Topic: Brain Food

Evolution Through Strategy: Pinpointing Growth Opportunities

Nancy Djordjevic

My last article explained the choice of Medicare Advantage (MA) health plans to evolve or disappear. Evolution is certainly the preferable choice, so let’s examine the steps needed to do so.

Read more

Leave a comment | Share | |

New Challenges in Network Development

Elena Martin

The sun is shining, kids are heading back to school, and fall will be here before we know it. Now is the perfect time to start planning for your network expansion needs. Plans need to be even more vigilant in managing their largest asset. Regardless of the size and scope of the organization, your plan’s network adequacy and accessibility is a cornerstone of any new initiative.

Read more

Leave a comment | Share | |

CMS Announces Expansion of the Medicare Advantage Value-Based Insurance Design Model

Jean LeMasurier

The Centers for Medicare & Medicaid Services (CMS) announced plans to expand the Medicare Advantage (MA) Value-Based Insurance Design (VBID) model to more states and more conditions in 2018 without the experience of the first year’s launch, which begins in January 2017. The schedule underlines the Administration’s goal of rapidly expanding the use of innovative payment and delivery models that emphasize quality and good outcomes rather than volume of services. VBID models have been used in the private sector to better manage the costs and care of persons with high healthcare needs and the Medicare population, which has the largest number of persons with chronic care conditions, and offers the potential to see even better results for more people.

Read more

Leave a comment | Share | |

Lessons on the Audit Front

Caron Wingerchuk

The regulatory scrutiny continues. The Centers for Medicare & Medicaid Services (CMS) 2016 Compliance and Program Audits are in full swing, and it is readily apparent plan sponsors must be “audit ready.” CMS’ intent to hold plan sponsors accountable to comply with Medicare standards and ensuring beneficiary protection is evident. Plan sponsors must be ready to take the test.

Read more

Leave a comment | Share | |

Evolution or Extinction

Nancy Djordjevic

“The Theory of Evolution has two main points,” said Brian Richmond, curator of human origins at the American Museum of Natural History in New York City. “All life on Earth is connected and related to each other,” and this diversity of life is a product of “modifications of populations by natural selection, where some traits were favored in an environment over others,” he said.

Read more

Leave a comment | Share | |

First Plan Preview of 2017 Star Ratings Data

Melissa Smith

It’s official ‒ the Star Ratings busy season is officially underway. The Centers for Medicare & Medicaid Services (CMS) recently notified plans of the first preview period for the 2017 Star Ratings data.

Read more

Leave a comment | Share | |

Medicare Advantage Pays Hospitals Less than Medicare

Jean LeMasurier

Researchers at Stanford University conducted a study of hospital payments by Medicare Advantage (MA) plans, Fee-for-Service (FFS) Medicare, and commercial insurers in 2009 and 2012 and found MA plans pay lower prices than FFS for most (but not all) types of admissions and in most (but not all) geographic areas. The study found: Read more

Leave a comment | Share | |