The policy analysis and guidance you need by the experts you trust, daily.
- After Hours
- Agent Oversight
- Brain Food
- Health Insurance Exchanges
- Part D
- Performance Optimization
- Policy & Health Reform
- Prospective Evaluations
- Provider Relations
- Risk Adjustment
- Sales & Marketing
- Star Ratings
- Alan Mittermaier on MA and Part D Proposed Rule Increases Plan Flexibility, Reduces Regulatory Burden
- Sharon Willliams on A New Source of Capital for Star Ratings and Clinical Innovations
- William on Will Trump and Price Pull Out the Scalpels for Star Ratings?
- Bobby on January Release of the Draft MMG – Perfect Timing
- Pam Lassila on Best Practices and Common Conditions of Audit Preparation
The Voice of David Sayen
The draft 2019 Call Letter for Medicare Advantage (MA) included new flexibility for plans around supplemental benefits. It was codified in the recent budget resolution to keep the government open and represents the biggest news for the industry in years. It offers a whole new toolbox for plans to address social determinants of health.
“We don’t have to invent Medicare, we have it…it is a popular, effective program. Unfortunately, it is only applicable to people 65 or over. So the simple answer is…Medicare should be available to all of us.”
No, the Reagan administration hasn’t come back, but things are looking up in our corner of the world. The Centers for Medicare & Medicaid Services (CMS) is a big ship, and it takes awhile to turn it around after a presidential transition. It is becoming clear the direction will continue to be towards value, but the path is shifting. The government needs to reduce the spend on healthcare, and reducing benefits and restricting eligibility aren’t going to fly on the Medicare side, so we have to get more bang for the buck.
In a word, it’s trouble. Let me count the ways.
Top of mind is the Medicaid overhaul. Block Granting Medicaid has been the Holy Grail on the Republican side since Reagan. And why not: the Department of Health and Human Services (HHS) wants to download the risk to the states. Whether it is the per capita limits required by law or the optional Hobson’s Choice of the block grant for the entire population, it means one thing. Pain. States have to balance their budgets, unlike Uncle Sam who has that bottomless checkbook.
On June 7, the Health Subcommittee of the House Ways and Means Committee heard and responded to testimony about Medicare Advantage (MA) and, in particular, how the program can be an instrument to advance care coordination and integration. The tenor of this hearing, combined with the recent unanimous passage of the bipartisan Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act by the Senate Finance Committee tells this reader ice isn’t just melting at the North Pole. There is a thaw in the chill that seemed to blanket parts of the healthcare industry since the election.