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The Wall Street Journal reported last night (Cigna Nears Deal to Buy Express Scripts) that Cigna is in final talks to acquire Pharmacy Benefit Manager (PBM) Express Scripts (ESRX) for a whopping $67 billion. ESRX was the last truly independent major PBM, and the deal signals the end of an era…and ushers in a new one, further blurring the lines between insurers, providers, and their primary vendor. The combined entity will reach over 250 million people and will have a ripple effect on many of their competitors.
On February 1, 2018, the Centers for Medicare & Medicaid Services (CMS) released its 2019 Advance Rate Notice (Part II) and Draft Call Letter. CMS estimates an expected increase of 1.84% to payments in 2019. CMS says its estimates do not reflect underlying coding trend, which it expects to increase risk scores by 3.1% in 2019.
It’s HEDIS® time again! Health plans should have data collection and audit activities in full swing for Healthcare Effectiveness Data Information Set (HEDIS®) 2018. High-performing plans will have started the hybrid chart collection and medical record review.
We all know this is the busiest time of the year – or so it seems. As we wrap up (pun intended!) end-of-year requirements, it intensifies the need to streamline efforts in completing priority projects. This should, of course, include re-evaluation of your Model of Care (MOC). Time spent NOW re-evaluating your organization’s most current Centers for Medicare & Medicaid Services (CMS)-approved Special Needs Plan Model of Care (SNP-MOC) will pay off later in the new year. This instantly becomes tangible when faced with a CMS audit in 2018, where CMS will take a step-by-step review of your organization’s operations as it relates to plan processes and performance outlined in your MOC.