Topic: Medicaid

Health Plans Need to Start Talking About Disparities in Care

John Gorman

On the heels of a recent groundbreaking RAND report on racial disparities in Medicare Advantage (MA), the US Department of Health & Human Services’ Office of Civil Rights (OCR) issued a regulation that requires serious attention in health plans participating in MA, Part D, Medicaid, and ObamaCare. It’s a game-changer in advancing health equity and reducing disparities.

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Building A New Provider Network or Planning Your Next Service Area Expansion? Don’t Lose Sight of Your Biggest Asset

Elena Martin

The sun is shining, kids are out of school, 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 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. Perhaps, maybe, summer is the perfect time to start planning for your network 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.

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Why are the Dual Eligible Demos Such a Hot Mess?

John Gorman

There’s no avoiding the steady stream of bad news facing the Centers for Medicare & Medicaid Services (CMS) financial alignment demonstrations for dually eligible beneficiaries. Enrollment is declining, beneficiaries are opting out at epic rates, and leading states like California are slowing their efforts despite crushing budget realities.  Dozens of health plans have invested millions to participate in what’s become a hot mess.  Where do we go from here?

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Latest Sherlock Benchmarks Confirm Medicare Advantage is a Miserable Beast to Manage

John Gorman

The geniuses at Sherlock Company, whose benchmarks on health plan administrative standards are considered the gold standard, have released their 2016 findings and the numbers paint a clear picture: Medicare Advantage (MA) is a miserable beast of a product.  It’s complicated and labor- and capital-intensive, requiring tremendous patience for executives and investors alike.

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What a Clinton Administration Could Mean for Government Health Programs

John Gorman

So the people spoke and we are heading for an epic cagematch smackdown general election between reality TV star Donald Trump and former Senator and Secretary of State Hillary Clinton.  And you’re asking, what’s going to happen to Medicare, Medicaid and ObamaCare? The answer is plenty — below the waterline and out in the states.  Stakeholders will need to pay attention or get left behind.

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Medicaid Final Rule Aligns the Program with MA and Exchange Regulations

Olga Walther

The Centers for Medicare & Medicaid Services (CMS) issued the final Medicaid “mega-rule,” a huge regulation that makes changes to every part of the current managed care rules. Although the final rule makes some tweaks based on the comments received from the industry, it largely adopts the proposals released last May. The new changes will be phased in over the course of three years, with some provisions going into effect starting July 1, 2017.

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Takeaways from the Gorman Health Group 2016 Client Forum

John Gorman

The Gorman Health Group 2016 Forum concluded last week with over 200 of our closest clients and partners. There was great news and rough news, so here are a few takeaways: Read more

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