Posts by highroads

Sets a new standard for Medicare Advantage compliance and operational efficiency June 18, 2025 — [Burlington, MA] — In a groundbreaking move for the healthcare industry, a leading regional Health Plan has successfully completed its Plan Benefit Package (PBP) filing through a fully automated process, integrating their plan management solution directly with the Centers for…

If your team is still using spreadsheets, manually entering data into HPMS, or scrambling during the final week of submission, it’s time to rethink your approach. This blog outlines five clear signs your current process needs an upgrade—and how automation can help you file faster, reduce errors, and stay compliant.   For many health plans,…

Touching Medicare ─ and by extension Medicare Advantage (MA) ─ has long been the one of the traditional third rails of U.S. politics. But this administration is attempting a potentially adroit bit of political jiu-jitsu by leaning into fraud, waste, and abuse as a rationale to bring MA back to the original aspirations of introducing…

For health plans, inaccurate documents aren’t just a compliance issue—they’re a financial and operational risk. Document errors in Summary Plan Descriptions (SPDs), Summary of Benefits and Coverage (SBCs), and provider directories can result in penalties, lawsuits, reprocessing costs, and even lost market share.  Below, we break down the 10 most costly impacts of document errors—and…

Every health plan leader shares a common goal: Ensure easy, affordable access to healthcare. But with policy changes, rising costs, and shifting member expectations reshaping the industry at a rapid pace, achieving this goal is more complex than ever. One thing remains certain though, to succeed, health plans must stay relentlessly focused on improving the…

With a renewed focus on cost containment, regulatory shifts, and evolving coverage models, health plans must be prepared for potential changes that could reshape the industry. As policy discussions unfold, organizations that take a proactive approach to strategy and operations will be best positioned to adapt. Here’s what leaders should focus on: Potential Funding Shifts:…

If Chicago were a health plan, the Kennedy Expressway would be a legacy system. Much like Chicago’s ongoing struggle to move more cars without increasing costs, health plans face relentless pressure to reduce administrative expenses while improving the member experience. This analogy, shared recently at the Fierce Healthcare Payer Summit, cuts to the heart of…

Years ago, when Medicare Part D was first introduced, a call center agent helped a senior member named Phyllis evaluate her prescription options. She was presented with a plan that would cost significantly less than what she was currently paying. There was a long pause. When Phyllis finally spoke, she was in tears. “I can’t…

Burlington, MA – HighRoads, the leader in health plan product management technology, is pleased to announce the addition of Joe Marabito and Elena McFann to its Board of Directors. Each brings extensive experience in healthcare, health plan operations, and technology, reinforcing HighRoads’ commitment to driving innovation and growth for health plans. “We are thrilled to…