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What more do employer groups expect from their health plan or TPA?

In this busy selling season for TPAs and health plans, we wanted to share an updated eBook that outlines some of what the Advanced Plan for Health is hearing from our TPA, health plan and employer clients related to what employers are really looking for as they’re shopping for benefits.

Here’s an excerpt:

Providing your employer clients with the right mix of services and support boosts your chances of standing out and winning and retaining their business. Fortunately, most self-insured employers want the same thing: healthy employees, positive employee healthcare experiences and reduced costs. Sounds simple enough, but how can you be sure that you are offering the best solutions in today’s strained and ever-changing healthcare environment so that you can continue to differentiate yourself and show value?

What more do employer groups expect from their health plan or TPA?
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Combatting the Crisis in Drug-Resistant Infections and Treatment

Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations, Advanced Plan for Health

A lot has happened since Alexander Fleming accidentally discovered Penicillin in 1928 after a chance exposure of staphylococcus to penicillin mold.  For his discovery, he won the Nobel Prize after penicillin was commercialized in 1945, used successfully for war wounds and surgery in World War II and hailed as the “miracle drug”. In his acceptance speech, Fleming admonished the world to beware that bacteria would become resistant in time.

Combatting the Crisis in Drug-Resistant Infections and Treatment
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Feature Engineering in Healthcare Analytics

Jason Rudy, Data Scientist / Programmer and Matt Lewis, Programmer / Product Manager

In a previous blog post, we walked through the process of building a predictive model using healthcare data. One of the things we touched on briefly there, was how important proper feature engineering can be to creating a useful representation of the underlying data, and how the choices made around shaping data into features can change the nature and performance of the resulting model. 

In this post, we’ll be going deeper into the process of feature engineering, and how to convert raw data inputs into a form that will make machine learning not only possible, but effective. 

Feature Engineering in Healthcare Analytics
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An APH Primer on Artificial intelligence and Machine Learning

Jason Rudy, Data Scientist / Programmer and Matt Lewis, Programmer / Product Manager

Fundamentally, machine learning is a set of techniques that allows the training of computer programs using example data. In the healthcare field, machine learning, coupled with large sources of patient / member data, can help generate predictions around population health, cost of care, events such as hospital admission and readmission, and give insight into the potential for individuals to experience specific outcomes and conditions (e.g. heart attacks, strokes, chronic kidney disease).

An APH Primer on Artificial intelligence and Machine Learning
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Taking the final mile with Population Health data findings - Nurse Navigation is one avenue

More and more frequently, our current and prospective employer group clients will ask us what we see as the most effective avenues to support employees and members who have been identified through analytics for outreach and support.

There are many avenues that our clients are taking to get individuals the education and support they need. Nurse Navigation is one of the most effective programs that we’re partnering with our clients to launch and manage. We thought this would be a good topic to cover during National Nurses Week.

Taking the final mile with Population Health data findings - Nurse Navigation is one avenue
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The Stars Impact of the CY2019 CMS Final Call Letter

Guest blog contributor:

Rex Wallace - Principal, Rex Wallace Consulting, LLC

On April 2nd, The Centers for Medicare and Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2019 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter. The entire document is a behemoth which includes important information about CY2019 for Medicare Advantage plans across a variety of topics. This paper will focus solely on the impact on Star Ratings.

The release of the Final Call Letter is one of a series of key milestone dates leading up to October 11, 2018, when CMS releases Star Ratings for each Medicare Advantage organization to the public.

The Stars Impact of the CY2019 CMS Final Call Letter
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New Diabetic Guidelines Aim to Improve Diabetic Care but Differ, Causing Confusion

Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations, Advanced Plan for Health

All entities managing health plans – self-insured employers, health plans, brokers and more – need to take note of the impact of diabetes on the health of their members and the financial bottom line of their health plans. Particular focus needs to be put on the recent changes to care guidelines for diabetic control as they aim to improve diabetic care – but differ –  which is causing confusion.

New Diabetic Guidelines Aim to Improve Diabetic Care but Differ, Causing Confusion
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The Growing Need for Better Access to Behavioral Health Support

Mental and substance abuse disorders and their downstream impacts are becoming a growing concern for employers – with costs to employers estimated at $225.8 billion each year. Notably, the financial impact goes beyond absenteeism to include presenteeism as well. Presenteeism, or individuals working with untreated illnesses, is estimated to cost employers $1,601 per person each year according to the same Inc. Magazine article.

Many employers are actively looking for better ways to offer their employees support in this area –  as they do for overall wellness and chronic conditions such as diabetes and high blood pressure.

The Growing Need for Better Access to Behavioral Health Support
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Unexpected Unreasonable Claims Costs in Intraoperative Neurologic Monitoring (IONM)

Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations, Advanced Plan for Health & Joy McGee-Cory - Senior Vice President, Advanced Plan for Health

Several of our Health Plan clients and their members have experienced unexpected and very unpleasant surprises following certain complex surgical procedures – usually spine-related. So we wanted to get a cautionary word out a bit more broadly on this topic to our clients and others who may be facing similar situations. The surprises are coming in the way of bills for intraoperative neurologic monitoring (IONM).

In one case, the billing technician was not a physician, and the member’s bill for monitoring services was an unreasonable, non-negotiable $120,000.

Unexpected Unreasonable Claims Costs in Intraoperative Neurologic Monitoring (IONM)
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Part 2 - Consumer Guide to High Blood Pressure to Share with Your Population

Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations, Advanced Plan for Health  & Joy McGee-Cory - Senior Vice President, Advanced Plan for Health

The team at Advanced Plan for Health (APH) is passionate about improving the health and well-being of as many healthcare consumers as possible, so in honor of Heart Health Month, we created a Consumer Guide to High Blood Pressure for you to use to share details on the risk of hypertension and some preventative measures with your member, employee and patient populations. We encourage you to share any of this information as you find appropriate.

Part 2 - Consumer Guide to High Blood Pressure to Share with Your Population
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