The costs were also unprecedented for the CMS Innovation Center's models, driven primarily due to risk score growth and prescription drug costs that could not be contained by policy modifications.
The costs are "substantial and unmitigable," exceeding $2.3 billion in 2021 and $2.2 billion in 2022, according to the CMS Blog post on...National News
The transition to value-based care has been ongoing for years. Although advances have certainly been made over the past decade, many have noticed that the switch is taking quite a while. This week, several experts and organizations weigh in on why the transition is slow, and what could speed it up.
Consistently, the leading issues...
Get the latest on the national and local Arizona trends in Medicare Advantage - a lucrative and popular product now responsible for privatizing the healthcare needs of half the eligible Medicare beneficiaries in the country. We also included Arizona's PDP market info.
What's Inside
No Stopping Medicare Advantage
2023...
Ahead of the upcoming Medicare annual enrollment period (AEP) beginning October 15, the Centers for Medicare & Medicaid Services (CMS) released 2023 premiums and deductibles for Medicare Advantage (MA) and Medicare Part D prescription drug plans (MAPD) October 1, 2023. It may be the biggest year ever for MA, we include a few Arizona...
Value-based payment arrangements are rapidly growing with several Arizona-based companies either joining national programs or expanding value-based design to other areas of the country. The National Association of Accountable Care Organizations (NAACOS) says that bigger changes can't come fast enough.
In a press release last week,...National News
The COVID-19 pandemic has revealed the necessity for immediate changes to the healthcare system at large and placed value-based care, the model that rewards providers for better patient outcomes, at the center of that discussion. This week, the discussion extends to population health, interoperability, and preventative...National News
Insurance giant Humana released a report on value-based care (VBC), physician progress and patient outcomes based on 2020 data. Overall, the report found that the value-based approach was crucial for providers to deliver care and maintain important channels of communication during the COVID-19 pandemic while also remaining financially...Arizona News
The Next Generation accountable care organization (Next Gen ACO) alternative payment model will end in 2022, but not before it saved Medicare some significant money, according to new data from the Centers for Medicare and Medicaid Services (CMS). CMS found that in 2020, the Next Gen model saved $637 million on the whole, but that number...
Medicare Advantage is under pressure to demonstrate its cost-savings for the Medicare program following a report for the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) that suggests Medicare Advantage (MA) plans "may have inappropriately" leveraged chart reviews and health risk assessments to...
When a large national employer removed cost sharing for primary care visits, medical utilization fell, as did monthly costs, driven mostly by reduced emergency department (ED) visits, according to research findings from a study published May 10 in the American Journal of Managed Care.
Findings in a nutshell: The removal of cost...National News
Designing benefits packages so that members pay less for high-value services and pay more for unnecessary, low-value services should result in lower overall costs and improved satisfaction. The VBID for Medicare Advantage has been expanded to all 50 states. Others are taking VBID to the exchanges. At the University of Michigan VBID...National News
The agency's Center for Medicare and Medicaid Innovation (CMMI) announced updates to the Value-Based Insurance Design (VBID) Model along with a brand new Part D Payment Modernization Model.
The VBID model was launched in 2017, the update announced last Friday is designed to further reduce Medicare costs, enhance the quality of care...
