Medicare Advantage Projected Market Growth Creates Untapped Opportunities for Insurers

Despite rapid-fire growth that has resulted in upwards of 33% of all Medicare beneficiaries now being enrolled in Medicare Advantage plans, few health plans are proactively marketing their offerings to consumers and all but a select few plans are falling short when it comes to successfully addressing provider integration and access to care for their members. Those are the key findings of the J.D. Power 2017 Medicare Advantage Study.

Medicaid Under-Utilization Group Demographics: Where’s Growth?

Possible opportunities for growth, for payers and providers connected with the Medicaid systems in eligible states, exist in the continually low enrollments in Medicaid Savings Programs.  The Medicaid under-utilization group demographics emerged through a recently released report from Medicaid and CHIP Payment and Access Commission (MACPAC).

Value Based Care Focus: The ACO

The shift to accountable care and value based payment models is coming. Accountable Care Organizations (ACOs) are just one of the value-based models making waves throughout the healthcare industry. Based on current growth trends it is predicted by 2020 approximately 70 million people will be covered by ACOs. Focusing on shared accountability and quality improvement, ACOs have become champions of the healthcare triple aim. Not to mention a major player in CMS’ plan to tie a large percentage of payments to value by 2017. As ACOs soar in popularity now is the time to weigh your options. Are you are thinking or making the transition to an ACO? What are the benefits

As Reported by Medicaid…

The shift to value based reimbursement has become inevitable, but Medicaid’s goal of tying 50 percent of all payments to value based initiatives by the end of 2016 may not be met. A recent survey by Health Catalyst shows that hospitals are slow to make the move towards value based initiatives. With only 3% of health systems currently meeting the target and 23% expected to meet the goal only by 2019.

Department of Health and Human Services Releases Final Rule on Managed Care in Medicaid & CHIP

On April 26, 2016 the Department of Health and Human Services (HHS) announced the finalized version of a new rule on managed care in Medicaid and the Children’s Health Insurance Program (CHIP). The “rule advances delivery system reform, strengthens quality and consumer protections, promotes accountability, and aligns Medicaid managed care rules with other health insurance coverage programs.”

Centers for Medicare & Medicaid Services Testing New Payment Models for Drugs

The Centers for Medicare & Medicaid Services is testing some new reimbursement and payment models for drugs, some of which mirror models currently used in the private sector. Medicare hopes working with providers, like many private payer networks, will lead to more efficiencies in prescriptions and eventually to lower costs.

CMS Announces Multi-Payer Initiative to Transform Primary Care

The Centers for Medicare and Medicaid Services (CMS) announced the launch of Comprehensive Primary Care Plus (CPC+), a new initiative that hopes to help transform and improve the ways primary care is delivered and paid for. CPC+ will help primary care practices move away from traditional fee-for-service models and the "one size fits all" mentality, to a more unified system of care where doctors have the freedom to provide the highest quality targeted care for their patients.

CMS Announces Finalized Mental Health & Substance Use Disorder Parity Rule for Medicaid

The Centers for Medicare and Medicaid Services (CMS) have announced the finalization of a new rule that will help strengthen access to mental health and substance-use services for individuals who receive Medicaid benefits though managed care organizations and those who have Children's Health Insurance Program (CHIP) coverage. According to CMS' press release, this "final rule strengthens access to mental health and substance use disorder benefits for low-income Americans." The new provisions of this rule will benefit the over "23 million people enrolled in Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and CHIP."

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