At Lilac we are fortunate to have some of the brightest and most innovative minds from the world of payer tech/operations contributing as we build our platform and business. One of those luminaries, Bill Georges, recently published an article in MedCity News about the future of Medicare Advantage. Some of the core points that Bill makes capture why we’re building what we’re building.
Article link: https://medcitynews.com/2024/11/where-medicare-advantage-goes-from-here/
Bill makes the case that despite some headwinds and negative press, Medicare Advantage is still an attractive business line. The main reasons he cites are:
- Per member margins are high relative to other business lines
- Success in MA is critical to deliver effective care to America’s aging population
- Stars program gives a well defined path to high performance
- Early indications are that the next Whitehouse will favor MA even more strongly
Even with those positives, there are a number of major challenges all MA plans are facing. These include:
- Growing regulatory complexity (e.g. a laundry list of annual Stars changes)
- Increased reporting requirements (e.g. supplemental benefits)
- Move towards Electronic Clinical Data Systems (ECDS) measures
- More interoperability requirements coming into effect
- Increased scrutiny on risk adjustment
- Complexities in more automated prior authorization
- 3rd party member acquisition channels being regulated more
These points describing the context of today’s MA environment lead to the main thrust of the article – plans absolutely can succeed in MA and it’s critical for the health of tens of millions of older adults that they figure it out. These are also the forces that inspired us to start Lilac. We are on a mission to bring plans the technology, infrastructure and expertise needed to deliver for members in the type of tough landscape MA presents.
The solutions we’re building accomplishes that in the following ways:
- Unlocking Operational Efficiencies: Most plans still have a lot of manual processes and workflows when it comes to getting needed data. Lilac automates the aggregation, cleansing, and normalization of data needed to drive Stars performance (and in turn, an effective MA plan). Lilac takes the time and effort out of getting good data.
- Powering Proactive Care Management: Lilac brings together all the data needed to identify at-risk patients and intervene early. The platform supports predictive modeling and risk stratification, facilitating proactive care strategies that engage high risk members.
- Navigating Regulatory Complexity: Lilac closely tracks all of CMS’ communications and builds in changes to measures, calculations and reporting requirements so everything is automatically available at appropriate times. This reduces a plan’s risk and allows more resources to go towards better serving members.
- Making Advanced Analytics & AI More Accessible: Lilac has sophisticated tools that automate joining together disparate data. This is an essential, and often overlooked, step in getting value from AI and analytics. Lilac’s platform is architected in a way that is fast to implement, minimizes resource requirements from plan IT teams and can work on nearly any infrastructure.
- Easing Path to ECDS and Interoperability: Lilac’s robust integration engine facilitates compliance with Electronic Clinical Data Systems (ECDS) and interoperability requirements. The platform ensures seamless data exchange between disparate systems, aligning with common Health Information Exchange (HIE) standards to promote efficient communication across healthcare networks.
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If you want to explore how we can help your plan, reach out to us via the form in this link to start the conversation.
