Medicare Advantage Value-Based Insurance Design: Key Considerations

The Centers for Medicare & Medicaid Services (CMS) recently announced a proposed demonstration that will test varying benefit designs based on health status.

ACOs Should Run for the Exits and Into Medicare Advantage

CMS initially selected 32 health systems to participate in the program.  It’s down to 19 today. For the year 2014, 622,000 beneficiaries participated.  Findings:

The Medicare Advantage Value-Based Insurance Design (MA-VBID) Model Test

The Centers for Medicare & Medicaid Services (CMS) announced on September 1 a proposed demonstration that will test varying benefit designs based on health status.   The overall goal is to improve clinical outcomes while reducing plan expenditures.

Final Rule for Medicare Prescription Drug Benefit Program Coordination Requirements

Where has the summer gone? When you get your formulary submission approval email, you breathe a sigh of relief and can relax for…a second. It’s time to start planning for Part D Readiness and Benefit Administration testing so when November 15 arrives, you are well on your way to having those completed.

For Medicare Advantage plans, the heat is on for point of sale Part B versus Part D determinations. The regulation set to take effect on January 1, 2016, follows:

The CMS Fall Conference: 4 Ways to Solve the Preparedness Problem

The Centers for Medicare & Medicaid Services (CMS) held their Fall Conference and Webcast on September 10 in Baltimore.  The presentations and videos from the event are found on the Compliance Training, Education & Outreach site here.  CMS covered various aspects of the Medicare Advantage Prescription Drug (MA-PD) program, but here I’ve focused on four lessons I heard loud and clear: work with CMS, prepare ahead of time, seek continuous improvement, and don’t wait until the last minute.

How to Partner with Key Health Systems in your Service Area to Optimize Benefit Plan Offerings

As we anticipate additional information this week on the Centers for Medicare & Medicaid Services (CMS) network adequacy (pilot) audit, we can’t help but consider how CMS’ rigorous access and availability standards hamper Medicare Advantage (MA) plans’ ability to be on the cutting edge of innovative network design.

Government Sends Stark Reminders that Insurers’ Biggest Customer is Still the Regulator

Since we opened our doors 19 years ago, we’ve preached to health insurers to think of the government as your business partner.  This week, we got several reminders that insurers’ biggest customers — Medicare, Medicaid, and ObamaCare — are still the regulator.  As business conditions improve for health plans across these business lines, government expectations are rising, and scores are about to get settled, as they always are in the second term of a Democratic administration.

Potential Changes in Part C Reporting

The Part C and Part D Reporting Requirements and Supporting Regulations were posted in the PRA Listing on August 24th for review and 30-day comment. Since we are still in this window, this is a great opportunity for Compliance and Operations to review these together. To follow are Part C highlights that merit your attention.

Teaming with Providers: Together, Everyone Achieves More

When a team works well together, the members collectively accomplish more than any of the individuals could have accomplished alone.  Certainly, we have proven that adage true in healthcare, as can be seen with the success of integrated delivery systems, Independent Practice Associations (IPAs), and Accountable Care Organizations (ACOs).