Topic: Brain Food

CHIP Reauthorization: Right Around the Corner

Thomas Johnson

Reauthorization for the Children’s Health Insurance Program (CHIP) lurks behind Washington’s focus on the Affordable Care Act (ACA) repeal and replace efforts. But the battle may be as contentious, and the added factor of a September 30th deadline makes stakeholders worry.

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New Challenges in Network Development

Elena Martin

The summer sun is shining and vacation season is in full swing! While our Health Plan Network and Product teams are taking a few deep breaths after application and bid filing deadlines, we cannot rest on our laurels for very long. Summer is the best time to start planning your next service area expansion (SAE) or even your first step into the Medicare Advantage (MA) world. Maybe you are an established MA plan evaluating where to expand your geographic footprint. Maybe you are a Medicaid plan looking to expand into the Managed Long Term Services and Supports (MLTSS) arena and are wondering what it would take to have a Dual Eligible Special Needs Plan (D-SNP) so many of the MLTSS Requests for Proposal (RFPs) are expecting; or maybe you are an Accountable Care Organization looking to leverage your infrastructure and enter the payer world. Now is the perfect time to start planning for your 2018 and 2019 network needs. Regardless of the size and scope of the organization, your plan’s network adequacy and accessibility is a cornerstone of any new initiative. And, Plans need to be even more vigilant in managing their largest asset

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Digital Marketing in the Medicare Advantage World

Angela Fox

“Internet shopping rates have surpassed the rates of all other shopping activities.” As marketers, we have heard for years now that omnichannel is the way to go and that baby boomers are online. But we still see a lack of focus on digital in many Medicare Advantage marketing strategies. Deft Research’s “2016 Age-in Study” shows for the first time that internet shopping is the highest utilized channel for researching products (the shopping part) among age-ins in 2016. Clearly, digital can no longer be considered an additional channel—it is the channel. And the best thing about digital marketing, it is data-driven. In nearly real time, you have the opportunity to understand what is working and what isn’t.

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Rising Drug Costs Continue to be a Concern

Jean LeMasurier

During the presidential campaign, Donald Trump highlighted the need to address rising drug costs, stating the drug industry was “getting away with murder.” Several recent high-price drug increases for HIV/AIDS drugs, hepatitis C drugs, and the EpiPen®, among others, have also raised Congressional, state, and public concern about the issue. During the campaign, Trump discussed allowing re-importation of cheaper drugs or allowing the government to negotiate drug prices as ways to lower prices.

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10 CMS Program Audit Risks

Regan Pennypacker

Program audits and oversight activities must be designed with many factors to balance: accuracy, consistency, efficiency, and in an effort to be least disruptive to a plan sponsor. Correspondingly, a plan should be tailoring its response to these audits with those same factors in mind. My colleague Deb Devereaux and I outline ten common risk areas we observe in plans large and small. Read more

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CMS Withholds Critical Medicare Advantage Analysis; Why?

Jessica Smith

Controversy is brewing in the healthcare insurance community since the much anticipated Medicare Advantage (MA) analysis due to be released at the AcademyHealth annual research meeting was cancelled. Today, MA plans enroll more Medicare-eligible beneficiaries than Fee-for-Service (FFS). The desire to understand the needs and services these beneficiaries have and are receiving is great.

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Evolve from Restrictive to Supportive Medical Management, or Die

John Gorman

I am continually amazed by how many health plans in Medicare Advantage (MA) and Medicaid still cling to restrictive, “Dr. No”’90’s-style managed care practices like pre-authorizations, referrals, and concurrent review. With massive policy changes looming in Medicaid, and the influence of Star Ratings in MA greater than ever, health plans may soon have a gun to their heads: evolve medical management from restrictive to supportive, or die.

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