Author: LBodnarchuk

National Prescription Drug Take Back Day

Did you know? April 22nd is National Prescription Drug Take Back Day.

Sponsored by the Drug Enforcement Administration (DEA), National Prescription Drug Take Back Day promotes medication safety and disposal in our communities across the country. Unnecessary prescription drugs, including opioids, can be misused, or abused by individuals prescribed the medications or unregulated members of the community with access to the medication supply. Encouraging the public to remove unnecessary medications from their homes is important to the public health and safety of Americans. This annual event can prevent prescription medication misuse and avoid potential opioid addiction. 

The disposal window for National Prescription Drug Take Back Day is 10 AM to 2 PM.

The DEA Prescription Drug Take Back Day website has resources to find collection sites in your area. The Collection Site Locator feature allows you to search for public collection sites by zip code, county, city or state levels. Unused and unwanted prescription medications will be accepted at more than 4,000 drop-off locations across the country. Be sure to remove any personal identifiers, such as name and date of birth found on your prescription bottles, from any packaging prior to medication disposal. You can find this tool and other information regarding National Prescription Drug Take Back Day here

The US produces the most medical waste among all countries.

Why is National Prescription Drug Take Back Day Important?

According to a 2015 article in the Journal of Environmental Management, the United States produces the most medical waste among all world countries, accounting for more than 3.5 million tons annually. Many households across the country have unused medications spread across different rooms and storage containers.  Some medication treatments become outdated due to advancements in disease treatment, changing of prescription medications for improved disease state management and general discontinuation of medication therapy.  Throwing unused medications into the regular trash at home can result in environmental harm, pollution and even accidental death if ingested. The DEA even accepts vaping devices and cartridges at these sites for safe disposal. More than 324 tons of unwanted medications were collected across the country at the October, 2022 National Prescription Drug Take Back Day.

ProspHire can assist your health plan with decreasing medication waste.

How Can ProspHire Help?

At ProspHire, we can assist your health plan with decreasing medication waste through the implementation of significant services focused on medication utilization. Our team of clinical experts can analyze your data and identify medication use patterns to provide waste reduction strategies with the opportunity for prescription medication deprescribing.   

For more on HEDIS Opioid Measures and Strategies to Mitigate Inappropriate Use of Opioids HEDIS Opioid Strategies to Mitigate Inappropriate Use (

Medicaid Awareness Month

Medicaid Awareness Month

Did you know? April is Medicaid Awareness Month. 

Medicaid Matters. It’s a lifeline for millions of Americans and is especially critical as the nation responds to the pandemic, providing key funding for hospitals and helping patients get the support they need.

Medicaid is the country’s most extensive health care program specifically designed to meet the needs of low-income individuals who have disproportionate medical needs and health challenges. Medicaid provides high-quality, affordable coverage to nearly 80 million low-income individuals and families, including 10 million people with disabilities. The program is the main source of long-term care coverage for millions of older adults and, along with the Children’s Health Insurance Program (CHIP), provides access to care for over 40 million children.

Why is Medicaid Awareness Month important?

One of the key goals of Medicaid Awareness Month is to raise understanding about the program and the services it provides. Many people may not realize that they are eligible for Medicaid or may not be aware of the range of services that are covered. By increasing awareness, we can help ensure that more people are able to access the care they need to stay healthy.

It has been proven that Medicaid expansion efforts have increased access to care, improved financial security and led to better health outcomes. The Medicaid expansion has played a pivotal role in reducing racial disparities in obtaining healthcare access.

The Public Health Emergency (PHE) is set to expire on May 11, 2023. The PHE has been in place since 2020 due to the Covid-19 pandemic. During this time, Medicaid/CHIP enrollment grew by more than 20 million. The PHE gave the federal government flexibility to waive or modify Medicaid and CHIP programs. Starting this Spring, States will begin the process to determine who will no longer be eligible for coverage. It is estimated that up to 15 million Medicaid and CHIP enrollees will lose coverage over the next 12 months.

It is expected that up to a third of those losing coverage will turn to Health Insurance Exchange Marketplaces. Consumers who have lost coverage during the Medicaid unwinding process will be eligible to apply for immediate coverage through a Special Enrollment Period (SEP). While many Issuers are scrambling to replace lost Medicaid revenue, ACA Marketplaces are a strategic place to look.

How Can ProspHire Help?

At ProspHire, our approach is to gain a fundamental understanding of your existing business, operations and goals and then develop the best strategy to achieve your ACA goals quickly and effectively. We can assist your health plan with conducting an assessment and instituting change management throughout the Medicaid unwinding’s and help to ensure ACA and other products are optimized to secure continued coverage for those losing Medicaid.

Why It’s Important to Address Social Determinants of Health (SDOH)

Imagine a world in which every person, from infant to senior, can achieve and maintain their highest level of health. This goal is health equity and while it should be a societal norm, many obstacles make it difficult to reach.

These barriers lead to health disparities, which are differences in the health statuses of varying groups of people. Health disparities are avoidable distinctions in the burden of illness, injury, disease, violence or chances to attain good health that socially disadvantaged groups face.

Health inequities link closely to the disproportionate allocation of social, economic and environmental resources. However, health professionals can work to address these disparities by understanding the importance of social determinants of health.

What Are the Social Determinants of Health?

Social determinants of health are the nonmedical circumstances in our environment that impact our well-being. Factors present in the places where we are born, live, play, learn, work, and age can profoundly influence our overall quality of life.  

Social determinants of health also cover a broader set of systems and forces that shape daily life. These comprise economic policies, development agendas, social and cultural norms, racism, climate change and politics.

To understand social determinants of health, consider the following examples:

  • Safe housing, transportation and neighborhoods
  • Discrimination, racism and violence
  • Education, job opportunities and income
  • Access to nutritious foods and opportunities for physical exercise
  • Clean air and water
  • Language and literacy skills

Professionals group the social determinants of health into five domains, which we’ll explore below.

1. Economic Stability

Economic stability means having enough secure, reliable income to meet your fundamental needs. Being economically stable can help you achieve a better quality of life by allowing you to access essential resources for your health and well-being.

Factors that influence economic stability include:

  • Affordable housing
  • Employment that provides a living wage
  • Employment benefits, like worker protections, paid sick leave and child care
  • Reliable transportation

It’s crucial to address economic instability as a social determinant of health because daily challenges surrounding unemployment, poverty, housing and food insecurity can elevate the risk of poor health outcomes for vulnerable populations.

2. Education Access and Quality

Education equips people with the tools they need to live fulfilling lives, thrive personally and contribute to their communities. Moreover, an educated person is more likely to access elements that contribute to their well-being, like quality healthcare, jobs that pay a living wage and safe living environments.

People with access to a good education tend to stay healthier throughout their lives than those without. Education gives people the opportunity for upward mobility, placing them in the financial circumstances necessary to access quality healthcare.

People with low education levels contend with unemployment and low income, which associates with poorer health. Data indicate that people of lower socioeconomic status experience more health problems like obesity, asthma, diabetes and heart disease than people of higher socioeconomic status.

And finally, having a college education helps job seekers obtain higher-paying work that poses fewer safety risks.

Ultimately, people with higher levels of education have more means to afford things that promote their health, like quality housing in toxin-free environments and expert physicians trained in the most successful techniques.

3. Healthcare Access and Quality

Access to quality healthcare means services like the prevention, diagnosis, treatment and management of diseases, illnesses, disorders and other health-impacting conditions are readily available to you. These services must also be affordable and convenient.

Unfortunately, many people encounter obstacles that make it challenging to obtain health care services, which may increase the risk of poor health outcomes and disparities. Such barriers include a lack of health insurance, inadequate healthcare resources and limited access to transportation.

Little or no health insurance coverage significantly hinders healthcare access. High costs may cause people to put off necessary medical treatment or avoid it altogether. Lower-income families often go without insurance and minority groups constitute over half of the uninsured population.

Inadequate health insurance coverage can adversely impact a person’s health. Adults without insurance are less likely to receive preventive care for chronic conditions like diabetes, cancer and heart disease. Likewise, uninsured children are less likely to get treated for conditions like asthma or receive critical services like dental care, immunizations and well-child visits.

Sometimes, a limited availability of resources further reduces people’s access to health services, increasing the likelihood of adverse health outcomes. For example, a shortage of doctors may mean patients wait longer to receive care.

Unreliable or inconvenient transportation can also make it difficult for people to receive consistent healthcare, potentially contributing to adverse health outcomes.

4. Neighborhood and Built Environment

The neighborhoods and built environments in which people live, work, play and learn can strongly influence their health and well-being for better or worse, depending on the circumstances.

Many people live in communities or work in jobs that present health risks like high rates of violence, pollution, unsafe water and others. Minorities and low-income people are more likely to live in neighborhoods and work in environments that present these risks.

The factors that make neighborhoods and built environments a social determinant of health fall into the following four groups.

  • Access to healthy foods: Access to nutritious foods is crucial to a sensible eating pattern. A lack of access to healthy foods can result in malnutrition, higher obesity levels and other diet-related conditions because low-income people tend to live in “food deserts.” However, accessing healthy food depends on more than having a grocery store nearby. People must also be able to afford it and affordability closely relates to employment rates and job quality.
  • Quality of housing: A home’s design and structure can significantly impact housing quality. Unsafe conditions such as the presence of asbestos, mold, lead, substandard air quality and overcrowding can lead to adverse physical and mental health outcomes.
  • Crime and violence: Whether experienced directly or indirectly, crime and violence can cause injury, mental distress and reduced quality of life. Some communities and groups are more likely to encounter crime and violence than others, such as low-income neighborhoods and Black adolescents.
  • Environmental conditions: Environmental conditions like water quality, air quality and the weather can influence a person’s health. Some groups are more vulnerable to poor environmental conditions and their associated health disparities. These include people of color, low-income families, the homeless, the elderly, pregnant women and children.

5. Social and Community Context

Social and community situations are vital aspects of health. Relationships and interactions between people and their family, friends, colleagues and community can shape their health and well-being.

Public health advocates classify social and community contexts into the following four categories.

  • Civic participation: Civic participation comprises activities like voting, volunteering, recreational sports, community gardening and more. Civic participation benefits the community and the participants by building social capital, expanding social networks and helping foster a sense of purpose.
  • Discrimination: Discrimination is a stressor that affects a person’s health by barring access to resources, dignity and quality of life.
  • Incarceration: People are more likely to develop chronic conditions like high blood pressure, cancer, asthma and arthritis. Black and Hispanic populations and people with low education levels have higher incarceration rates.
  • Social cohesion: Relationships are an essential part of physical and psychosocial wellness. Social cohesion is the strength of relationships and the perception of harmony within a community. High levels can positively influence health outcomes.

The Impact of Social Determinants of Health

Social determinants can dramatically impact physical and mental health outcomes, especially for vulnerable populations. Providers must account for circumstances like patient income, education and environment for providers to deliver the holistic care necessary for health and well-being.

The public health sphere widely understands that poverty impedes access to nutritious foods and safe neighborhoods, and that higher educational levels contribute to better overall health.

If means are available to overcome adverse social determinants of health, populations can experience better health. But without resources, social determinants can foster troublesome circumstances like discrimination and disparities. Moreover, undesirable social determinants can affect a person’s knowledge of healthcare and resources and restrict access to them.

The Truth About Negative Social Determinants of Health

Health studies have indicated that:

  • Children of adults who did not earn a high school diploma are more likely to grow up in areas with barriers to health.
  • As income levels decrease, the risk of premature death increases.
  • There is a direct connection between lower income, smoking and shorter life expectancy.
  • Poor white people are less likely to live in neighborhoods of concentrated poverty.
  • A person’s living environment may influence that of future generations.
  • Disparity-related stress relates to health and is often the result of overlapping factors.
  • Stress harms children and adults throughout their lives. Repeated exposure to environmental and social stressors may result in a cumulative burden that puts people’s health at risk.

Social determinants that result in health disparities are expensive and can hinder the quality of care that people receive, leading to additional healthcare expenditures, loss of efficiency and early death.

Research related to the price of health disparities puts the situation into perspective. For Black people, Hispanics and Asian Americans, 30% of direct medical costs relate to health inequities. On a broader scale, the U.S. loses approximately $309 billion each year to the direct and indirect costs of health disparities.

How ProspHire Can Help

As our population diversifies, it becomes more vulnerable to the concerns associated with adverse social determinants of health. One straightforward path to addressing this issue is coordinating services across the spectrum of care. Merging social support and assistance with healthcare delivery is vital for providers to confront the various social determinants that have such a bearing on patients’ wellness.

ProspHire prioritizes helping you provide high-quality healthcare to your patients, and we tailor solutions to do that. We understand the far-reaching effects that nonmedical factors have on a person’s health, so we’ve implemented strategies to help you address them.

Below are the services we offer related to social determinants of health.

  • SDoH solutions: These solutions allow you to look beyond the point of care and address all areas that impact health outcomes, such as housing, food insecurity, transportation and improving access to needed community programs.
  • Population health assessment and transformation: Assess your population, understand the underlying drivers of health and implement change to address social determinants and equitable health outcomes through turnkey interventions.
  • Organizational strategic planning: Drive organizational transformation through defined goals and a developed playbook for change management and actionable strategies to address health disparities.
  • Community-based partnership development: Evaluate, align and partner with community-based organizations to address social determinants and close care gaps to improve equitable outcomes and increase community-based care management.
  • Maternal health equity: Address inequities and improve outcomes in maternal health through population-based interventions and recommendations curated to meet the needs of vulnerable patients and members.
  • Quality accreditation achievement: Be a leader in the industry through the pursuit and award of health equity and other quality accreditations.

With these services, health providers can build a more comprehensive awareness of the biological, behavioral and social components that shape wellness. The result is an equitable healthcare system that makes better health outcomes attainable for everyone.

Let ProspHire Help You Address Social Determinants of Health

Tackling the challenges presented by negative social determinants of health is no small undertaking, but patients deserve your best effort. A multifaceted approach is necessary to make the changes that will allow our society to find health equity. ProspHire has the expertise and enthusiasm to develop a solid plan for your organization.

ProspHire helps our clients provide better access to quality healthcare. We’re here to help you implement the strategies and interventions needed to fight health disparities and achieve health equity.

With our commitment to culture, leadership, diversity, equity and inclusion, our minority-owned business is a leader in healthcare strategy and execution. Contact the experts at ProspHire today to learn more.

What Are CMS Documentation Requirements?

The Centers for Medicare and Medicaid Services (CMS) require Mandated Documents for Medicare and Medicaid Beneficiaries, which describe member benefits and provide clear and accurate explanations through standardized templates. Since requirements change annually, it’s important for payors to update these documents and relay them to plan beneficiaries to maintain compliance.

Learn more about CMS medical record documentation requirements with ProspHire.

Who Needs Required Documentation?

Any provider approved to offer Medicare- or Medicaid-sponsored plans to their beneficiaries must comply with CMS Mandated Documents.

If you are approved to offer Medicare Advantage plans, you must follow the directives of Medicare and share up-to-date CMS Mandated Documents with beneficiaries.

What Are the Required Documents for CMS?

While CMS Requirements may vary by plan type, there are generally two categories of required documentation for CMS — communications and marketing. If a document is classified as a communication, it provides information to current or prospective enrollees. Marketing materials might include intent and content intended to draw an enrollee’s attention to particular information.

Two categories of required documentation for CMS, communications and marketing

Plans must submit all marketing documents and some communications to the Health Plan Management System (HPMS) for review. HPMS requires some documents to be submitted by particular dates, while others are considered file and use (F&U), meaning the plan can use the materials five days after submitting them to HPMS for review. If the review finds any discrepancies, the plan may be subject to compliance actions.

These documents include the following:

Annual Notice of Change (ANOC)

Plans must send beneficiaries an ANOC each year, usually in the fall and no later than September 30. This document will detail any changes in cost or coverage that will take effect in January of the following year and is considered F&U.

ANOC and EOC Errata

If there are errors in the ANOC or EOC, plans must provide this document to enrollees immediately after they receive CMS approval.

Comprehensive Medication Review Summary

If enrollees are in a plan’s Medication Therapy Management program, they should receive this document immediately following the comprehensive medication review (CMR) or within 14 days.

Coverage/Organization Determination, Discharge, Appeals and Grievance Notices

If an enrollee has filed an appeal or someone has filed an appeal on their behalf, plans must issue this form based on the relevant time frames.

Enrollment/Election Form/Request

Plans must provide enrollment documents on request, and these materials require an HMPS review.

Enrollment and Disenrollment Notices

Medicare has very specific requirements for enrollment and disenrollment notices. Plans can find specific information on these materials in the Medicare Managed Care Manual.

Evidence of Coverage (EOC)

In the fall, plans must also send an annual EOC document that explains what the plan will cover the following year and how much beneficiaries must pay. This document falls under F&U review requirements.

Excluded Provider Notice

Providers can be subject to penalties for using individuals or entities listed in the Office of the Inspector General’s List of Excluded Individuals/Entities. CMS also keeps a list of excluded entities on the preclusion list. If an enrollee uses a provider listed on one of these excluded provider lists, plans must present them with this notice.

Explanation of Benefits — Part C

When enrollees use a Part C benefit, plans need to provide these materials monthly or per claim with a quarterly summary.

Explanation of Benefits — Part D

When enrollees use their prescription drug benefit, often referred to as Part D, plans must provide this documentation to enrollees by the end of the month following the month when they used their benefits.


Also known as a drug list, this communication lists the prescription drugs a plan covers. Plans must make these documents available to enrollees annually by October 15.

Low Income Subsidy (LIS) Notice

If potential enrollees are eligible for Extra Help, plans must provide this document before the enrollment effective date.

Low Income Subsidy (LIS) Rider

Plans must provide this document to current Extra Help enrollees each year by September 30.

Membership ID Cards

Plans must provide both hard and digital copies of ID cards to their enrollees within either 10 calendar days of enrollment or before the end of the month before their enrollment.

Mid-Year Change Notification to Enrollees

If there is a change to the plan rules, benefits or formulary, plans must provide notice of these changes 30 days in advance, unless otherwise stated by the specific CMS regulations.

Non-Renewal Notices

If enrollees are impacted by a non-renewal or service area reduction, plans must provide this notice 60-90 days before the end of the contract year, depending on the material.

Outbound Enrollment Verification

If the enrollee is using an agent or broker enrollment, plans must provide this outbound enrollment verification by hard copy, telephone or email within 15 calendar days of the enrollment request.

Part D Transition Letter

If a beneficiary receives a transition fill for a non-formulary prescription drug, plans must send this letter within three days of adjudication.

Pharmacy Directory

All plan enrollees must receive this pharmacy directory by October 15 for the following plan year.

Plan Termination Notices

Before reaching the plan termination effective date, plans must provide this notice by hard copy and newspaper publication.

Pre-Enrollment Checklist

Plans should provide this document alongside the Summary of Benefits (SB) before enrollment, in the same format the SB is delivered.

Prescription Transfer Letter

If an enrollee’s Part D sponsor requests to fill a prescription at an alternate pharmacy than the one they currently use, plans must send this letter in a timely manner.

Provider Directory

All plan enrollees will receive a provider directory annually by October 15 for current enrollees, within 10 days of enrollment for new enrollees and within three days for current enrollees when requested.

Provider Termination Letter to Beneficiaries

If an enrollee’s provider is no longer part of the plan’s network, plans need to notify enrollees by hard copy via mail 30 days before the effective date.

Safe Disposal Information

At a minimum of once annually, plans need to distribute information on the safe disposal of prescription drugs that constitute controlled substances, including information on drug takeback sites in the enrollee’s community.

Scope of Appointment (SOA)

The SOA form provides enrollees with the opportunity to mark which products they want to discuss, and plans must provide this via signed hard or electronic copy or telephonic recording before the appointment.

Star Ratings Document

The Star Ratings document is generated from HPMS following a standard format. Plans must provide one to enrollees before enrollment and upload the document for HPMS review within 21 days of the updated information.

Summary of Benefits

Plans must provide the SB to all enrollees annually by October 15 and submit the document for HPMS review by that date.


Plans must also include any relevant disclaimers in all CMS required documents for patients.

Contact Us to learn how we can help optimize your required documentation processes

How ProspHire Can Help

Complying with CMS document requirements often requires annual updates with the participation of various departments, which can impact an organization’s efficiency and optimization. However, failing to meet the document requirements for government programs like Medicare and Medicaid can lead to non-compliance actions like fines and member abrasion.

ProspHire can help organizations maintain compliance and streamline their required documentation delivery management systems. With resources like a Required Documents Playbook and Program Toolkit, ProspHire can help organizations create a foundational operating model to ensure plan beneficiaries receive the necessary documentation on time.

Contact us through the form below to learn how we can help optimize your required documentation processes.

ProspHire Names First Chief Marketing & Communications Officer

PITTSBURGH, PA – Founding Principals Lauren and Chris Miladinovich today announced that ProspHire has named Tricia Egry as its first Chief Marketing & Communications Officer. Tricia was previously Senior Director and remains a member of the Firm’s Executive Leadership Team. She is responsible for enhancing and amplifying the ProspHire brand and building and driving a marketing & communications strategy and digital-first programs that drive engagement and conversation, while inspiring a team of nearly 100 employees and consultants across the U.S. ProspHire is a woman-owned and rapidly expanding Pittsburgh-headquartered management consulting firm focused on healthcare advisory, project delivery and strategic resourcing. 

“Since Tricia joined ProspHire in 2021 she has championed an aggressive multi-functional digital marketing strategy that focuses on creating a Best-in-Class client experience to drive lead generation, cross-selling and sales,” said Lauren Miladinovich, ProspHire’s Managing Principal and CEO. “Tricia’s dedication to ProspHire and its people is exceptional and we are thrilled to promote her to be our first Chief Marketing & Communications Officer.”

A proven marketing leader, Tricia brings considerable experience in delivering high-impact, integrated marketing, brand and communications strategies across diverse industries, locations and geographies. Prior to joining ProspHire, she served as National Marketing & Communications Leader of Field Teams at BDO, USA, where she led marketing & communications strategies for more than 60 U.S. offices by managing the development and execution of go-to-market plans that included digital and social media campaigns, public relations and advertising initiatives, sales enablement and bid management and event and sponsorship strategies. She came to BDO through the expansion of Alpern Rosenthal, where she led strategic marketing initiatives for numerous industries as Director of Marketing. Tricia’s career experience also includes being a journalist and news producer for NBC and a disc jockey at several radio stations in Western PA.

“The story of ProspHire is one that I can really relate to,” commented Egry. “It’s a brand that lives at the intersection of relationships and innovation and the leadership aims to help our people, our clients and our communities prosper. I look forward to continuing to evolve the Firm’s marketing and communications program and playing a critical role in our continued momentum and expansion.”

“This is a big moment for ProspHire,” said Christopher Miladinovich, ProspHire’s Principal and Chief Operating Officer. “Tricia’s extensive experience leading marketing organizations at various stages of growth will help our Firm drive revenue and accelerate as we embark on our next chapter.”

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