HighRoads

Regulations Shift. Markets Change. Agility Keeps You Ahead – Let’s Connect at AHIP’s Medicare, Medicaid, Duals & Commercial Markets Forum! Health plans are under more pressure and challenged to quickly find ways to stay compliant while keeping costs down and operations running smoothly. Meet HighRoads At AHIP MMDC to talk about: --- How to adapt quickly to evolving CMS regulations --- Ways to reduce complexity and cut administrative costs --- Strategies to optimize product + benefit operations --- What’s ahead for 2025—and how to stay agile in a shifting market Are these challenges on your radar? Let’s connect. ?? Meet with our team: R. Matt Clark and R. Scott Reid https://lnkd.in/e8ahhJA6 ?? Baltimore, MD | March 25–27, 2025 #AHIP2025 #MedicareAdvantage #HealthPlans

Recently announced ACA changes could lead to big shifts for Payers. What will the latest policy changes do to ACA plan enrollment? A drop is likely—but how big? Scenario planning starts now. Here’s what to consider: ???????????????????? ???? ????????????????????. Shorter open enrollment and the end of continuous sign-ups for low-income individuals will reduce coverage opportunities. How are you modeling potential shifts in your membership base? ?????????????? ???????????????????? ?????????? ?????? ????????????????. Requiring past-due payments before re-enrollment could improve cash flow but also increase customer service burdens and disenrollment rates. Are your systems and teams ready? ?????????????? ?????????? ???????? ???? ????????????. With gender-affirming care no longer an essential benefit in 2026, states will dictate coverage requirements. Will you standardize benefits nationally or take a state-by-state approach? ???????????? ?????? ?????? ?????? ???????? ???????? ?????????? ???? ?????? ????????????????????. Are you preparing your strategy, modeling risk, and evolving your member experience? What’s your product team doing to prepare? Contact us to schedule time with our strategy teams to discuss scenario planning.?Link is in the comments. ?#HealthcareStrategy #ACA #ScenarioPlanning #PayerInnovation

We're #hiring a new Sr. Associate Product Manager in United States. Apply today or share this post with your network.

Congratulations, Brandi D.! Your hard work and dedication inspire us all!

A breakdown of how healthcare was addressed in yesterday’s joint session of Congress originally posted by Jeff Yaniga. From lowering prescription drug costs to acknowledging healthcare professionals, the conversation touched on key industry challenges and opportunities. What stood out most to you? #Healthcare #Policy #Leadership

Health plans are bleeding cash due to inaccurate plan documents. What’s the real cost? You might be surprised. --- Regulatory fines: $11M+ --- Claims reprocessing costs: $2.5M --- Lost employer contracts: $50M+ And that’s just the beginning. Is document inaccuracy a concern for your team? What’s been your biggest challenge? Drop your thoughts below! ??

With potential changes to Medicaid funding, ACA subsidies, and cost-containment efforts, health plans need to be ready for a shifting landscape. Key focus areas: ?? Coverage & Funding: Possible Medicaid and ACA subsidy changes could reshape enrollment and risk pools.? ??Regulatory Flexibility: States may take a bigger role in defining healthcare programs.? ??Cost & Efficiency: Drug pricing, fraud prevention, and automation will be key levers for sustainability. Staying ahead means scenario-planning, optimizing operations, and preparing for change. PwC’s latest report offers sharp insights—worth a read. https://lnkd.in/e9rbdfzA #HealthPlans #ScenarioPlanning #IndustryInsights?

When it comes to healthcare, health plans are ensuring easy and affordable access to it. But delivering that access isn’t simple—it’s shaped by policy, technology, and market shifts.? In our recent webinar, Elena McFann and Jeff Yaniga shared insights on 3 critical challenges shaping health plans today and what “great” leaders are doing differently: 1.??????? ?????????????? ???????? ???? ???????????????? ?????????????????? ??????????????????: In a world where members have more choices, prioritizing member retention is critical, and health plans are looking to strategies that: ?Design member-centric, sustainable plans that drive long-term loyalty ?Use automation and a single source of truth to control operational costs and ensure accurate, timely member communication ? Make it simple for members to access care and understand what’s covered—before they even ask 2. ???????????? ????????????????????????—?????? ?????????????????? ???????? ???????????? ???????? ????????????: To strengthen member engagement, health plans are: ?Investing in automation to simplify enrollment, ID cards, and benefit updates ?Creating seamless experiences so members always know what’s covered and how to access care ?Building a culture of accountability that drives better results for both the organization and its members 3. ?????? ?????????????????????? ???? ?? ?????? ????????????????????????????—?????? ???????????????? ???????????????? ???? ????????????????: With every election cycle, health plan leaders know change is coming. The question isn’t if policies will shift—it’s how quickly and in what direction. Health plans are already investing in scenario planning, asking: ?What policies have the potential to change? How do we prioritize these? ?What strategies will allow us to pivot and win for the various scenarios? ?How do we stay ahead of regulatory shifts before they impact us? Want to hear more about how industry leaders are tackling these challenges? ?????????? ?????? ????-???????????? ?????????????? ??????. ?? https://lnkd.in/eazKqPGi

?? Exciting opportunity to join the Team at HighRoads! We are currently hiring for a Platform Solution Specialist -- a key role in understanding client needs and designing solutions that address challenges and drive business success. Learn more and apply: https://lnkd.in/e7bzc2kj #Hiring #Jobopportunity #HighRoadsEverywhere

?? Exciting opportunity to join the Team at HighRoads! As we continue to evolve and focus on delivering value to our health plan clients, we're looking for talented professionals to join our team. We are currently hiring for a Platform Solution Specialist -- a key role in understanding client needs and designing solutions that address challenges and drive business success. Learn more and apply here: https://lnkd.in/ee3NqwY5 #Hiring #Jobopportunity #HighRoadsEverywhere