prevention and treatment initiatives and as recently as July 22, 2016 President Obama signed into law S.524, the Comprehensive Addiction Recovery Act (CARA), a framework addressing opioid abuse prevention and treatment, including evidence-based interventions. Listen as AJ Ally, Vice President of Clinical Operations at Argus Health helps you understand the new policies and implications for managing the complexities of prescription opioid abuse. The following areas will be reviewed during this discussion: 1.       Drivers for opioid misuse and overuse 2.       Potential impact of retail pharmacies offering free naloxone without a prescription 3.       Proposed approach to managing opioid abuse and misuse through analytics and convergent solutions 4.       Utilization management guidelines (FDA, CDC, CARA) & implications to health plans and manufacturers 5.       Down the horizon - new and innovative treatments and solutions

Earlier this year HHS released guidance on new regulations related to the Health Insurance Marketplace.  Listen as Stephanie Leftwich, Director of Health Insurance Marketplace Strategy at DST Health Solutions helps you understand these regulations in order to gain a strategic business advantage.  Let us help you master these complexities of the Health Insurance Marketplace.  The following areas will be reviewed during this discussion: Standard Plan Design Network Adequacy Rate Review Risk Adjustment Eligibility and Enrollment

In an increasingly fragmented health care system, there is a need to understand the coordination of physicians involved in patients’ care to optimize quality of care and patient safety. Listen as Dr. Karen Kinder, Executive Director, Johns Hopkins ACG® System, explains the importance of care coordination and information sharing among physicians and how leveraging care density metrics can affect the health of your members and the financial well-being of your health plan.

What are the challenges facing healthcare in the UK? Are these similar or different to the challenges faced by the healthcare organizations in the US? Listen as Alan Thompson, (MSc), Senior Consultant and UK Team Leader at John Hopkins University, explains the tools and techniques they are using to address these healthcare challenges.

Customer experience is the sum total of all experiences that a person has with a company. The healthcare market is becoming more and more a consumer retail market. Learn the three things every health plan should be doing right now to engage and serve consumers.

We spend more than 10% of our healthcare expenditures on medications. The need for medications has gone up as life expectancy has gone up over the years. In many cases, a patient is seeing several physicians who are prescribing medications without being aware of all the medicines the patient may be taking.  Listen to Marilyn explain why this makes medication management even more important now-a-days.

The Accountable Care Organization (ACO) model is about orchestrating care delivery in kinship with fellow providers for success as an organization – a community – instead of care delivery in a vacuum, only focused on an individual component piece of the delivery system.  Today, there are an estimated 20.5 million lives covered by ACOs in the U.S.  To learn more, listen as Adele Allison shares her knowledge of ACOs.

Network Optimization seems to be a challenge faced by many health plans right now. For health plans to successfully compete in today’s market, they must quickly move to faster and more powerful tools fully capable of executing complex multivariate analysis based on actual operating models and that yield actionable recommendations and real-time improvements in costs, service and quality. Learn how network optimization can simplify the complexity of health plan operations.

Get educated on Health Plan Alliance, learn about the goals of this integrated healthcare system and what benefits are being received. What challenges are members facing in this innovative and fast growing time in healthcare?

Whats driving reducing hospital readmissions?  Why is this the most importantant opportunity for reducing waste? Find out what CMS is offering hospitals for reducing readmissions rates as well as penalties that could be received.

Receive some important information about the Affordable Care Act, Healthcare.gov and what to expect for 2015.

Amy Salls serves as Director of Population Health Strategy for DST Health Solutions.  In this episode, Amy draws on more than 20 years of experience in data analysis and healthcare informatics to unpack the three R's of risk - Reinsurance, Risk Corridors, and Risk Adjustment.

DST Health Solutions has a broad experience in providing enrollment, administrative and care management services for dual eligibles in compliance with CMS and state requirements. Learn what areas health plans need to focus on to effectively serve dual eligibles.

The Affordable Care Act establishes quality-related requirements for Qualified Health Plan (QHP) issuers and Marketplaces including a system to rate QHP's on the basis of quality and price and an enrollee satisfaction survey system to assess enrollee experience with each QHP.  To provide our listeners with the answers to their most pressing questions, Amy Salls addresses the important topics on this matter.  Amy Salls serves as Director of Population Health Strategy for DST Health Solutions.