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The Centers for Medicare & Medicaid Services (CMS) is the largest health-care organization in the US, serving approximately 90 million beneficiaries. CMS is charged with administering health-care services, including hospitalizations, physicians’ visits and prescription drugs through a network of pharmacists and PBMs; health plans, including Medicare Advantage organizations; and health-care providers.
Health plans regulated under CMS face difficult challenges to ensure quality health-care coverage and assure member satisfaction. Today’s health plans are squeezed by tight budgets and shrinking reimbursement rates, strong competition from other plans, escalating regulatory requirements and intense scrutiny from legislators, public advocacy groups and members with high expectations for service.
UL helps health plans meet the critical goals of cost efficiency, regulatory compliance and member satisfaction. We provide services, knowledge assets and technologies for enterprise-wide performance and compliance with requirements, including those related to Medicare Advantage, Medicare Part D, HIPAA, marketing and sales and ethics. Training can be cost effectively extended to downstream entities, including brokers and agents, to manage supply chains and meet flow-down requirements. Additionally, UL maintains an alliance with the Pharmacy Benefit Management Institute (PBMI) to provide learning services for professionals involved in the delivery of drug benefit programs.
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