COPE Health Solutions

Every health plan has a complex care management program. Almost none of them are reaching the members who drive the spend. Look at who's actually enrolled: members who answer the phone. Members who attend appointments. Members who respond to mailers. Members already connected to the system. Now look at who's generating the emergency department visits, the readmissions, the unplanned utilization. Different list. That's the engagement gap, and it isn't a strategy problem or a software problem. It's a reach problem. Phone calls, letters, and portal messages work for reachable members. They don't work for someone without stable housing, without transportation, without trust in the health system, or without the plan's primary language. These members aren't non-compliant. They're unreachable within a remote model. Check out our first article in a four-part series on closing that gap: https://lnkd.in/g8CyiKuR

Health plans are heading into 2027 with more moving at once than at any point in the last decade: tighter risk adjustment rules, rising utilization, Medicaid funding cuts, PBM reform and a wave of market exits. Swipe through for what's changing, and six moves resilient plans are making now.

Join us October 6 for a webinar hosted by the Association for Community Affiliated Plans on what Medicare Advantage leaders should be evaluating right now, while definitive CMS guidance on measures affected by recent litigation is still outstanding and bid, quality, and product decisions can't wait. 📆 October 6 🕐 2 p.m. ET 📍 Register here: https://lnkd.in/gAFG-Yip

Wednesday was a wonderful evening spent with friends and colleagues at "The Value Agenda: Trends Transforming Healthcare in the New York Market," an event we hosted with our colleagues at Ropes & Gray. Thank you to all who joined us and special thanks to our guest speakers: Theresa Dreyer, Brett R. Friedman, Errol L Pierre, Jing Shui, and Arthur Gianelli, MA, MBA, MPH, FACHE. As our CEO Allen Miller noted, what was clear from the discussion is the weight of the moment we're in. Federal policy, Medicaid financing, Medicare Advantage economics, the future of social care funding, the pace of technology and AI — these are not separate pressures arriving one at a time. They are converging on the same organizations at once. Very little about the next three years will look like the last ten, and the decisions being made right now, in this quarter, will determine who is positioned well on the other side of it. We look forward to bringing everyone together again soon.

Webinar | October 6 | Stars Under Uncertainty: A Practical Playbook for Medicare Advantage Plans CMS has not issued definitive guidance on how measures affected by recent litigation will be treated going forward. Plans are making bid, quality investment, care management, and product decisions this quarter anyway. Waiting isn't a strategy, and neither is assuming the program looks the same in two years. Join us on October 6 for a webinar hosted by the Association for Community Affiliated Plans on what Medicare Advantage leaders should be evaluating right now. What we'll cover: → Modeling future-state Stars scenarios, including what happens if affected measures don't return → Reassessing quality programs built around Part D measures, without overcorrecting → Identifying which measures stay durable regardless of how CMS restructures the program → Building the care coordination, chronic disease management, and member engagement capabilities that hold value across regulatory outcomes 📆 October 6 🕐 2 p.m. ET 📍 Register here: https://lnkd.in/gAFG-Yip Elissa Toder - Nick D'Ambra - Rex Wallace - Jessica Columbus - Association for Community Affiliated Plans (ACAP)

Webinar | October 6 | Stars Under Uncertainty: A Practical Playbook for Medicare Advantage Plans CMS has not issued definitive guidance on how measures affected by recent litigation will be treated going forward. Plans are making bid, quality investment, care management, and product decisions this quarter anyway. Waiting isn't a strategy, and neither is assuming the program looks the same in two years. Join us on October 6 for a webinar hosted by the Association for Community Affiliated Plans on what Medicare Advantage leaders should be evaluating right now. What we'll cover: → Modeling future-state Stars scenarios, including what happens if affected measures don't return → Reassessing quality programs built around Part D measures, without overcorrecting → Identifying which measures stay durable regardless of how CMS restructures the program → Building the care coordination, chronic disease management, and member engagement capabilities that hold value across regulatory outcomes 📆 October 6 🕐 2 p.m. ET 📍 Register here: https://lnkd.in/gAFG-Yip Elissa Toder - Nick D'Ambra - Rex Wallace - Jessica Columbus - Association for Community Affiliated Plans (ACAP)

Since 2020, HRSA has posted hundreds of manufacturer notices affecting covered entities, and litigation over contract-pharmacy restrictions and state protections continues to reshape 340B. In a new piece, Karen Kinter examines what that means operationally for community health centers. A manufacturer notice can look like a pharmacy issue at first. In practice, it can change which prescriptions qualify, how inventory is replenished, what data must be submitted, and when savings are realized — often before leadership sees the full effect on cash flow, compliance, and patient services. Three points from the article: ✔️Compliance and performance are not the same measure. A health center can pass an audit and still leave eligible prescriptions uncaptured, or generate value while carrying risks that aren't visible to leadership. ✔️Savings reporting alone is incomplete. A monthly view of budget-to-actual performance, expected versus realized value, aging payments, and unresolved exceptions surfaces what the article calls 340B value at risk. ✔️A management system can start small. Three connected tools — a change tracker, a monthly financial report, and a budget and forecasting tool — give leadership a foundation that technology can then automate. Effective 340B oversight answers five questions: What changed? Where are the gaps? What dollars are at risk? What opportunities are being missed? What action is required? Read the full article: https://lnkd.in/gUp3Bpaw

Medicare Advantage policy is shifting. Medicaid funding remains under pressure. Expectations around social determinantss of health continue to rise, and regulatory attention is sharpening across it all. On September 16th, COPE Health Solutions and Ropes & Gray are hosting The Value Agenda: Trends Transforming Healthcare Economics in the New York Market — an evening of cocktails and conversation on what the convergence of these forces means in practice. Joining us are healthcare leaders from across New York: Theresa Dreyer, CEO, Health Care Transformation Task Force Brett Friedman, Partner at Ropes & Gray and former New York State Medicaid Director Arthur Gianelli, President and Chief Transformation Officer, One Brooklyn Health Allen Miller, Principal and CEO, COPE Health Solutions Errol Pierre, Chief Growth Officer, Healthfirst Jing Shui, COO and Chief Strategy Officer, Coalition of Asian-American IPA This is a closed-door event for leaders at health plans, health systems, and provider organizations in the New York market. Space is limited, so we review each request to attend individually. If you’re interested in joining us, you can apply to attend here:  https://lnkd.in/g2u3rhkt

Medicare Advantage policy is shifting. Medicaid funding remains under pressure. Expectations around social determinantss of health continue to rise, and regulatory attention is sharpening across it all. On September 16th, COPE Health Solutions and Ropes & Gray are hosting The Value Agenda: Trends Transforming Healthcare Economics in the New York Market — an evening of cocktails and conversation on what the convergence of these forces means in practice. Joining us are healthcare leaders from across New York: Theresa Dreyer, CEO, Health Care Transformation Task Force Brett Friedman, Partner at Ropes & Gray and former New York State Medicaid Director Arthur Gianelli, President and Chief Transformation Officer, One Brooklyn Health Allen Miller, Principal and CEO, COPE Health Solutions Errol Pierre, Chief Growth Officer, Healthfirst Jing Shui, COO and Chief Strategy Officer, Coalition of Asian-American IPA This is a closed-door event for leaders at health plans, health systems, and provider organizations in the New York market. Space is limited, so we review each request to attend individually. If you’re interested in joining us, you can apply to attend here:  https://lnkd.in/g2u3rhkt

Two hours. Thousands of meals. Mark your calendars for the 2nd Annual CAHP Give Back Event — a meal packing event presented by ModifyHealth in partnership with COPE Health Solutions. Kick off your week at the CAHP 40th Annual Conference doing something with lasting impact. Healthcare leaders from across California will stand shoulder to shoulder at the packing tables and put together thousands of meals for families and communities across the state.   📅 Monday, October 19 · 2:30–4:30 PM 📍 CAHP Annual Conference | JW Marriott, Desert Springs Check out highlights from last year, and if you're attending CAHP, add this event to your agenda: https://lnkd.in/gJ8H_9sh ModifyHealth California Association of Health Plans