Axtria Principals David Wood, PhD and Randy Risser present analytical techniques developed in Axtria's R&D labs.
Improving the quality of care and services to patients and enrollees is one of the key imperatives of Affordable Care Act (ACA). Several initiatives and measures have been put in place to make this imperative an operational reality across the entire healthcare landscape. CMS has posted quality ratings of Medicare Advantage plans (STAR Ratings) to help Medicare beneficiaries. All Medicare Advantage plans are rated on a one-to-five-star scale, with one star for poor performance, three for average, and five for excellent. Plan’s bonus payments are attached to STAR rating. CMS will have the authority to use its discretion to terminate the contracts of Part C and D sponsors that fail to achieve at-least a 3-star plan rating for 3 consecutive years beginning 2015. However, financial benefit and penalties represent only one dimension of the importance and relevance of the Medicare STAR ratings. It has also evolved into a key competitive advantage for the plans competing for Medicare beneficiaries. By design of Medicare STAR rating, any eligible Medicare beneficiaries can switch over to a 5 star rating plan any time during the year and not only during the open enrollment period. This is an immense advantage for performing plans!!
Processing claims quickly and accurately is one of the biggest challenges payers face today in healthcare industry. Huge volume of claims notwithstanding, multiple and incompatible systems requiring significant manual hand offs have made the timely disposal of claims the single biggest burden on operating costs of payers. Add to it the problem of incorrectly filed claims that payers need to handle, leading to choking of band-width on account of re-processing; the problem suddenly becomes even more acute. With state specific regulations penalizing such delays, it has become a matter of survival for payers to figure out the optimal trade-off between analysis one claim warrants versus time it takes to get it through the system.
Continuing our blog series examining a ‘year in the life’ of Sales Strategy and Operations. This time of the year (late spring, early summer) marks the classic sales force sizing season. Why now ? Many executives engage in the strategic planning and/or anticipate next year’s budgeting process, which is why this is a perfect time to take a fresh look at the overall sales force investment.
Welcome to Axtria’s blog series on sales strategy and operations. This series will examine a ‘year in the life’ of sales operations. In the process, we will highlight the major ‘seasons’ throughout the year as the annual cadence goes through a strategy, planning, implementation, tracking and measurement processes.
Over the past several years a number of Pharma companies have developed processes and procedures to ensure that promotional activities, personal and non-personal, are targeted appropriately. Customers are either “included or excluded” based on the specialty of a healthcare professional (HCP) and a product’s approved indication(s). As noted in a variety of recent legal and financial settlements, the costs associated with inadequate promotional controls is extremely high.