Despite high hopes for the Medicare Shared Savings Program (MSSP) and agency reports that the model produced about $250 million in savings annually, these findings suggest the savings produced by the federal government's largest alternative payment model (APM) had only a minor financial impact on the Centers for Medicare & Medicaid...
Last week, Humana published its 10th annual Value-Based Care (VBC) Report for 2023. The report found that Medicare Advantage patients in value-based arrangements were more likely to receive preventive care and were hospitalized less frequently.
The report found that because clinicians are incentivized to provide patients with...
The December 2023 issue brief provides four key strategies Medicare Advantage (MA) organizations leverage to improve the quality of primary care and enrollee engagement. The research was conducted by ATI Advisory on behalf of the Better Medicare Alliance, the nation’s leading research and advocacy organization supporting Medicare...
The data in this recently published chartbook illustrates where and how many MA plans are offering certain nonmedical supplemental benefits and which MA organizations offer the most plans with a given benefit in 2024.
The report doesn't assess the effectiveness or use of supplemental benefits, but provides useful information to...
It appears likely that Cigna and Humana, two of the country's largest insurers, are discussing a merger that some report could be finalized by the end of the year.
The first report of the potential deal came from the Wall Street Journal, which reported that the structure and terms of the deal were under wraps, but the deal does...
UnitedHealth Group (UHG) is facing a class action lawsuit initiated by two families of deceased Medicare Advantage policyholders who say that the insurer's use of proprietary AI software developed by UGH subsidiary NaviHealth, denied coverage for post-acute care and left them with an untenable bill.
The family members filed suit in...National Reports & Surveys
New studies are showing the benefits of value-based care organizations, including the rapid rise of accountable care organizations (ACOs).
Physician participation in accountable care organizations (ACOs) has increased to represent most doctors, according to a survey of 3,500 physicians by the American Medical Association (AMA)....
On Monday, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule that would impose tighter regulations on Medicare Advantage insurers. The rule covers some hotly debated issues including prior authorization, supplemental benefits and marketing.
President Joe Biden announced last year that his administration would...
The congressional scrutiny of Medicare Advantage continues with advocacy organizations voicing support for increased oversight and the introduction of bills that would curb some of the program's most unpopular practices.
In October, the Senate Finance Committee held a hearing on deceptive marketing tactics by Medicare Advantage plans...
The Health Care Payment Learning & Action Network (HCP-LAN) survey was designed to understand how widely value-based care models are being adopted as health insurance providers, clinicians, hospitals, and healthcare systems work together to move from paying for volume to value. The results include the percentage of provider payments...
Last week, the Senate Finance Committee held a hearing on the topic of "cracking down on deceptive practices" related to the advertisement of Medicare Advantage (MA) plans.
The hearing covered a long list of issues with third-party marketers who represent MA plans, including allegations of false information, harassment, switching...
The Centers for Medicare and Medicaid Services (CMS) released its Medicare Advantage (MA) star ratings last Friday, we've compiled the options available to the 1.4 million Medicare-eligible beneficiaries in Arizona along with their quality ratings. Open Enrollment began October 15, 2023.
This year, the average star rating fell to...
A new audit conducted by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) found that between 2015 and 2016, insurer Aetna received $25.5 million in Medicare Advantage overpayments. Also, plans are developing new offerings that aim to target the needs of specific demographics.
The OIG audit...
About 1.4 million Arizona Medicare-eligible beneficiaries can now choose a Medicare Advantage or Medicare Advantage with Prescription Drug Plan for their 2024 healthcare coverage. Medicare's Open Enrollment Period began October 1, 2023. The Hertel Report compiled MAPD plans and premiums for Arizona's 15 counties, average premiums, number...
As regulators make efforts to rein in prior authorization delays and denials by private insurers and Medicare Advantage (MA) plans, Medicare and Medicaid managed care organizations (MCOs) are also garnering scrutiny over denials and network adequacy.
A new consumer survey from Kaiser Family Foundation (KFF) found that roughly 60% of...National News
A new white paper by Harvard Medical School and Inovalon, a company that provides health data aggregation services, compared healthcare utilization and expenditures between Medicare Fee-for-Service (FFS) and Medicare Advantage beneficiaries.
The paper, "Utilization and Efficiency Under Medicare Advantage vs. Traditional...National News
Although UnitedHealthcare's national footprint is expanding in 2024, the nation's and Arizona's largest MA insurer said last week it was reducing some MA service areas and discontinuing certain plans including AARP Medicare Advantage, UnitedHealthcare MedicareDirect, UnitedHealthcare Dual Complete or other UnitedHealthcare Medicare...National News
Medicare Advantage (MA) plans in collaboration with the Centers for Medicare and Medicaid Services (CMS) offers comprehensive healthcare services covered by Traditional Medicare (TM) with many now providing robust supplemental benefits. MA continues to grow rapidly and covers half of all eligible Medicare members from diverse...
A new study reviews the volume of advertisements that seniors receive during or around the Medicare enrollment period, and how these reports relate to recent changes in how Medicare Advantage programs will be expected to conduct future advertising campaigns.
The Commonwealth Fund found that "certain marketing experiences reported in ...
Under the Inflation Reduction Act (IRA) people with Medicare may pay a lower coinsurance for some Part B drugs if the drug’s price increases faster than the rate of inflation.
The IRA, signed by President Biden in 2022, applied to Part D the same year, whereas Part B took effect in 2023. The Centers for Medicare & Medicaid...