Healthcare solutions with the end in mind
While the COVID-19 pandemic is not over, and the transition to a post-pandemic world will be blurred rather than discrete, it is time to recognize that while we as healthcare leaders have had our heads down keeping patients alive and trains running, a new cultural zeitgeist is emerging that will dramatically shape and change health …
The Post-Pandemic Zeitgeist for Healthcare Leaders Read More »
In its recent 2023 Advance Payment Notice, CMS proposed the development of a Health Equity Index as an enhancement to its Medicare Advantage Star Ratings program. CMS states that “As we further explore this option, we are considering what other data are available and what other social risk factors might be appropriate to include over …
Health care costs have been a concern in this country for many decades. It has been well-documented that the United States spends substantially more on health care services than other developed countries for similar, if not worse, outcomes. Additionally, high health care costs represent major challenges to government budgets, employer competitiveness, and household finances. During …
Money for Nothing: How COVID-19 Could put Provider Value in Dire Straits Read More »
Medicare Advantage (MA) is the program by which private plans can offer Medicare coverage. Medicare beneficiaries can choose either traditional fee-for-service (FFS) or enroll in a private MA plan. Over one-third of beneficiaries choose private plans, but that proportion varies greatly by the region of the country. Traditionally, services related to social determinants of health …
Is a Medicare Advantage SDOH Partnership Right for Your Organization? Read More »
March 26, 2020—While the policy and regulatory environment continues to adapt to the unprecedented challenge of COVID-19 and the focus at this time is appropriately on identification and treatment, in the coming months those in the healthcare industry will begin to consider the longer-term impacts of this pandemic. For Medicare Advantage (MA) organizations, one major …
What you Need to Know about Medicare Advantage Star Ratings and COVID-19 Read More »
Earlier today CMS released its new Healthy Adult Opportunity (HAO) demonstration initiative that allows States to pursue additional flexibilities to provide Medicaid coverage for the ACA expansion population (i.e. not otherwise Medicaid-eligible adults below 133% of FPL). While the primary element of this demonstration opportunity is the requirement that States to enter into either a …
Not Having your Brand Name Drug and Eating Rebates Too: State Flexibility under HAO Read More »
Recently, the CMS Center for Medicare & Medicaid Innovation (CMMI) released its 2021 Request for Applications (RFA) for its hospice Value-Based Insurance Design (VBID) model. This model will allow Medicare Advantage Organizations (MAOs) to test incorporating the Medicare hospice benefit into Medicare Advantage (MA). This model is open to all MAOs and will allow plans …
In the next decade, high-cost case management, population health, and social determinates of health will remain active and important approaches to rein in the increasing costs of healthcare services. However, there is a risk that trend-bending savings from these efforts could remain elusive. Moreover, while some progress has been made to shift providers to value-based …
While the answer may be no, with health insurance risk-mitigation mechanisms again in the news—related to the forthcoming release of the 2021 Notice of Benefit and Payment Parameters and 2021 CMS-HCC methodology, continued state interest in 1332 waivers, and upcoming oral arguments in the Supreme Court, it may be time to brush up on the …
Looking to Impress the Actuary at the Company Holiday Party? Read More »
On November 25th, CMS announced that it is reopening the opportunity submit a Letter of Intent (LOI) to participate in its Direct Contracting: Professional and Global demonstration (through December 9th). This model allows providers that participate in Fee-for-Service (FFS) Medicare to take on a risk/reward-like Medicare Advantage (MA); however, depending on the practice geography and …