“Bei impressed me from the very beginning with her enthusiasm and attention to detail. She makes sure to understand a project thoroughly and brings her own style and ideas to every task. Bei has put her background in operational efficiency to great use, and has automated several cumbersome processes that were previously intensely manual. Above all, I believe that Bei's intense desire to learn and make a positive difference with her work, combined with her considerable technical and mathematical knowledge, would make her an invaluable asset in any position.”
About
After working in the traditional actuarial field for 13 years, I’ve decided to transition…
Activity
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Congrats to all my fellow CVS Health CEO award winners! #TeamCVS
Congrats to all my fellow CVS Health CEO award winners! #TeamCVS
Liked by Bei Zhu
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Now settled back in Pittsburgh, I am reflecting on the days spent in Baltimore this week. This may have been my most enjoyable conference ever! The…
Now settled back in Pittsburgh, I am reflecting on the days spent in Baltimore this week. This may have been my most enjoyable conference ever! The…
Liked by Bei Zhu
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What an honor to receive the CEO Award, CVS’s highest award! So grateful to have the opportunity to work with such amazing and talented team members,…
What an honor to receive the CEO Award, CVS’s highest award! So grateful to have the opportunity to work with such amazing and talented team members,…
Liked by Bei Zhu
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Associate of the Society of Actuaries
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Mandarin
Native or bilingual proficiency
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1 person has recommended Bei
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Thrilled to have had the opportunity to speak on the Medicaid directed payments panel about federal provider tax policy at the Human Services Finance…
Thrilled to have had the opportunity to speak on the Medicaid directed payments panel about federal provider tax policy at the Human Services Finance…
Liked by Bei Zhu
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Mercer US Government's Tom Dahl will moderate a presentation on "The Evolution of #PHE #Unwinding Expectations" next week at the #SOA Health Meeting…
Mercer US Government's Tom Dahl will moderate a presentation on "The Evolution of #PHE #Unwinding Expectations" next week at the #SOA Health Meeting…
Liked by Bei Zhu
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🎉 Celebrating mPulse's third year in the Gartner Hype Cycle 🎉 And for the first time, we are recognized as a sample vendor across three market categories! 📍 Health Navigation Solutions: Integrate data and workflows across disparate functions to support all aspects of the member journey. ❤️ Social Determinants of Health Resource Management: Orchestrate non-medical services to mitigate the effects of social determinants on health outcomes. 👩⚕️ Provider/Partner Network Management Platforms: Technology and tools to manage relationships between payers and providers to deliver high value healthcare to individuals.
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Certifi, Inc
The future of Medicare Advantage (MA) is up for debate. While some major insurers are shrinking enrollments and exiting markets due to reimbursement cuts from CMS, others see it as an opportunity to improve. Early 2024 saw CMS implement changes to MA risk adjustment, a move opposed by many insurers. These phased-in changes are causing lower margins for insurers while utilization rates are rising for beneficiaries. Large insurers like CVS Health and Humana prioritize profitability, potentially exiting markets in 2025. Other insurers, like SCAN see the cuts as a chance to re-evaluate and provide a better product to members. Learn more: https://hubs.ly/Q02yVgCS0
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The Health Management Academy
The Great Reckoning in Medicare Advantage: Collaboration or Division? The landscape of Medicare Advantage is facing its biggest shift in two decades, according to McKinsey, which is presenting new challenges for payers and providers alike. As pressures mount, the vital question emerges: “How can health systems avoid getting the smallest slice of the remaining pie?” In a recent panel of payer and health system executives hosted by Strategy Catalyst, executives from both sectors discussed the future. The consensus? Those positioned to thrive in the impending Medicare Advantage "great reckoning" will be the innovators who foster collaborative efforts to optimize each other's cost structures. What might this entail? • Payers could seek to reduce their own cost-regulating denials and prior authorizations by trying to work collaboratively, focusing on efficient data sharing and solution-driven dialogues with providers. • Providers could streamline contracts to only work with those seeking mutual value, guided by well-defined principles for selecting partners and governing contract performance. Potential collaborative areas: • Jointly deciding on supplemental benefits that will be high impact of the population and promoting their utilization through the health system's medical group. • Establishing joint quality measures that would allow movement to prospective payment systems. • Exploring evidence-based care guidelines that could be agreed upon jointly to reduce administrative burdens, like unnecessary prior authorizations. Join the conversation and let us know your thoughts. For more detailed insights, ask for our two-pager on the future of Medicare Advantage.
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No Patient Left Behind
News of potential CVS Health #breakup is great opportunity for top plans (UnitedHealth Group, Elevance Health, Humana, The Cigna Group), benefit consultants/brokers (Aon, Marsh McLennan), and regulators (Centers for Medicare & Medicaid Services, Federal Trade Commission) to help #FixInsurance by unraveling conflicts of interest that prioritize vertically integrated plan revenue optimization over effective patient care management. Improving customer health outcomes and employer/government premium value needed for all plans to show they truly can bend nation's cost curve. https://lnkd.in/eu3mSCHk
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Cotiviti
Medicare Advantage plans require an increased commitment to improving risk adjustment coding practices while optimizing medical record retrieval and interoperability. But health plans don’t have to handle these challenges alone! Watch our on-demand RISE webinar, where Cotiviti’s risk adjustment experts unravel trends shaping 2024 and beyond. https://bit.ly/49HsK7m #RiskAdjustment #HealthPlans
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American Board of Quality Assurance and Utilization Review Physicians® (ABQAURP)
New Online Course! CMS-HCC Risk Adjustment Model Version 28: Be Proactive What can you do to mitigate the impact of the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Codes (CMS-HCC) risk adjustment model Version 28? This online course reveals a proactive approach to mitigating the potential negative impact of Version 28 through proper identification of diseases and conditions coupled with addressing, assessing, and properly treating those diseases. It follows clinical and coding guidelines to address diagnoses and conditions for which the risk adjustment factor has been eliminated or reduced. It does this through a disciplined approach of reviewing co-morbid conditions, alternative diagnoses, and improved specificity. In all cases, the primary purpose is to treat the patient's diagnoses and conditions to improve the quality of life for the patient. Learn more about this course at https://lnkd.in/eVmECiEs. #CMS #hcquality #patientcare
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Adam Brown, MD MBA
A lot has been made about Humana's stock plummeting following the news of their decline in star ratings. What does this actually mean? Well, it means a lot. And the answer connects to taxpayer value and how Humana may be delivering quality. Humana might say that the way star ratings are measured has changed or that star ratings are flawed. (And they may be right.) Still, when you look beyond the corporate communications spin, the reality may tell a different story—they still may not meet certain quality metrics, and their beneficiaries may not be satisfied with their experiences. #MedicareAdvantage star ratings are built on 5 factors: ➡️ Member experience – how satisfied members are with their plan. ➡️ Customer service – how well the plan handles complaints and appeals. ➡️ Plan performance – how the plan addresses complaints, makes improvements, and avoids problems. ➡️ Chronic conditions management – how effectively the plan helps members manage long-term conditions. ➡️ Staying healthy – whether members get preventive care like screenings and vaccines. Humana’s ratings dropped from 4.5 to 3.5, indicating they’re not meeting those standards; remember, 3 = poor, and they aren't too far from that. But here’s the critical question: Why? Financial incentives may be at play. Medicare Advantage plans (like Humana's) are funded by #taxpayer dollars, transferring dollars on a per-member-per-month basis to a private company to administer the insurance plan. Whatever the company spends, they lose; whatever they keep is theirs. Therefore, they make money by saving on healthcare expenses. Here's the problem. Reducing expenses without appropriate checks can mean limiting care or creating barriers to care, which could harm patients and worsen experiences. Centers for Medicare & Medicaid Services created the star rating system to counter these behaviors, rewarding plans that prioritize quality care and patient satisfaction with financial bonuses while penalizing those that don’t. Additionally, if the company scores high, it can promote its star ratings, like a Yelp or TripAdvisor review, encouraging new participants and more revenue. So yes, Humana is having a rough day, but this goes beyond a lousy headline or a stock tumble. Their lower star ratings tell us they may not be providing the same level of care they once were, and that should be a concern for anyone involved in healthcare or enrolled in their plans. It also means that taxpayer value may be worse. We need to ask ourselves: Isn't this what the star ratings are for? Are the financial incentives in Medicare Advantage leading to cuts in quality care? And how can we ensure that these plans prioritize patient outcomes over profits? #Healthcare #MedicareAdvantage #QualityCare #HealthcareStrategy #healthinsurance #Humana ABIG Health Kerrie Rezac Rushton MBA@UNC UNC Kenan-Flagler Business School
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