Setting the Stage for the 2026 Medicare Advantage Rate Announcement
On April 4th and April 7th, 2025, the Centers for Medicare & Medicaid Services (CMS) released 2026 Medicare Advantage Final Rule and 2026 Final Rate Announcement, respectively. These releases outline critical policy updates and payment adjustments that will shape the present and future of Medicare Advantage plans. The impact of these changes and signals present both a challenge and an opportunity for plans to reassess their strategies and adapt to the new normal.
More than Just the Numbers
CMS finalized a 5.06% increase in Medicare Advantage payments for 2026, amounting to $25 billion in additional plan revenue. Big number. Big headline. But the real story is how CMS continues to evolve its role—not just as a payer but as a regulator, standard-setter and advocate for Medicare enrollees. It’s not just how much CMS is investing in the Medicare program, it’s also about the standards for how the they expect plans to operate.
Star Ratings and Measure Impacts: Few Changes but Signals for What’s to Come
From a Stars perspective, these regulatory updates weren’t the tidal wave that some predicted. There was a notable measure rebrand, formerly the Health Equity Index (HEI). The much-maligned measure has been renamed to Excellent Health Outcomes 4 All (EHO4A). This change is not merely cosmetic but signals CMS’s ongoing commitment to reducing cost to the Medicare Advantage program (the true intention of the Health Equity Index anyway). In addition, the possibility of integrating geography as a social risk factor adds an extra layer of complexity for plans to consider. Plans may soon be required to account for geographic location when measuring and addressing health disparities and outcomes – a major nod to challenges in rural health. This could have a profound impact on how programs are designed and how quality measures are calculated, especially in communities facing systemic health challenges.
Finally, CMS has established official deadlines for plans to review and dispute data:
May 30, 2025 – CTM data review deadline
June 30, 2025 – Appeals data review deadline
May 18, 2026 – Part D Patient Safety data review deadline (SY2027)
March 31, 2026 – Deadline for all contracts to request a review of 2025 CTM data (SY2027)
With these fixed deadlines for data review, last-minute efforts to improve measure performance may be a challenge due to time constraints. Plans need to be much more proactive and diligent when reviewing their own data and searching for improvement opportunities.
A New Normal: The Need for Innovation in the Evolving CMS Landscape
The changes outlined in the 2026 Medicare Advantage announcements are more than just policy adjustments—they are part of a broader shift in the healthcare landscape. With figures like Dr. Oz and RFK Jr. now influencing the conversation, it’s clear that CMS is moving in a direction that prioritizes innovation, positive health outcomes, efficiency and adaptability.
CMS also showed strong interest in AI and operational efficiency, suggesting this administration is open to exploring technology’s role in modernizing Stars and other quality programs. The emphasis on the Universal Foundation of core measures—and the potential removal of many operational-style metrics—means plans will also need to focus on clinical outcomes, data capture/interoperability and measurement strategy in areas that matter most.
Plans must take a hard look at how they operate today and prepare to adjust their strategies under this new lens. The healthcare industry is entering a “new normal,” where the plans that succeed will be those that innovate and respond proactively to emerging trends. Those that fail to adapt risk falling behind in a competitive market. The future of Medicare Advantage will belong to innovators who can navigate this shifting terrain, ensuring that they are providing high-quality, outcomes driven care that meets the evolving needs of beneficiaries.
Conclusion: Building for the Future By Assessing Your Present
The Rate Announcement and Final Rule aren’t just technical documents—they’re a glimpse into CMS’s evolving philosophy: tighter guardrails, enhanced beneficiary protections and a firmer hand on program integrity and efficiency. The takeaway should be about building health plan infrastructure that can keep up with the direction that CMS is heading.
So, what should plans be doing now? We’re entering a summer and fall that will be filled with speculation, potential demonstration programs and policy previews that will shape 2027 and beyond. But 2026 is already defined—and it presents a critical opportunity for health plans to re-evaluate their Stars strategy, challenge current assumptions and reimagine how performance, data and member experience come together. At ProspHire, we’re working with clients to assess Stars readiness from every angle and every function—clinical workflows, data infrastructure, provider engagement and more. In this moment of change, everything should be on the table: new partnerships, new technologies and bold innovations that improve performance and drive sustainable results.
If your team is looking to get ahead of these changes and set the foundation for long-term success, let’s talk. At ProspHire, we have the experience and expertise in the Medicare Advantage and Stars space and the frameworks for evaluating plans capabilities and Stars potential. The way we approach our assessments of plans is comprehensive and wholistic, understanding that Stars success is about the entire health plan not just one team. Gaining a better understanding of your present, in order to prepare for the future will enable long-term success. Change is hard, but the work we do today will define your outcomes of tomorrow.
At ProspHire, social responsibility isn’t just a guiding principle—it’s a fundamental part of who we are. As we work toward our mission to help our clients provide better access to quality healthcare, we recognize that true impact goes beyond our profession. It means actively contributing to the well-being of the communities we serve, particularly those most vulnerable.
One of the most meaningful ways we demonstrate this commitment daily is through our ongoing efforts to improve government programs that provide healthcare to those in greatest need. But our responsibility doesn’t stop there. We understand that healthcare extends beyond policies and programs—it’s about people. That’s why we proudly support the Children’s Hospital of Pittsburgh Child Advocacy Center and its Patient Family Support Fund, which was established and continues to be sustained through ProspHire’s philanthropic support.
During National Child Abuse Prevention Month, we reaffirm our dedication to protecting and advocating for children who have experienced abuse or neglect. The Patient Family Support Fund ensures that the Child Advocacy Center has a dedicated budget to meet the immediate needs of these children—whether it’s providing essential resources, medical care, or emotional support. This initiative reflects our core belief that healthcare is not just about treatment but also about compassion, advocacy and meaningful action.
At ProspHire, social responsibility is not just an obligation, it’s a privilege. It’s the reason we do what we do every day and it’s why we will continue to use our expertise, resources and passion to make a tangible difference in the lives of those who need it most.
Did You Know?
Children living in poverty are significantly more likely to experience abuse or neglect—and over 70% of children involved in child welfare systems are enrolled in Medicaid or CHIP. That’s why our work to strengthen these public programs and support advocacy organizations is so critical to protecting children and ensuring they receive the care and compassion they need.
Social Determinants of Health (SDOH) shape health outcomes more profoundly than clinical care alone, influencing everything from chronic disease prevalence to healthcare utilization. As health plans, providers, and policymakers seek to address health disparities and improve outcomes, the key to success lies in leveraging data to inform targeted, high-impact interventions.
The Data-Driven Imperative
Without reliable data, SDOH interventions risk being broad and inefficient—potentially missing the communities and populations that need support the most. By harnessing robust, localized SDOH data, healthcare stakeholders can design interventions that address specific community needs, ensuring resources are allocated effectively for maximum return on investment (ROI).
The Medicaid Imperative
Medicaid enrollees are disproportionately affected by adverse SDOH, making a data-informed, community-driven strategy particularly critical. With Medicaid managed care organizations (MCOs) increasingly accountable for addressing SDOH, access to granular, zip code-level data—when paired with community input—empowers plans to:
Optimize Resource Allocation: Direct funding to programs with the highest potential for impact, such as housing initiatives or nutrition support.
Enhance Member Engagement: Tailor outreach efforts based on both regional SDOH insights and direct feedback from members about their most pressing needs.
Strengthen Value-Based Care Models: Align interventions with risk-based arrangements, reducing total cost of care while improving quality outcomes.
Pairing Data with Community Engagement
Data alone cannot capture the full context of challenges individuals and communities face. While it provides valuable insights into where disparities exist, it must be combined with community engagement and lived experiences to drive meaningful action. It must be complemented by:
Local Partnerships: Collaborating with community-based organizations (CBOs), faith-based groups and local leaders enables interventions are culturally appropriate and aligned with real needs.
The Voice of the Customer: Engaging directly with Medicaid members and other impacted populations through focus groups, surveys and advisory councils provides firsthand insight into barriers to care and potential solutions.
Flexible, Community-Driven Solutions: A data-informed intervention might indicate a need for increased access to transportation, but without community input, the solution may not be effective—whether due to affordability, scheduling issues or cultural considerations.
Turning Insights into Action
Our newest data insight tool, snapshot shown above, provides health plans, providers and policymakers with the first layer of data and information needed to make strategic, high-impact decisions. By visualizing SDOH indicators at the county level, users can identify gaps and drive toward evidence-based interventions. Success, however, depends on further investigation and the complementing of data insights with strong community partnerships and the voices of those most affected.
At ProspHire we believe we can achieve more equitable health outcomes and drive meaningful change, particularly for those who need it most with our partners.
After the 2026 Final Letter to Issuers was published this January, Issuers likely felt relief that no major changes were in store for the upcoming QHP Certification cycle and 2026 Plan Year. Fast forward to today and the industry is scrambling to digest the 2025 Marketplace Integrity and Affordability Proposed Rule released on March 10th. The proposed rule introduces several changes that could impact ACA Marketplace enrollment and member subsidies.
Barriers to Continued Enrollment
Below are a few of the largest barriers to continued enrollment that members would face under the new Rule:
Satisfying Debt for Past Due Premiums
Today, Issuers are prohibited from taking a member’s current plan year premium and using it to satisfy a previously unpaid premium. In the proposed rule, this direction would be reversed and members could be forced to pay any outstanding debts on top of their new premium prior to receiving coverage.
Eliminating Gross Premium Percentage-Based and Fixed-Dollar Premium Payment Thresholds
Health Plans are allowed to set their own payment thresholds prior to marking a member as “delinquent”. Plans have the autonomy to decide if this threshold is a percentage of the gross premium due (prior to subtracting any government subsidies), percentage of net premium or fixed dollar amount. Under this new rule, Plans would only be able to use a net premium percentage threshold.
For Example:
Gross Premium Percentage Threshold
Member Premium = $1,000
Federal Subsidy = $950
Percentage Threshold = 95% Paid
Member would not become delinquent if they missed a payment as the subsidy would still cover 95% of the bill
Net Premium Percentage Threshold with same premium
Net Premium = $50
Member would have to pay at least $47.50 to avoid delinquency
Shortening Annual Open Enrollment Period
The new rule proposed shortening the annual open enrollment window by a full month, changing the last day to enroll from January 15th to December 15th.
Subsidy Verification
Several measures in the proposed rule aim to increase the difficulty for consumers to obtain and keep federal subsidies. Americans living below 400% Poverty Level currently depend on these subsidies to make ACA Marketplace coverage affordable. Under the new rule, these members would face a higher burden of proof for proving income as well as be required to continually respond to redetermination requests. Failure to comply would result in a reduction or loss in subsidies.
In addition to the barriers consumers will face, this new rule would also put a large administrative burden on Marketplaces and Issuers. Interested to hear how Health Plans will be responding to the request for comments on this Proposal.
How Can ProspHire Help?
At ProspHire, we specialize in navigating complex regulatory changes and optimizing health plan operations. Our team of experts can help your organization:
✅ Assess the Financial and Operational Impact – Understand how these rule changes will affect your enrollment, member retention and subsidy compliance.
✅ Develop Compliance Strategies – Ensure your health plan meets the new regulatory requirements while minimizing disruption to members.
✅ Optimize Member Engagement and Retention – Implement solutions that reduce member churn and improve payment processes under the new thresholds.
✅ Streamline Administrative Processes – Enhance efficiency in handling redeterminations, subsidy verifications, and enrollment period changes.
With our deep expertise in ACA Marketplace strategy, risk adjustment and quality performance, we’re here to help you stay ahead of the curve. Let’s connect to discuss how your health plan can proactively adapt to these changes.
Beginning April 1, 2025, Medicare beneficiaries could face reduced telehealth coverage as the temporary flexibilities introduced during the COVID-19 pandemic expire, unless extensions are approved. These waivers, which allowed expanded access to telehealth services, will no longer be in effect. This shift could lead to access challenges for Medicare beneficiaries, especially those in rural or underserved areas.
A decline in telehealth services could lower beneficiary satisfaction, reduce access to care, significantly impacting key CAHPS measures, hinder gap closure efforts and ultimately overall Star Ratings in some cases.
Impact on Star Ratings
Telehealth Services and HEDIS Performance
The reduction of telehealth coverage for Medicare beneficiaries would directly impact a beneficiaries’ access to care, making it harder for health plans to manage their health. This could lead to delayed chronic condition management and inadequate follow up care, all of which could lower Medicare Star ratings due to poor HEDIS performance. Without telehealth, many beneficiaries may face difficulty accessing these services, leading to unaddressed care gaps and lower performance across multiple HEDIS measures.
Beneficiary Experience CAHPs Impacts
The elimination of telehealth services could potentially lead to beneficiary dissatisfaction and ultimately negatively impact a plan’s overall CAHPs rating due to the following reasons:
Loss of Convenience, Flexibility and Accessibility: Telehealth has provided beneficiaries with flexible, convenient care regardless of location. Its removal forces in-person visits, which may be inaccessible due to distance, transportation, finances, work, caregiving or other barriers.
Longer Wait Times and Delays: Without telehealth, provider availability may become more limited, resulting in longer wait times for appointments. This can cause frustration among beneficiaries seeking timely medical attention.
Quality of Care Perceptions: Beneficiaries who turned to telehealth for routine care, follow up appointments and chronic condition management may feel their care has been downgraded, reducing their satisfaction with the health plan.
Actions for Health Plans to Take Today
Scenario Modeling: Health plans should assess the number of beneficiaries relying on telehealth services to close gaps in HEDIS measures. Gaps that were not closed already may not be closed during the remainder of the year and therefore multiple scenarios should be developed for assessing risk.
Outreach to Impacted Beneficiaries: Health plans should identify beneficiaries who have used telehealth services and proactively reach out to inform them of the upcoming changes. Additionally, they should support beneficiaries in finding alternative care options that best meet their individual needs.
While there is a possibility that the legislation will be extended and telehealth access will continue, it is essential to fully understand the potential implications for your plan. Being proactive and strategically preparing for any changes will ensure you can adapt smoothly and make informed decisions with confidence.
DISCLAIMER: There are currently drafted continuing resolutions to extend waivers through the end of September 2025. If the extension is not approved, certain exceptions will still allow Medicare members to access telehealth, including those based on geographic location and behavioral health needs.
How ProspHire Can Help
Unlock the full potential of telehealth while optimizing your Stars Performance. Partner with ProspHire and Andrew Bell to navigate the complexities with confidence. Let’s drive measurable results together – reach out today.
The Centers for Medicare & Medicaid Services (CMS) has proposed changes to Medicare and Medicaid coverage for glucagon-like peptide-1 (GLP-1) medications, which are currently covered primarily for the treatment of type 2 diabetes. These medications have also gained attention for their effectiveness in managing obesity, although coverage for weight loss remains limited under Medicare and Medicaid today. The intent of this change is to drive improved health outcomes, which could have substantial benefits and downstream impacts, but if enacted, the proposed changes will expand coverage criteria, significantly impacting health plans in quick time.
Evolving CMS Policy on Anti-Obesity Medications
Historically, Medicare Part D excluded coverage for weight loss drugs under a statutory provision allowing Medicaid programs to do the same. CMS reinforced this stance in 2008, clarifying that even non-cosmetic weight loss agents were ineligible for Part D coverage. However, exceptions were made for medications treating conditions like AIDS wasting and cachexia, recognizing their broader therapeutic benefits.
The emergence of GLP-1 drugs, such as Ozempic and Wegovy, has challenged this framework. While originally approved for type 2 diabetes and cardiovascular disease, these drugs have demonstrated significant efficacy for weight loss, fueling public demand and legislative proposals to expand coverage. Medicare already covers GLP-1s for non-weight-loss indications, with spending on Ozempic alone reaching $4.6 billion in 2022. Medicaid policies vary by state, with 13 states covering GLP-1s for obesity as of August 2024.
In response, CMS has proposed a reinterpretation of the statutory exclusion, distinguishing between drugs “used for weight loss” and those “used for the treatment of obesity.” This shift would allow Part D and state Medicaid coverage for anti-obesity medications (AOMs) prescribed specifically for obesity.
Financial Impacts at Federal and State Levels
Federal Level
Increased Spending: Medicare spending on GLP-1 medications could rise by $24–$37 billion over the next several years, depending on the breadth of the coverage expansion and member uptake rates. Medicaid spending could see increases of an estimated $15 billion over the next decade, with significant variability by state.
Cost Offsets: Studies suggest GLP-1 medications can reduce healthcare costs for diabetes-related complications by 20%–30% annually per member. However, it may take several years for these savings to offset initial spending increases.
State Level
Medicaid Budgets: States with high obesity and diabetes prevalence, such as Mississippi and West Virginia, could face disproportionate budget impacts, with projected increases in Medicaid drug spending annually.
State Supplemental Rebates: States may need to renegotiate rebate agreements, with some states potentially achieving savings of up to 15% on GLP-1 medication costs through innovative pricing models such as outcomes-based contracts.
Anticipated Utilization Increases
Expanded Eligibility: Coverage for obesity treatment could lead to a 40%–60% increase in GLP-1 utilization over the first two years, with an estimated 1.5–2.5 million additional beneficiaries initiating therapy annually across Medicare and Medicaid. An estimated 3.4 million Medicare beneficiaries and 4 million Medicaid beneficiaries could benefit.
Chronic Disease Management: Increased use of GLP-1 medications may reduce the incidence of diabetes-related hospitalizations by 10%–15% and cardiovascular events by up to 20%, improving long-term population health outcomes.
Provider Demand: Endocrinologists, dietitians and primary care physicians may experience appointment volume increases as patients seek guidance and prescriptions for GLP-1 therapies.
Cost Impacts to Health Plans
Rising Pharmacy Costs: Health plans could face a 20%–35% increase in overall pharmacy spending for members with diabetes or obesity.
Formulary Management: Expanding coverage criteria will require plans to refine formularies, potentially increasing formulary-related administrative costs.
Risk Adjustment: Accurate coding and risk adjustment will become critical, with plans needing to account for increased annual GLP-1 costs per member.
Operational Impacts
Care Management Programs: Plans must scale care management programs to handle up to 30% more members receiving GLP-1 prescriptions, requiring investment in digital tools and personnel.
Prior Authorization Processes: Prior authorization requests for GLP-1 medications may double, prompting the need for enhanced automation and workflow efficiency.
Member Communication: Plans must prepare targeted outreach campaigns members potentially eligible for expanded GLP-1 coverage.
Provider Networks: Expanding network capacity to manage increased GLP-1 demand could require adding providers in key specialties like endocrinology and primary care.
How ProspHire Can Help
ProspHire brings expertise in navigating regulatory changes and optimizing health plan operations. We offer:
Financial Impact Analysis: Forecasting cost impacts and developing mitigation strategies.
Formulary Strategy: Supporting formulary adjustments to balance compliance and cost containment.
Utilization Management: Designing efficient prior authorization and care management processes tailored to GLP-1 medications.
Stakeholder Engagement: Building robust communication frameworks for members, providers and regulatory bodies.
With ProspHire’s guidance, health plans can navigate the complexities of CMS’s proposed changes with confidence, ensuring financial sustainability while delivering improved member outcomes.
In recent years, the health insurance industry has witnessed a profound shift towards harnessing artificial intelligence (AI) to streamline operations and enhance service delivery. At ProspHire, we are at the forefront of this transformative wave, leveraging AI-enabled process reengineering to drive unprecedented improvements in efficiency, accuracy and customer experience.
Enhanced Efficiency Through AI
AI’s ability to analyze vast amounts of data with speed and precision has revolutionized how health insurers manage administrative processes. Tasks that once consumed valuable time and resources are now automated, allowing teams to focus on more strategic initiatives. Whether it’s claims processing, member enrollment or provider management, AI has optimized workflows, reduced operational costs and accelerated decision-making processes.
Precision and Accuracy in Decision-Making
The accuracy of decisions in health insurance is paramount. AI algorithms, trained on historical data and equipped with machine learning capabilities, have significantly enhanced the accuracy of risk assessments, fraud detection and claims adjudication. This precision not only minimizes errors but also improves compliance with regulatory requirements, ensuring that insurers can confidently deliver on their promises to stakeholders.
Elevating Consumer Experience
Consumer expectations in healthcare are evolving, demanding personalized experiences and seamless interactions with insurers. AI-powered tools, such as chatbots and predictive analytics, enable proactive customer engagement, personalized recommendations and real-time support. By understanding consumer behaviors and preferences, insurers can tailor their services, anticipate needs and enhance overall satisfaction.
The Future of AI in Health Insurance
Looking ahead, AI’s role in health insurance will continue to expand. From predictive modeling for disease management to optimizing network management and beyond, AI promises to unlock new opportunities for innovation and efficiency. At ProspHire, we remain committed to driving this transformation, empowering insurers to navigate complexities and deliver exceptional value to their stakeholders.
In conclusion, AI-enabled process reengineering represents more than a technological advancement—it is a catalyst for profound industry-wide transformation. As we embrace AI at ProspHire, we are excited about the possibilities it brings to revolutionize the health insurance landscape, ensuring sustainable growth and improved outcomes for all.
How Can ProspHire Help?
At ProspHire, we specialize in helping health insurers leverage AI-driven process reengineering to maximize efficiency, improve accuracy, and enhance customer engagement. Our expert consultants bring deep industry knowledge and technical expertise to ensure a seamless AI integration that aligns with your strategic goals.
✅ AI Strategy & Implementation – We assess your current processes and develop AI-driven solutions tailored to your needs. ✅ Operational Efficiency Optimization – Our team helps automate manual workflows, reducing costs and improving productivity. ✅ Advanced Analytics & Risk Management – We implement AI-driven risk assessment models to enhance error detection and compliance. ✅ Customer-Centric AI Solutions – We enable personalized customer interactions and improved retention. By partnering with ProspHire, health insurers can confidently navigate AI transformation, unlocking new efficiencies and delivering superior member experiences. Let’s shape the future of health insurance together!
ProspHire brings a wealth of expertise and insights into the dynamic field of Dental Practice Management. We’re talking with Practice Leader Luke Laurin and diving into the strategies, challenges and innovation that shape the modern dental landscape.
What are the current trends and challenges in Dental Practice Management?
There are several trends we are seeing:
Increased focus on preventive care and oral health education with patients to reduce the need for more invasive treatments. There’s more emphasis on prevention rather than just treatment.
Greater use of digital technologies like integrative practice management systems (PMS), digital imaging, digital impressions and scans, digital treatment planning and AI. This includes technologies like CAD/CAM for restorations.
Rising popularity of cosmetic dentistry procedures like teeth whitening and veneers driven by greater consumer focus on dental aesthetics and appearance.
Use of minimally invasive techniques and materials to preserve more natural tooth structure whenever possible. Less drilling and removing of tooth material.
Growing use and integration of dental implants to replace missing teeth and provide anchor points for replacements like bridges and dentures.
We are also seeing a number of challenges:
Practices are aiming to control costs, reduce overhead expenses and manage lower insurance reimbursement rates. Not focusing on these challenges can impact profitability and the ability to reinvest into implementing new technology at the clinic.
It is challenging to keep up with rapidly evolving technologies and integrate them into the dental office and workflow. Additionally, there are significant learning curves with clinic employees and DSO support staff.
The increasing amount of student debt for new dentists makes it harder for them to purchase and finance a practice.
Increases in the cost of capital have led to a slowing in acquisition activity and lowering ROI, forcing some to consolidate practices.
There are ongoing shortages of non-dental healthcare workers like dental assistants and hygienists in many areas. This makes it harder to adequately staff practices.
How does ProspHire support dental practices?
ProspHire’s Dental Management Practice team addresses challenges for our dental clients with innovative solutions that help streamline practice/administrative processes, improve communication and collaboration between DSOs and practices, ensure compliance, enhance revenue cycle management and bolster your reporting capabilities. We partner with you and your vendors to implement standard solutions that are fine-tuned to your unique way of operating dental practices.
Here are some of the ways we can support you through PMS implementation and optimization:
Lead Implementation, Training and Go-Live Support
Conduct training sessions (both online and in-person if possible) for staff on using the new software, focusing on workflows, key features and basics.
Provide user manuals and standard operating procedure guides for workflows that are changing.
Offer onsite go-live support when transitioning from old system to new PMS, having IT staff/PSM vendor on-site to help troubleshoot issues in real time.
Set up feedback channels to gather input on challenges or questions about the system post implementation and provide timely responses.
Optimization Assistance
Review initial workflows set up in the PMS and work with practice to optimize these based on how the staff actually uses the software. Look for unnecessary steps and correct user behavior
Examine reporting needs and ensure correct reports are being generated and used to support decision making around patient care, inventory, billing etc. Set up new reports as needed
Conduct usage reviews to identify additional PMS features that could streamline workflows. Offer recommendations and end-user training.
Ongoing Support
Field staff questions and respond to system issues. This includes troubleshooting error messages, fixing configuration bugs, resolving login issues etc.
Set up system for feature requests/enhancement suggestions from dental practice and prioritize these change requests based on impact to operations and effort required to complete.
Maintain PMS with regular software patches, updates and bug fixes to improve stability and performance and provide release notes of changes to end-user community.
Workflow Redesign and Improvement
Discovery, Analysis and Redesign
Conduct interviews and shadow staff to map out current workflows, identify bottlenecks and improvement opportunities.
Review relevant metrics and key performance indicators (production, patient cycle time etc.).
Document findings in process maps and improvement recommendations report.
Facilitate working sessions with dentists and staff to redesign workflows based on findings.
Consider opportunities to standardize processes, eliminate non-value steps and improve technology integration.
Develop updated process documentation and job aids once new workflows are finalized.
Workflow Implementation
Provide staff training on changes to workflows, systems and responsibilities.
Ensure forms, checklists and other documents align to support new workflows.
Project team members remain available onsite during rollout to answer questions and resolve transition issues.
Ongoing Workflow Refinement
Gather staff feedback regularly post-implementation to identify remaining pain points.
Continuously review metrics for target areas not yet hitting goals and make minor tweaks.
Conduct refresher training on updated workflows if major gaps are observed.
Clinical Operations Management
Staffing & Scheduling
Help dental practices create schedules that maximize provider time while ensuring adequate coverage for projected patient demand. Adjust as needed based on cancellations, no-shows, emergencies, etc.
Develop a staffing plan tied to a schedule that allows for proper patient handoffs, task distribution across dental assistants and hygienists and coordination with front office team.
Patient Flow & Experience
Review office layout and patient flow to identify opportunities to improve bottlenecks and lag times and provide recommendations.
Ensure schedule allows sufficient time for procedures while avoiding excessively long patient cycle times. Adjust slots if needed.
Offer front-office optimizations for phone interactions and in-office exchanges to deliver positive patient experiences and that correct information is collected during scheduling and registration.
Quality & Safety Protocols
Provide templates for clinical operation policies and protocols around infection control, medical emergencies, documentation etc.
Implement checklists and reminders to verify compliance with dental regulations and quality control procedures.
Coordinate OSHA and HIPAA training logistics with practice safety officer.
Performance Reporting
Help leadership define relevant KPIs to track patient access, cycle time, cancellation rate, procedure volume etc.
Set up dashboards and automated reporting to distribute for consistent monitoring of operational performance.
Identify areas not meeting targets and facilitate problem-solving initiatives to resolve.
Can you share an example of a successful cost-saving measure or revenue enhancement strategy you’ve advised dental practices to adopt?
One effective strategy is the adoption of modern technologies to streamline operations, enhance patient experience and improve overall efficiency. While the initial investment in technology may seem significant, the long-term benefits often outweigh the costs. Improved efficiency and patient satisfaction can lead to increased revenue and reduced operational costs contribute to overall savings. It’s essential for dental practices to carefully evaluate their specific needs and select technologies that align with their goals and patient demographics.
Additional examples of cost-saving revenue enhancements include:
Offer cosmetic dentistry or whitening services. These are often paid directly out-of-pocket so increase profitability.
Provide membership plans tied to regular exams and preventive care. Steady recurring revenue stream.
Upsell elective procedures during checkups. Many patients don’t think of upgrades until prompted.
Expand social media marketing and online reputation management. Drives new patient growth and better word-of-mouth.
Offer patient financing plans through vendors. Increases ability for patients to purchase bigger ticket treatments.
Pay attention to legacy AR and devote a task force / team-based approach.
How do you stay up to date with the latest industry trends and best practices in dental practice management?
Staying informed is an ongoing process and a combination of these is often the most effective approach: regularly reviewing materials and guidance from ADA and state/local dental associations; attending major dental conventions and conferences; meeting with technology vendors for software previews and demos of emerging tools and shadowing dental contacts in their cutting-edge practices. It’s crucial to assess the credibility of the information sources and tailor efforts to the specific needs and goals of the dental practice.
What is your approach to helping dental practices streamline their administrative and operational processes to improve efficiency?
Here is a comprehensive approach I would recommend to help dental practices streamline processes and enhance efficiency:
Ensure accurate CDT coding for maximum insurance reimbursement
Provide ongoing coding education to billing staff
Strategize Staffing Plans and Roles
Cross-train where helpful to increase flexibility
Consider expanded roles for hygienists and assistants
Track KPIs for Continuous Improvement
Key metrics like chair utilization, case acceptance rates, accounts receivable
Make adjustments based on practice data
Implementing these strategies requires a collaborative effort and a commitment to ongoing improvement. Regularly reassess and adjust processes based on feedback, technological advancements and changes in industry standards to ensure long-term efficiency gains.
In what ways do you guide dental practices in ensuring compliance with industry regulations and maintaining high standards of patient care?
Maintaining rigorous compliance and high care standards is a top priority when supporting dental practices and ProspHire can play a crucial role in guiding the practices to ensure compliance with industry regulations and maintain high standards of patient care. Here are some of the ways we can support:
Stay constantly up to date on changing regulations from OSHA, CDC, ADA and state dental boards and relay important updates to the practice.
Conduct regular reviews with the practice to identify any areas of vulnerability or gaps related to infection control, radiography safety, data security, etc and develop action plans.
Develop easy-to-follow protocol guidelines and visual aids for display in clinics regarding proper PPE use, disinfection techniques, etc.
Schedule annual or bi-annual practice infection control audits using established assessment frameworks to systematically identify opportunities.
Monitor patient review/rating platforms along with internal surveys to benchmark satisfaction and care experience.
Develop staff continuing education curriculums covering both hard and soft skills to reinforce stellar care delivery.
Guide the design and scheduling of clinical spaces to allow abundant time for complete sterilization/disinfection between patients.
Ensure clarity on latest regulations around digital patient record storage systems including frequent encrypted backups.
Update informed consent forms and advise on appropriate patient documentation procedures.
Promote high standards by comparing the practice against quantified benchmarks on key parameters.
ProspHire’s Dental Practice Management team can empower dental practices to navigate complex regulatory landscapes, uphold high standards of patient care and implement continuous improvement processes. This collaborative approach helps practices not only meet regulatory requirements but also excel in delivering quality dental services.
What key performance indicators do you use to measure the success and progress of dental practices you work with?
Measuring the success and progress of a dental practice involves tracking key performance indicators (KPIs) that reflect various aspects of the practice’s operations, financial health and patient satisfaction. Here are some key performance indicators that we recommend assessing the success and progress of dental practices, including clinical and operational metrics:
Clinical KPIs:
Treatment acceptance rates – % of recommended procedures ultimately performed
New patient conversion rates – % that schedule follow-up from inquiries
Recall compliance rates – % of patients following maintenance intervals
Cancelation and no-show rates
Patient retention rates year-over-year
Operational KPIs:
Production per provider/hygienist – tracks revenue contribution
Accounts receivable days outstanding – gauge collection efficiency
Patient wait times – ensures prompt service
Schedule effectiveness – measures how well appointment slots are filled
Cost per patient visit – manages practice overhead
Rating platform reviews and survey feedback – indicates patient satisfaction
We collaborate with dentists to determine the optimum targets for each KPI based on practice goals and then build customized dashboards that compile the data points from electronic records, billing systems and patient platforms to allow for clear tracking over time. Reviewing the insights together enables data-driven decisions to continuously refine strategies and operations.
How do you tailor consulting services to meet the unique needs and goals of each dental practice you serve?
Our approach always starts with developing a deep understanding of each dental practice’s unique set of circumstances, priorities and objectives. From there, tailoring the unique needs and goals of each practice is essential for providing effective guidance and support. Here are a few key steps and strategies:
Goal-setting collaborations – Facilitate sessions to define practice vision, targets for growth/profitability, areas for improvement.
Custom practice analyses – Conduct assessments aligned to established goals, focused specifically on SWOT variables, operations data, patient metrics.
Targeted execution planning – Develop strategies and detailed project plans based directly on the practice’s most pressing identified opportunities.
Personalized coaching services – Provide regular guidance aligned to practice strengths, culture and growth pace, adjusting as dynamics shift.
Differentiated reporting tools – Design KPI dashboards indexing indicators like production, collections, ratings etc. per the practice’s key areas of focus.
Hand-picked recommendations – Curate technologies, solutions and vendor partnerships appropriately suited to support the practice’s priorities.
Ongoing innovation – Continually suggest fresh, relevant ideas tailored to the practice’s evolving objectives.
The most impactful solutions emerge when every aspect stems from a complete understanding of the practice’s unique starting point challenges and aspirations for the future. Our personalized approach enhances the likelihood of successful outcomes and long-term collaboration.
How is ProspHire positioned to assist dental practices to stay ahead of the industry curve?
We aim to help dental practices stay ahead of the industry curve by providing tailored solutions from strategic planning to technology integration to performance optimization to staff training and development. The combination of broad industry perspective and personalized practice partnership enables us keep clients on the cutting edge.
Connect with us today for more details on our services, methodologies and industry-specific expertise.
Healthcare faces constant scrutiny due to ever-changing industry regulations. Healthcare compliance necessitates adherence to ethical, legal and professional standards. These regulations increase patient and consumer safety by preventing abuse, fraud and waste. A strong culture of compliance is a proactive and continuous commitment to not only meeting regulatory requirements but also safeguarding the organization’s reputation and fostering ethical conduct.
Healthcare providers and insurers must stay ahead of evolving regulations and develop strong compliance strategies. Noncompliance can result in penalties, license revocation, sanctions, business cessation and patient and consumer risks.
This guide explores key regulatory changes and how organizations can ensure compliance.
The Importance of Regulatory Compliance in the Healthcare Industry
Regulatory compliance in healthcare is essential because it ensures safe, quality patient care. Healthcare regulations apply to all healthcare enterprises, including hospitals, practices, insurers and pharmacies. Complying with healthcare regulations is critical for the following reasons:
Avoids legal risks: Healthcare organizations must adhere to local, state and federal laws. Legal violations can lead to patient lawsuits or imprisonment.
Improves patient care: Regulations set safety and infection control measures for patient safety.
Ensures protected health information (PHI): Medical records contain patients’ sensitive data. Healthcare institutions must follow privacy and security standards to prevent unauthorized access.
Enhances reputation: Adhering to best practices enhances an organization’s trustworthiness and reputation.
Prevents financial loss: The cost of noncompliance is higher than imposed fines. Sanctions or license revocation can cause service disruption that impacts revenue.
Significant Healthcare Regulatory Bodies
Key regulatory bodies govern healthcare industry standards. These include the following:
Centers for Medicare & Medicaid Services (CMS): Regulates Medicare, Medicaid and related policies.
Food and Drug Administration (FDA): Ensures the safety of medical devices, drugs, and food.
Occupational Safety and Health Administration (OSHA): OSHA governs safe and healthy working conditions for healthcare workers and other employees. Healthcare workers face unique safety hazards. OSHA enforces standards around biological waste, chemical exposure and bloodborne pathogens.
State Insurance Commissions and Inspectors General regulate and oversee healthcare and insurance markets, as well as related policies, to enhance the efficiency and integrity of healthcare programs.
Fundamental Regulatory Changes Affecting Healthcare Organizations
Recent changes in healthcare regulations address healthcare transactions. Many changes in the first quarter of 2024 focused on healthcare transactions. Noteworthy developments include:
Transaction Review Laws
States have adopted healthcare transaction legislation on access, quality, competition and need impacts. The definition of “material transactions” may differ depending on the state.
Healthcare transaction review laws require:
Prior approval for some transactions based on due diligence.
Long timelines for the relevant bodies to review transactions.
Consideration of proposed transaction cost, competition, access and equity.
Transparency on all aspects of a healthcare transaction, including divulging all parties involved.
CMS Broker Rule and 80/20 Rule
In April 2024, CMS published the Medicare Advantage and Part D Final Rule. The rule increased guardrails in many programs, including the Medicare Advantage and Cost Plan. Part of the rule included a cap on broker compensation. This limit prevents brokers from guiding patients to specific plans for financial incentives.
CMS released the Ensuring Access to Medicaid Services Final Rule. The rule states that 80% of Medicaid payments for home health services must go to care workers instead of overheads or profit.
Laboratory-Developed Tests Final Rule
Another legislative release in April 2024 was the FDA’s final rule on laboratory-developed tests (LDTs). LDTs are diagnostic tests developed and validated in-house by laboratories. The regulation amends in vitro diagnostic (IVD) products to fall under the Federal Food, Drug, and Cosmetic (FD&C) Act. This amendment phases out the FDA’s previous approach of discretion. It aims to ensure that LDTs are safe and effective for clinical use.
Evolving Telehealth Regulations
Since the COVID-19 pandemic, telehealth has shifted from a secondary to a primary healthcare choice. Regulations have risen to meet this shift:
Payment parity: Some states require insurers to reimburse telehealth at the same rate as in-person visits. This differs from service parity, which requires the same services for in-person and telehealth.
Licensure: States have specific regulations for providing telehealth services across state lines. Some, such as California, have exceptions, such as treatment for life-threatening illnesses. Other states, like Florida, have registration processes for external providers.
Safe: Prioritizing patient safety in care and service delivery
Effective: Allocating care to those who need it and refraining from misuse
Patient-centered: Considering the patient’s needs in all care decisions
Timely: Preventing delays or lengthy wait times
Efficient: Using resources in a way that avoids waste
Equitable: Equal care provided regardless of demographics or socioeconomic status
These metrics help healthcare entities ensure quality and meet changing regulations.
The Impact of Regulatory Changes in the Healthcare Landscape
Each regulatory change brings unique challenges and opportunities to healthcare. Organizations must adapt or risk noncompliance.
Challenges Posed by Changes
Shifting regulations can pose obstacles for healthcare providers, including:
High compliance costs: Adapting to changing regulations can mean spending funds on new systems, training or data handling.
Administrative burden: Updating policies, procedures or practices requires time and administrative effort.
Service impact: Evolving healthcare standards can impact the services offered. The COVID-19 pandemic increased the use of telehealth and virtual consultations.
Noncompliance penalties: Organizations may face fines or lost business due to brand damage.
Pricing revisions: Regulations may require changes to pricing strategies. Healthcare organizations with Medicare patients must account for changing Medicare reimbursement rates.
Increased risk management: New standards introduce compliance, financial and operational risks. The shift to value-based care models in the U.S. requires healthcare providers to prioritize care quality over volume.
Staff training: Healthcare employees need ongoing training to keep updated with regulatory changes. Training involves costs and operational disruption.
Technology adoption: Regulations mandate technologies like EHRs (HITECH) and data security measures (HIPAA). To comply, healthcare organizations must adopt these technologies. New systems come at an expense and require training.
Opportunities Created by Changes
If healthcare organizations can navigate the obstacles, changing regulations present significant opportunities:
Improved patient care: Complying with regulations increases patient safety and satisfaction. Strict controls mean lower infection rates with better quality care.
Enhanced data security: Data privacy laws lower breach risks, safeguarding patients and organizations. Security measures restrict unauthorized access.
Competitive advantage: Effective compliance makes healthcare organizations stand out from competitors. Regulations level the playing field. Providers who use sneaky practices to win patients risk the consequences.
Streamlined operations: Advanced healthcare technology can increase efficiency, boost productivity and reduce errors.
New revenue opportunities: Expanding services can create additional revenue streams for practices.
Increased brand reputation: Following compliance and ethical best practices enhances brand reputation. Compliant healthcare organizations that provide high-quality care gain more patient trust.
Collaboration benefits: Regulations can foster partnerships with entities like EHR compliance-focused IT firms. These partnerships offer knowledge not available internally. Collaboration can open up new markets and make it easier to adapt to regulatory changes.
How to Create an Effective Compliance Program
A compliance program is a set of policies and processes to ensure healthcare organizations follow relevant laws. This program helps prevent, detect and correct regulatory noncompliance.
Follow these best practices for a successful compliance program:
1. Establish Procedures, Policies and Conduct Standards
The first step in creating a compliance program is identifying which regulations apply. The second step is evaluating the existing compliance measures. Following this assessment, formulate a plan to address any gaps. Policies and procedures establish guidelines for compliance. They should be straightforward, easy to understand and communicated to all staff. Below are examples of what to include:
Compliance responsibilities: Outline roles for compliance officers, the compliance committee, management and staff.
Program structure: Describe the program’s operations, including reporting procedures, compliance resolutions and monitoring.
Success measures: Determine methods to measure program effectiveness.
2. Assign a Compliance Officer and Committee
HIPAA regulations mandate healthcare providers to appoint a privacy officer. The compliance officer ensures the organization complies with internal and external standards. A compliance committee of individuals with diverse backgrounds supports the officer. The compliance officer and committee administer the program together. They should hold regular meetings to discuss regulation updates, reporting and compliance enforcement.
3. Train and Educate Staff
All healthcare staff must receive continuous training on compliance and regulatory updates. HIPAA’s Privacy Rule mandates training staff on policies, procedures and security awareness. This education ensures staff and management understand expectations and codes of conduct. Any vendors or associated partners should also understand compliance standards.
4. Develop a Communication Strategy
Creating open channels of communication is essential for both top-down and bottom-up communication. This way, staff remain aware of regulation updates and can report compliance issues.
A strong communication plan should include:
The process for reporting compliance issues.
Methods for anonymous reporting, such as a hotline.
A log for reported compliance issues.
5. Monitor and Audit
A healthcare compliance program doesn’t mean automatic compliance. Regular program assessments ensure compliance with the relevant laws, rules and regulations. Monitoring and auditing serve different objectives:
Monitoring: Internal reviews assess procedure effectiveness and identify potential issues. Problems uncovered while monitoring may lead to an audit for further investigation.
Auditing: This process involves deep-diving into specific areas of concern and using measures to assess compliance. An audit looks into how or why issues occur.
Healthcare organizations must enforce compliance violations or noncompliant behavior through appropriate disciplinary measures. The consequences must be consistent and well-communicated. A disciplinary policy detailing transgression mechanisms must be accessible to all staff.
7. Respond Fast and Take Corrective Action
Prompt responses and corrective actions address ineffective policies, compliance violations or data breaches. Quick correction of identified issues can prevent penalties or legal action. Corrective actions may include disciplinary action, overpayment recovery or policy updates.
8. Stay Informed About Regulatory Updates
Keeping updated on the latest trends and changes helps keep your organization compliant.
Several tips to stay informed include:
Subscribe to regulatory body newsletters, like the HIPAA Journal, or set up Google Alerts for specific regulations.
Network with industry professionals at conferences, webinars or on social media platforms.
Consult with compliance experts, whether internal or external.
Why Trust ProspHire for Healthcare Regulatory Compliance?
ProspHire’s sole focus is healthcare. Since 2015, we have built a team of experts experienced in both public and private healthcare. With our extensive industry knowledge, we help our healthcare clients meet regulatory changes. Our areas of expertise include Medicaid practice, ACA planning, dental practice management and Stars performance improvement.
A recent example illustrates our compliance expertise. A large Pennsylvania managed care organization (MCO) had to achieve CMS document compliance. ProspHire assessed existing processes, established formal governance and implemented an operating model. We developed a Required Documents Program and Program Toolkit that defined processes. The result? The client achieved document compliance, saved costs and satisfied members.
Let ProspHire Help You Meet Regulatory Requirements
Healthcare organizations can find it challenging to stay updated with changing regulations. At ProspHire, healthcare is our passion. Our team anticipates healthcare regulation changes to offer effective compliance strategies. We customize our solutions to meet your organization’s unique needs.
There’s a reason ProspHire has appeared on Inc. Magazine’s annual list of America’s Fastest-Growing Private Companies five years in a row. Our people-first culture and exceptional customer service drive our continuous growth.
Many healthcare organizations implement technology to enhance patient care or consumer engagement. However, implementing new technology is also a powerful strategy for improving operational efficiency, streamlining project delivery and prioritizing collaboration. These improvements can lead to cost savings and more satisfied patients, making technology a worthwhile investment.
Read on to discover various emerging technologies within healthcare that can help your business complete projects, stay competitive and provide quality care.
What Is Project Delivery in Healthcare?
Healthcare project delivery refers to planning and executing projects for healthcare organizations. Projects can include initiatives that improve facilities, processes, technology, systems and services. The goal of project delivery is to implement projects that modernize your business, improve communications and decision making, improve quality and timeliness and help you provide improved patient care.
Successful project delivery can streamline business operations, reduce compliance risk, save employees time, improve service offerings and provide quality care to patients. However, the success of a project lies in its implementation. With the right tools and processes, you can deliver projects on time, within budget and with minimal disruptions. Technology is a key factor in achieving this outcome.
Current Challenges in Project Delivery for Healthcare Providers
Despite the necessity and benefits of healthcare projects, businesses often face many challenges throughout the project delivery process. Some of these include:
Project complexity: The sheer scale and scope of some healthcare projects can make delivery challenging. Miscommunication can happen when coordinating various departments, resulting in delays and failure to meet project objectives.
Regulatory compliance: During project delivery, healthcare providers must comply with rules, regulations and standards. The number of regulations and how often they change make staying compliant challenging.
Stakeholder coordination: Healthcare providers must receive buy-in from several stakeholders before beginning a project. Managing each stakeholder’s expectations and coordinating with them throughout project delivery can be difficult.
Budget constraints: Healthcare projects often have large budgets and resource requirements. Acquiring funds and allocating sufficient resources for projects are two of the biggest project delivery challenges.
Need for data: Project success often relies on the collection of accurate and timely data. Without it, tracking project progress and determining goal alignment becomes a challenge. Outdated systems and technology are often to blame for data issues.
Emerging Technologies in Healthcare
Emerging technology is any technological innovation that is gaining traction but has yet to realize its full potential. This includes current and old technology that people are discovering new applications for. Your business can take advantage of the following emerging technologies to overcome project delivery challenges and streamline project management.
1. Telemedicine and Telehealth
Telehealth broadly refers to remote health services that use communication technology to enable long-distance provider and patient contact. A subsection of telehealth is telemedicine, which doctors use to provide virtual care to patients. Telemedicine and telehealth are revolutionary for patient care, as patients can receive medical services regardless of bad weather, mobility limitations, poor access to healthcare and other obstacles.
Telehealth technology and software make offering patients remote services a breeze. This technology allows your staff to collaborate and work from various locations. It can speed up administrative processes related to these services, saving them time. Most telehealth software also includes integrated data management tools. Staff can quickly collect and analyze essential patient information, and patients can access a portal to view their important information quickly and easily.
Telehealth also allows specialized physicians to connect with and assess patients who may be experiencing a medical emergency. For example, neurologists from around the country use telehealth to assess possible stroke patients quickly and efficiently without making them wait for a physician to be available in person.
2. Artificial Intelligence and Machine Learning
Artificial intelligence (AI) can simulate human thought processes. It encompasses various subsets, including generative AI and machine learning (ML). AI is most beneficial in healthcare for quickly analyzing large data sets that would previously take a long time to assess. The time savings alone help healthcare providers reduce the administrative burden on staff and encourage them to use data to make more informed decisions.
AI is also beneficial for project delivery. Most AI and ML solutions can analyze historical data and provide accurate predictive analytics. Predictive analytics allow you to predict future events or trends, such as staffing needs, patient admissions and resource utilization. With this information, you can identify and address project delivery challenges or disruptions before they occur.
3. Project Management Software
Project management software is a must for healthcare project delivery. This software is designed to make creating project plans, managing resources and tracking progress simple. Most project management software provides a centralized place for project timelines, tasks, budgets and objectives. With everything in one place, all stakeholders have access to the same up-to-date project information.
Project management software often has built-in communication tools that facilitate team collaboration and prevent human error related to communicating with various providers. Improved communication and collaboration can eliminate confusion, reduce conflict and increase the chances of project success.
Software can often integrate seamlessly with other healthcare systems to enable seamless data transfer and streamline workflows.
4. Internet of Medical Things and Wearable Technology
The Internet of Medical Things (IoMT) refers to medical devices — with sensors and software — that collect data and communicate with each other over a network. IoMT often refers to wearable devices patients can use to track health and fitness data. The device can send this data to a patient’s healthcare provider, allowing them to monitor their health remotely.
For example, some devices can monitor irregular heart rhythms to decrease hospital stay and help prevent readmission. Wearable devices can also be used in hospital settings to assess a patient’s vital signs and automatically upload them to their chart. This saves time and allows for closer monitoring.
Beyond patient monitoring, healthcare providers can also use IoMT devices to manage resources. Smart devices can attach to medical equipment and other resources, allowing you to track their status and location. Having access to real-time patient and resource data is pivotal to project delivery. It enables staff to make informed decisions quickly, increasing efficiency and reducing the chance of mistakes that often derail project timelines.
5. Electronic Medical Records
Gone are the days of physical medical records. Today, healthcare professionals can use electronic medical records (EMRs) — also called electronic health records (EHRs) — to record and store patient data in the cloud. In addition to saving staff time, EMRs protect patient data and help practices comply with privacy laws.
The digitization of health records benefits patients because it means their information is readily accessible and sharable, which can contribute to more accurate and timely diagnoses. For healthcare providers, EHRs are vital to efficiency and on-time project delivery. Having easy access to data allows staff to easily create, access and share patient information. Digital health records can also integrate with other systems, improving workflow, cross-departmental communication and care delivery.
Why Trust ProspHire to Implement New Technology?
ProspHire is a leading national management consulting firm dedicated to transforming healthcare businesses. We specialize in optimizing project delivery and implementing new technology. Our team consists of certified Project Management Professionals, Six Sigma Green Belts, Scrum Masters and Product Owners. We’ll work closely with your business and its stakeholders to understand expectations, tackle operational challenges and meet long-term goals.
Don’t just take our word for it — check out what our clients have to say. One of our clients recently required assistance with their care management system. Their old system involved manual processes that were time-consuming and inefficient. The ProspHire team conducted a current state assessment and collaborated with key stakeholders to establish the requirements for a new care management system.
Our partnership resulted in their first multistate clinical software platform. Thanks to automated workflows, enhanced analytics and a better member experience, they saw improvements in their overall efficiency.
Collaborate With ProspHire Today
We work tirelessly to provide consistent and reliable results for all our clients and look forward to doing the same for your business. If you’re ready to implement new technologies and achieve your organizational goals, fill in our online contact form. A member of our team will be in touch to discuss your requirements further.
