Every year, healthcare organizations prepare for platform upgrades, new releases, enhanced features, and the promise of better performance across care management (CM) and utilization management (UM). On paper, it sounds like progress. In reality, that’s not the case. Many of these upgrades underdeliver, not because the technology falls short, but because the clinical and operational […]
Read MoreAcross the country, states are accelerating the move toward integrated Special Needs Plans to better serve dually eligible populations. Fully Integrated D-SNPs, Highly Integrated D-SNPs, unified appeals processes, and exclusively aligned enrollment are no longer pilots or policy experiments. They are becoming the expected operating model. The strategic intent behind this shift is sound. Integration […]
Read MoreWhy most health plans overspend, underdeliver, and can’t clearly explain why Every health plan executive today is under the same pressure: do more with less, improve outcomes, modernize platforms, stay compliant, and protect margin. The problem isn’t ambition. The problem is that most of these decisions are being made without a true understanding of delivery […]
Read MoreAt Impresiv, we know the pressure of Star Ratings has never been higher. The Centers for Medicare and Medicaid Services (CMS) released Medicare Advantage star ratings in October, showing an average score of 3.65 for 2026, down from 3.92 in 2025. Standards continue to rise, measurement is increasingly outcomes-focused, and scoring updates shift the landscape […]
Read MoreIn 2025, “doing more with less” became a mandate. Health plans invested heavily in platform optimization—care management systems, analytics, interoperability, and workflow automation—expecting efficiency gains and cost relief. As teams look toward 2026, a quieter question is emerging: Why didn’t these efforts deliver the outcomes we expected? The issue wasn’t technology. In most cases, platforms […]
Read MoreAs payer organizations head into 2026, we’re hearing the same themes from clinical, IT, and operational leaders across the country: The reality is simple: Organizations that wait until Q2 to stabilize operations, add capacity, and tighten execution rhythm are already behind. Below, we’ve summarized the most consistent patterns we’re seeing across the market — and […]
Read MoreDisclaimer: This article is for informational purposes only and does not constitute legal advice. Always consult qualified immigration counsel for your specific situation. When news of the $100,000 fee for H-1B visas broke, most coverage and immediate concern focused on big tech and IT companies. But for health plans and managed care organizations, this policy […]
Read MoreAt Impresiv Health, we see one challenge come up again and again: staffing decisions are being made without a clear understanding of capacity. Too little capacity creates compliance risk, backlogs, burnout, and member dissatisfaction. Too much capacity strains budgets and erodes margins. The real challenge isn’t just getting staffing “right.”It’s understanding how much operational capacity […]
Read MoreHow do you balance regulatory compliance, member outcomes, and operational efficiency—while keeping administrative costs under control? For health plan leaders, the mandate is clear: improve outcomes, stay compliant, and reduce administrative cost. Yet one of the biggest opportunities to achieve this often sits right in front of us—the care management platform. Whether it’s ZeOmega Jiva, […]
Read MoreShared by Dr. Jerry Osband, Former Chief Medical Officer for EXL and Member of the Impresiv Health Executive Advisory Board As described in previous articles, Population Health Management (PHM) is a key driver of reducing clinical and financial risk while improving health outcomes for healthcare organizations. We’ve already described the key components of PHM and […]
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