Higher Star ratings continue to be a key motivation for all participating plans as they look at winning competitive mindshare and quality bonus incentives which significantly impact a health insurance provider’s competitive existence. However, recent CMS and NCQA regulatory changes have forced the insurance industry to focus on member experience and interoperability, thereby enabling a member-centric healthcare ecosystem.
The proposed regulations have brought in multitude of policy changes that reflect the same – changing quality measures and timelines, interoperability, digitized quality, network fulfilment, MLR compliance among others, which touch the length and breadth of health insurance operations. With so many current and upcoming regulatory changes, health insurance providers must streamline operations to gain efficiencies, while delivering on quality improvement objectives. Data science and augmented capabilities such as NLP, RPA, and AI/ML will allow health insurance providers to design intelligent automated and optimized workflows with significant savings on wastage.
The session will cover key characteristics of high-performing health insurance providers and discuss the role of advanced analytics and data science to create efficiencies for quality programs such as HEDIS and CMS Star ratings while answering all key questions pertaining to the recent quality program changes around NCQA HEDIS and CMS Stars. It will also cover examples of how NLP and AI/ ML models with embedded intelligence driven process optimization can help rationalize processes related to holistic quality improvement.
Senior Vice President, Products & Solutions
Jeff Springer is the Senior Vice President of Products & Solutions at CitiusTech, driving the product management, business analyst and product strategy for all products and solutions. He has more than 20 years of healthcare industry experience, having worked with leading healthcare technology vendors. Jeff holds a Mechanical Engineering Degree and an MBA from University of Pennsylvania, Wharton School, where he graduated as a Palmer Scholar.
Associate Vice President, Health Plans
Shitang Patel is a Senior Healthcare Consultant at CitiusTech, with 15 years of experience spanning healthcare management and health policymaking settings, with a focus on payer strategy, business operations and supporting technologies. Prior to joining CitiusTech, Shitang worked for PwC Health Industries Advisory (serving payer and provider clients) and also worked in the areas of health services research and policymaking in Washington D.C. Shitang holds a Master’s degree in Health Services Administration from the University of Michigan.