“I have the pleasure of working with Steve, whose accomplishments over the decades lend to his ability to foster confidence and trust in those he leads today. If I were asked to sum up Steve's professional business acumen in one word, while there are many 'COMPETENT' sticks out the most. I have witnessed Steve out-think extreme challenges to organizational performance, that convinces you he has successfully tackled these obstacles before. When an individual is operating in their element, it is evident to everyone around them. This is what it's like working with Steve Solomon, who I consider to be the Michael Jordan / Labron James of C-Suite Executives. Under Steve's leadership, I witnessed him: * Leverage years of relationship building to his advantage, by fostering a diverse web of talented individuals who aid him in overcoming the toughest of challenges faced by businesses today. * Diversify a portfolio, that at one time posed high-risk to long term revenue growth potential. * Find common ground between feuding department heads, who now have open communication and collaboration, focused on company goals and performance objectives. * Provide the vision and support needed to anchor a highly productive training and development function. * Provide guidance and leadership to an already effective Workforce department, strategically aligning it to company over goals. It's rare to find this kind of executive in today's marketplace. Steve undoubtedly has what it takes to get the job done.”
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I am a Senior call center executive that applies sustainable improvements and turnarounds…
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Lisa Wright
Unlocking the Power of Healthcare Data in Texas Big data holds immense potential to reshape healthcare, from enhancing patient care to streamlining operations. But the question remains: Are we tapping into its full capabilities? How is your organization utilizing data analytics to drive better outcomes and improve efficiency? Let’s share insights and strategies to harness the power of data in healthcare. #HealthcareAnalytics #DataDrivenHealthcare #HealthTech
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Advantmed
Join us in #Austin November 4–6 at the Texas Association of Health Plans conference! Connect with Phillip Cardona and other industry experts to discuss the current landscape of risk adjustment and quality—and let's talk about how we can collaborate to achieve your 2025 goals. #Texas #TAHP #AlwaysElevating #RiskAdjustment #QualityImprovement
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Business of Primary Care
"The adoption of Value-Based Care (VBC) business models is here to stay." Some VBC headwinds from Juliette Price: - V24 to V28 shift is coming - Increased utilization post-covid in Medicare - Fewer new-to-VBC providers - Hospital and insurance market consolidations #valuebasedcare RISE Value Based Care Summit
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Josh Martin
Here's news from the latest Medicare trustees report: the key trust fund now has an insolvency date of 2036, five years later than previously estimated. Factors like increased revenue from higher wages and reduced spending on healthcare services contribute to this extension. However, while this offers a temporary reprieve, the long-term sustainability of Medicare remains a significant concern, and this article outlines why. #Medicare #Healthcare #FinancialPlanning
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Arbital Health
🎥 Missed our panel discussion? Catch up now! We recently brought together industry experts to discuss #MedicareAdvantage Risk Deals in 2025 & Beyond and how to prepare for the challenges ahead. The panel covered: ✅ 2024 Rising Healthcare Claims Costs ✅ Inflation Reduction Act Impact on Part D Plans ✅ HCC Model Changes Explained ✅ CMS Star Ratings Updates If you couldn’t join us live, you can still access the recording. Request it here: https://hubs.ly/Q02Z4B1X0 #VBC #ValueBasedCare #HealthTech
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Adam Rosenfeld
The opening line to this article nearly knocked me over: "Today, healthcare generates approximately 30% of the world’s data – a figure that is expected to hit 36% by 2025." A THIRD OF THE WORLD'S DATA! That's a lot of data. But so what? Why am I posting this article at all? Money. See below on ways AI can drive down healthcare costs. From the article: "AI is exceptionally well positioned to emerge as a change agent to facilitate, streamline, and improve payment accuracy operations. By utilizing the abundance of healthcare data—held by stakeholders—AI and predictive analytics enable the development of innovative solutions that address a wide range of challenges across the payment integrity value chain." "AI-powered platforms and solutions can tackle both traditional pain points, such as fraud, waste, and abuse, as well as emerging challenges, like the rapid growth in claims related to genetic testing and the complexities of specialty pharmaceuticals." If you know a young person looking for a career path, healthcare data analytics seems to be growing! Let's hope AI can help drive healthcare costs down. We need some downward pressure in this area. #healthcarespending #employeebenefits #hr Rubicon Benefits, a division of World
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B.T Elite Healthcare Consulting Group LLC
FAQ Q Can I submit claims through availity.com A Availity provides a platform allowing healthcare providers to submit claims electronically to various insurance payers. You can get this done by Logining to Availity: Access the Claims Submission Feature Enter Patient and Service Information: Attach Supporting Documents Review and Submit Check Claim Status . . . . . . . . #MedicalBilling #BillingSolutions #RevenueCycleManagement
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Insurance Evolution Partners
Andrew Toy, President of Clover Health, talks about how the US healthcare system being almost exclusively provided through a health insurance model can change the dynamics of the market versus other countries. That can create complications, but can also create opportunities for an insurer to make change, like Clover is working to do. Watch the clip at https://lnkd.in/eVJFHTiq and catch the full episode at https://lnkd.in/eQbhWN6E #insurtech #insurance #futureofinsurance #innovation
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Dutable International
Your Guide To Navigating Health Insurance In Texas Navigating the world of health insurance can be overwhelming, especially in a state as large and diverse as Texas. With a myriad of insurance providers, coverage,… Read more on the following link https://lnkd.in/evTufYSb
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Outlook Publishing (India) Pvt. Ltd.
Anil Bhatt, global CIO of US health insurance provider Elevance Health, began his career navigating early challenges and skepticism, which included convincing the security near the Prime Minister's residence in Delhi about his work installing a pioneering point-of-sale system. From these beginnings, he is now leading technological advancements at Elevance Health, such as leveraging AI for operational efficiency and improving customer healthcare access. Bhatt emphasises the importance of data-driven decision-making, customer-focused technology solutions and fostering a culture of inclusivity and questioning within the workplace. Read the article by Vinita Bhatia to know how Bhatt is driving digital transformation in healthcare. https://lnkd.in/gU5eGq_s #healthcare #digitalisation #AI #inclusivity #technology
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Papa
It’s crucial for supplemental benefits today to demonstrate clear value for both members and their health plan partners. This is a concept we understand well at Papa, having created and scaled a category-defining model—and we continually invest in research to further validate and inform our approach. Like our latest claims analysis that showed Medicare Advantage members who engaged in at least one #Papa visit were associated with a 9% reduction in medical costs. And the impact doesn’t stop there. 🚀 Members who engaged in more Papa visits saw even greater cost reductions, showing the potentially exponential impact long-term connection can have on an individual’s health, including: • 19% reduction in medical costs for members who average more than two Papa visits per month • 30% reduction in medical costs for members who average more than three Papa visits per month 📈 As plans look to enhance their offerings following the recent #CMS Star Rating recalculations, further investing in companion care is proven to maximize impact for your members. Learn how Papa can reduce healthcare costs and improve outcomes for your plan: https://lnkd.in/ejMf_But
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Aspen RxHealth
2025 is less than 5 months away. Do you have a plan for the expanded MTM eligibility expected? Health plans across the country are wondering how they'll deliver the drastically larger volume of CMRs needed in such a short timeframe. The answer is by working with a trusted MTM partner like Aspen RxHealth. With the nation's largest network of pharmacists, there's no CMR volume we can't manage. Learn more about our MTM program offerings today: https://hubs.ly/Q02FW1Mw0 #AspenRxHealth #RevolutionizePharmacy #CMSchanges
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ClaimShark
An 𝗔𝗜 “𝗮𝗿𝗺𝘀 𝗿𝗮𝗰𝗲” is already underway and will reshape the future of claims review. 🚀 Mature Payment Integrity teams at health plans have a temporary upper hand, but providers are rapidly catching up. 𝗖𝗹𝗮𝗶𝗺𝗦𝗵𝗮𝗿𝗸 helps Payment Integrity teams of all maturity levels stay ahead in this evolving space, maximizing recoveries and streamlining operations with precision and efficiency. Source: https://lnkd.in/gdNhRTZk #AI #HealthPlans #ClaimsReview #PaymentIntegrity #ProviderAbrasion
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ClaimsBridge
🚀 Brokers, your clients count on you to bring solutions that simplify healthcare administration. Are you equipped with the right tools? ClaimsBridge Network Hosting and Contract Pricing Solutions streamline network management and claims processing, reducing the administrative load while boosting accuracy. Give your clients access to a platform that ensures smoother operations, lower costs, and increased satisfaction. Set yourself apart by offering more than just coverage—offer efficiency and peace of mind. #Brokers #HealthcareSolutions #NetworkManagement #Efficiency #ClaimsBridge #ClientSuccess
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Health Payer Specialist
#Centene's rapid ascent has redefined the health insurance landscape, doubling premiums in five years and nearing Elevance Health's market share. What fueled this unprecedented growth? Click to explore. https://lnkd.in/egTJQdkW #HealthInsurance #MarketGrowth
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Dustin VanDuine, CLU
Great post from NABIP Medicare Final Rule. Industry Reaction and Next Steps Carriers, FMOs, agents and call centers are still digesting the impact of the rule and the growing consensus now is that FMOs will be able to contract with issuers has they have to provide the agent support they need. In addition, agents will receive an additional $100 as part of their fair market value. That said, how much of this AEP will be disruptive due to the rule and how much of it will be a consequence of the Inflation Reduction Act? We have believed for some time that capping the out of pocket expense and limiting premium increases would affect plan pricing, particularly for Part D carriers. Expectations are that premium increases will double and perhaps triple for some standard plans and that they may be non-commissionable as well. The additional $100 payment is considered an all or nothing payment and with already thin margins, advisors are likely to shift many of these clients to Medicare,gov for service. Adding to the problem is a new provision of the IRA to defer paying for pharmaceuticals at the drug counter for expenses exceeding $500. Little is known how this will work but we do know that beneficiaries can request deferment even in the 12th month of the plan year. We expect formularies to change substantially and beneficiary requests to increase so serving your current book of business will take time away from adding new clients. In this environment, the role of the FMO will be more critical than ever as you seek ways to structure your time efficiently. Many FMO have already anticipated this need and are putting into place ways to ease your workflow. We are pressing House appropriators to include report language to get CMS to withdraw the rule based on a faulty process that relied on assumptions rather than data. Our request is that they reissue a request for information (RFI) to collect and analyze data which they freely admit they did not. CMS also leaves the door open to further rule making which could upend any assumptions we have on the rule today which creates ongoing uncertainty. There is much to be done going forward and we want you to know we continue to dialogue with stakeholders to ensure that you can serve your beneficiary clients as you have always done so well. The need is clearly there, with over 12,000 newly eligible beneficiaries every day for the next four years, there simply aren't enough servicing agents. Our Medicare Advisory Group and FMO Council have been instrumental in our advocacy efforts so if you are not a member, I encourage you to engage now to preserve your role and vital service you provide to your clients. https://lnkd.in/gRc-3ay8
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