Topic: Brain Food

Could Medicare Advantage Be Facing More Legislative Reform This Year?

Olga Walther

The House Ways & Means Committee held a hearing Tuesday on the Medicare Advantage (MA) program. Lawmakers eagerly pointed out the success and bipartisan support for the program and were generally very receptive of the feedback received from the panel of experts. The panel included two plans – Clover Health and Independence Blue Cross of Philadelphia – and two policy researchers.

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Takeaways from the Gorman Health Group 2018 Client Forum

John Gorman

The Gorman Health Group 2018 Client Forum concluded last week in Las Vegas with over 300 of our closest clients and partners. As we enter our 22nd (!) year, we returned to the Red Rock Resort where a great time and shared learnings were had by all.

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Work Requirements in Medicaid: The True Costs

Thomas Johnson

Many states are looking to add work requirements for their Medicaid recipients. The “fever” that has spread with various governors and state legislators has translated into 20 states in some form or another considering work requirements, either through the waiver process or through legislation. Some states are dealing with this question through their budget process, and some states are attempting to couple Medicaid expansion with work requirements.

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Integrated OTC Benefits: A Prescription for Customer Satisfaction

Convey Health Solutions

Most over-the-counter products and medications like pain relievers, allergy medications, heartburn drugs and topical antimicrobials were once available only by prescription. In OTC form, these drugs are FDA approved and often equally effective as prescription drugs at a fraction of the cost. Yet their OTC status has long meant these drugs are not covered under prescription drug plans for Medicare Advantage, Medicaid or commercial health plans. As a result, consumers with limited incomes may simply forgo needed medications while others may opt for more expensive prescription drugs that are covered by their health plans.

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Latest Audit Enforcement Actions Issued by CMS

Regan Pennypacker

Like clockwork, the Centers for Medicare & Medicaid Services published the enforcement action notices issued to sponsors related to 2017 program audits. Additional detail regarding conditions, audit scores, and enforcement is expected to be included in the 2017 Program Audit Enforcement Report, which the agency hopes to release before their conferences taking place May 9-10. In the meantime, we break down the published data, which includes not only program audit actions but others as well: Read more

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The Effects of Rising Healthcare Costs in the U.S.

David Sayen

nyt - david sayenWednesday’s New York Times includes a piece about the impact of health and the cost of care on financial health. Health insurance was created to cushion these shocks, but it’s not working anymore. Why?

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Four Common Operational Pitfalls in Medicare Advantage

Julie Billman

I live in the Northeast, and we are once again in the midst of a nor’easter. It is this time of year when I consider moving south. The only way to keep on top of this volume of snow removal is to regularly clear driveways and sidewalks. Some snow is a very heavy lift, and some is very light and easy to shovel—and so it is with working through some of our common Medicare Advantage (MA) operational issues. Our experiences with clients cover a wide range of projects: we complete operational assessments, financial reviews, operational trainings, and policy and procedure (P&P) reviews. Throughout our projects, we see some common themes that cause health plans to trip. Some take more effort to resolve, but some are light lifts.

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