Medicare and Medicaid Experts

2018 Health Plan Star Ratings Released By CMS

2017-10-12T00:07:48-04:00By |Medicare and Medicaid, News and Events, Trends|

The Centers for Medicare & Medicaid Services (CMS) released the Star Ratings for the 2018 Medicare health and drug plans. With the release of the Star Ratings, people with Medicare will have improved access to high-quality health choices for their Medicare coverage in 2018. This news comes on the heels of the recent release of the benefit and premium information for Medicare health and drug plans which shows that there will be more health coverage choices and decreased premiums in 2018.

Exchange Reinsurance Stabilization: 17% Premium Reductions

2017-10-03T13:14:39-04:00By |Managed Care, Medicare and Medicaid|

America’s Health Insurance Plans (AHIP) released new research on exchange reinsurance stabilization efforts leading to higher enrollment in exchanges. Funding a $15 billion reinsurance stabilization package, in combination with a delay of the Affordable Care Act’s (ACA’s) health insurance tax (HIT) through the end of 2018 and guaranteeing funding of cost-sharing reductions (CSRs), could reduce average yearly premiums by $1,363 (a 17% reduction). Uncertainty in the individual market, rising premiums, and declining issuer participation have created the need for federal and state policy makers to address these issues to stabilize the marketplace.

Insurance Markets Stabilization: Bipartisan Proposal From Governors

2017-09-05T18:02:22-04:00By |Health Care Reform, Managed Care, Medicare and Medicaid, Taxes|

The governors John Kasich of Ohio, John Hickenlooper of Colorado, Brian Sandoval of Nevada, Tom Wolf of Pennsylvania, Bill Walker of Alaska, Terence R. McAuliffe of Virginia, John Bel Edwards of Louisiana, and Steve Bullock of Montana sent a letter to the Republican and Democratic leaders of the House and Senate asking them to take immediate steps to restore insurance markets stabilization structures. The letter was sent ahead of the testimony governors are expected to offer to the Senate Health, Education, Labor, and Pensions committee on September 7.

Health Insurance Tax (HIT) Impact on Medicare Plans: 2 Views

2017-08-30T18:00:35-04:00By |Medicare and Medicaid, News and Events|

Sweeping repeal and replace legislation may be slowed, but does not mean significant healthcare changes are not coming off the legislative wish list. The debate on funding aspects of the healthcare law will likely continue through the 2018 election. The Health Insurance Tax (HIT) comes up for discussion and two organizations presented their takes on HIT's impact on Medicare programs and payers. 

All-Payer Model Maryland Update: Care Redesign Program

2017-08-21T18:03:30-04:00By |Financial, Medicare and Medicaid|

In July of 2017, CMS and Maryland continued their partnership and announced the Care Redesign Program (CRP). The CRP is a new voluntary program within the Maryland All-Payer Model that advances efforts to redesign and better coordinate care in Maryland. The CRP provides hospitals participating in the Maryland All-Payer Model the opportunity to partner with and provide incentives and resources to certain providers and suppliers in exchange for their performance of activities and processes that aim to improve quality of care and reduce the growth in total cost of care for Maryland Medicare beneficiaries.

Medicare Advantage Projected Market Growth Creates Untapped Opportunities for Insurers

2017-08-15T21:28:11-04:00By |Financial, Medicare and Medicaid|

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?

2017-08-08T22:51:46-04:00By |Managed Care, Medicare and Medicaid|

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

2017-07-05T15:12:32-04:00By |Accountable Care Organizations, Health Care Reform, Medicare and Medicaid, Organizational Analysis, Strategic Planning|

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

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