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Public Payers News

New Framework for MACRA’s Alternative Payment Models Released

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Earlier this year, the federal government passed the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), which reforms the Medicare program by abolishing the Sustainable Growth Rate (SGR) formula, developing a more effective value-based...

CMS Stresses Informed Decision-Making in Performance Reports

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Since the Affordable Care Act was initially created, the Centers for Medicare & Medicaid Services (CMS) have been focused on improving informed decision-making among payers, providers, the patient community, and other stakeholders. CMS announced...

Physician Compare Website Upgrades Benefit Medicare Population

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Medicare and Medicaid beneficiaries along with consumers of plans via state health insurance exchanges gained an advantage last week when the Centers for Medicare & Medicaid Services (CMS) announced website improvements to the Physician Compare...

Prescription Drug Spending Growth Skyrocketed 13% in 2014

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In 2014, the rise of prescription drug spending hit 13 percent while overall healthcare spending growth increased by 5 percent. This steep rise is causing concern among both federal agencies like the Centers for Medicare & Medicaid Services...

Top 4 Policy Changes Affecting the Health Payer Market in 2015

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The last year has had a huge impact on the health payer market as well as the entire healthcare industry from providers and educational institutions to the federal government and the patient community. Below we will outline the top four policy...

Vermont’s All-payer Model May Curb Rising Healthcare Costs

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While healthcare reform has been taking place on a national level over the last several years, the state of Vermont is in the process of undergoing its own transformation within the medical industry through a new statewide all-payer model. The...

CMS Innovation Center’s Role in Improving Value-based Care

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As healthcare payers and providers look toward adopting value-based care and move away from fee-for-service payment models, the Centers for Medicare & Medicaid Services (CMS) Innovation Center has been pursuing a variety of new healthcare...

How Value-Based Care Payment Models Could Reduce Costs

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Did you know that 8 million people gained private insurance through the health insurance exchange and 3 million young adults gained coverage since the Affordable Care Act was passed? In recent years, the health insurance market and the medical...

MACRA’s Merit-Based Incentive Payment System Removes SGR Flaws

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Did you know that healthcare payment legislation passed earlier this year allows providers to take part in the Merit-Based Incentive Payment System (MIPS), a quality program from the Centers for Medicare & Medicaid Services? This past April,...

DC Tops Medicare List for Wasteful Healthcare Spending

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When it comes to medical care reimbursement, one of the most pivotal issues is eliminating wasteful healthcare spending. The Council for Medicare Integrity released a report detailing wasteful healthcare spending throughout the Medicare fee-for-service...

Do Beneficiary Incentive Programs Cut Costs, Prevent Disease?

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Within the health insurance market, the patient is seen as a consumer in need of medical coverage. Payers must also consider the financial implications of managing the health of more and more patients with chronic medical conditions. As the baby...

How the Supreme Court Ruling Affected State Medicaid Expansion

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When the Patient Protection and Affordable Care Act was passed into law in 2010, opposition led the provisions to the Supreme Court where it was decided whether or not the legislation was Constitutional. While the Supreme Court did support the...

CMS Releases Final Rulings for 2016 Healthcare Payment Models

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Last Friday, the Centers for Medicare & Medicaid Services (CMS) announced its issuance of the final rules regarding Medicare payment in 2016 to physicians and healthcare professionals in an effort to further support patient-centered medical...

Children’s Health Insurance Program Funding Extended to 2017

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The federal government has key programs to help lower class American citizens obtain the healthcare coverage that they need. The Centers for Medicare & Medicaid Services (CMS) offers Medicaid coverage for those that have healthcare needs....

OPA Report Cards Let CA Healthcare Consumers Compare Choices

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The California Office of the Patient Advocate (OPA) has released the latest edition of online quality Report Cards intended to help healthcare consumers better compare care quality with the mere click of a mouse or finger swipe across a mobile...

What to Consider During Medicare Open Enrollment Period

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Health payers and consumers need to be aware that the Medicare open enrollment period begins this week on Thursday, October 15. This means that individuals aged 65 years old and older who have health insurance through Medicare will have the chance...

NCPA Urges Policymakers Promote Medicare Price Sensitivity

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If policymakers fail to advance price sensitivity among beneficiaries, Medicare spending will only escalate, confirms a new study from Devon M. Herrick, PhD, Health Economist and Senior Fellow with the National Center for Policy Analysis (NCPA)....

ACA Medicaid Expansion Leads to Decreased Uninsurance Rates

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As a result of Medicaid expansion as a part of the Affordable Care Act, many previously uninsured patients are shifting to Medicaid as their health insurer. A recent study by Kaiser Family Foundation shows that this shift in payer is decreasing...

Healthcare Insurance Rates Rise by 2.9% in 2014, Census Says

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The rate of uninsured Americans decreased by 2.9 percent between 2013 and 2014, says the latest data from the US Census Bureau, thanks to higher rates of coverage for private and government payers.  In 2014, only 33 million Americans lacked...

CMS Announces Cost Reduction Medicare Advantage VBID Model

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The Medicare Advantage Value-Based Insurance Design (VBID) Model, announced by the Centers for Medicare & Medicaid Services (CMS), aims to advance the health of Medicare beneficiaries, decrease preventable high-cost care utilization, and...

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