In this episode of The Totally Adequate Podcast, we delve into the proposed rules for Medicare Advantage organizations and the new California Assembly Bill. Join Kate Deiters and Zach Snyder as they discuss the key aspects of these policies and their potential impact on healthcare provider network management.

Proposed Rule for Medicare Advantage Organizations: Gain insights into what updates could be coming to network adequacy and provider directory requirements.

California Assembly Bill: Learn about the new bill that aims to set provider directory accuracy benchmarks for health plans, requiring a 95% accuracy rate by 2029.

State Legislative Actions: Discover how other states are exploring similar initiatives and the implications for provider directory accuracy programs.

The Final Notice of Benefit and Payment Parameters for 2026 is out, and we're here to break it down for you. Kate Deiters and Zach Snyder discuss the key changes in network adequacy requirements. Tune in to learn how these changes will impact Qualified Health Plans (QHPs) Certification for issuers on the federal and state exchanges.

Topics Covered

New Network Adequacy Calculations: Learn about the shift to using geographic distance for network adequacy evaluations.

Implications for State-based Exchanges: Find out about the requirements for state-based exchanges to meet federal standards by January 1, 2026, and potential legislative and regulatory shifts.

State-Specific Legislative Actions: Get an overview of how states like Nevada and Oregon are aligning their standards with federal requirements and the legislative processes involved.

Get ready for 2025 with the latest insights on major health policy changes! Join Kate Deiters and Zach Snyder as they break down federal policy updates related to network adequacy and provider directory accuracy. Discover what's changing and how you can start preparing for the new requirements. Highlights: Proposed Notice of Benefit and Payment Parameters for Plan Year 2026: Learn about the new Geographic Distance measurement and rollover changes from last year.

Managed Care Final Rule: Understand the updated provider directory accuracy and network adequacy requirements, and their impact on Medicaid RFP bids.

Mental Health Parity and Addiction Equity Act (MHPAEA) Final Rule: Dive into the new comparative analysis standards and their implications for your network evaluation strategies.

CMS National Provider Directory Pilot: Explore the pilot program aiming to improve provider directory accuracy nationwide.

Trends and Predictions for 2025: Get insights on upcoming trends in healthcare policies and understand how these changes could affect your organization.

Tune in to stay informed and prepared for the shifting landscape of health policies!

Get an Exclusive Preview of Vision Quest 2024 with April Beane! In this episode, guest host Kate Deiters, sits down with April Beane, VP of Marketing at Quest Analytics, to discuss what makes Vision Quest the premier forum for professional development in healthcare provider network management and performance. Key Highlights: - How Vision Quest fosters an inclusive, collaborative atmosphere for professionals at all career stages. - Insights into multi-track sessions designed to enhance your skills and knowledge. - Unique networking opportunities that drive innovation within your organization. - Expert-driven learning experiences that broaden your understanding and capabilities. Event Details: 📅 Dates: September 10-12, 2024 📍 Location: Austin, TX Learn More About Vision Quest: https://visionquest.questanalytics.com/ Learn More About Quest Analytics: https://questanalytics.com/

Big changes are coming to Medicare Advantage and Marketplace policies! April Beane and health policy expert Kate Deiters dig into the CMS Contract Year 2025 Medicare Advantage and Part D Final Rule and HHS Notice of Benefit and Payment Parameters for 2025 Final Rule. Discover what these updates mean for network adequacy and provider accuracy at both federal and state levels. Get ahead with key trends and actionable insights that every healthcare professional and policymaker needs to know.

Resources Mentioned

• CMS Contract Year 2025 Medicare Advantage and Part D Final Rule Policy Brief: https://questanalytics.com/cms-mao-medicaid-resource-hub/medicare-advantage-final-rule/
• HHS Notice of Benefit and Payment Parameters for 2025 Final Rule Policy Brief: https://questanalytics.com/qhp-marketplace-resources/qhp-legislative-brief/

Leaders from Quest Analytics and Highmark Health join April Beane to discuss the future of provider network performance. As strategies evolve, how we build networks is critical in achieving member and payer outcomes that drive business success. Finding the path to "right-sized" networks is also vital to providing quality and equitable care to all members. And, as our guest will tell you, connecting benefit design and network structuring is the goal we should all have the courage to achieve.

Panelists:

• Steve Levin, CEO, Quest Analytics
• Jim Brown, Vice President for WPA Markets Operations and Strategy, Highmark Health

Hosted by April Beane, VP Marketing, Quest Analytics

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The national talk track in healthcare tends to focus on cost, utilization management, serving underserved and high-cost populations, benefit design, and consumer engagement. Underappreciated, or even ignored, is the underlying platform on which everything rides: the health network. In this episode, two Healthcare IT executives who have spent decades in healthcare around financial management, cost analytics, and provider performance share their takeaways on understanding provider network management since joining Quest Analytics®. Both have been astounded by the sophistication of network development and the opportunities to bring the network into the current national debate. Join us for a fireside chat between these experts as they reflect on their past knowledge and explore the future of provider network management.

Panelists:

Steve Levin, CEO, Quest Analytics

Subhash Seelam, SVP, Applied Network Analytics, Quest Analytics

Host:

April Beane, VP Marketing, Quest Analytics

What a difference 10 years makes! In this episode, host Kate Deiters talks with Eliza Hoffman, VP of Regional Payers at Quest Analytics, about the last decade in healthcare provider network management. From what's changed to aha moments to the current hot topics, Eliza shares her perspective on the evolution of provider network management and what she's most excited about for the future. Sit back, relax and enjoy this episode!

Host Kate Deiters sits down with Anita Shields, Director of Client Support & Training at Quest Analytics. We talk about Anita's experience in the insurance industry and how she got her start at Quest Analytics. Anita shares some tips for keeping up with the industry and what it takes to stay on top of your game in this ever-changing landscape. She also talks about her excitement about the advancement of technology in the insurance software space and how that is helping to make things easier for clients who are looking for new ways to streamline their operations.

Kate Deiters and Zach Snyder discuss the current state of telehealth. The crystal ball is glowing bright as Zach and Kate peek into the future of telehealth credits and how states could be impacted.

Guest:

Zach Snyder, VP of Government Affairs, Quest Analytics

Host:

Kate Deiters, Marketing Specialist, Quest Analytics