Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Medicare Advantage

Does Medicare Advantage Bidding Hold the Key to Reducing Costs?

December 14, 2018 - In light of future research on Medicare Advantage spending compared to Medicare fee-for-service, a trio of researchers writing on the Health Affairs blog see the promise in competitive bidding to drive down healthcare spending. “Overpayment of MA plans could be eliminated by basing government payments on bids submitted by both fee-for-service Medicare and MA plans to cover the...


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Risk Scores at Center of Sutter-DoJ Medicare Advantage Dispute

by Kyle Murphy, PhD

A complaint against Sutter Health and Palo Alto Medical Foundation over appropriate risk scores has drawn the attention of the Department of Justice. The federal agency officially announced its intervention into a lawsuit that alleges...

Private Medicare Advantage Plans Receive Marketing Boost from DC

by Chuck Green

While officials claim to not be pivoting patients to private plans, the subject lines of recent emails appear to suggest differently, according to a report by Robert Pear in The New York Times. With the open enrollment period for the plan...

Proposed Rule Seeks Lower Medicare Advantage, Part D Drug Prices

by Kyle Murphy, PhD

CMS has opened comments on a proposed rule with the purpose of lowering the cost of prescription drugs and out-of-pocket expenses under Medicare Part C (Medicare Advantage) and Part D. The proposed rule aligns with the Trump...

HHS Sets Sights on Addressing Social Determinants of Health

by Chuck Green

Speaking at the Hatch Foundation for Civility and Solutions in Washington, DC, early this month, Azar pointed to social determinants of health as “the root cause of so much of our health spending,” contributing to the $1...

Employer-Sponsored Medicare Advantage Enrollment Up 12% for 2019

by Thomas Beaton

Employer-sponsored Medicare Advantage (MA) enrollment for plan year 2019 increased by 12 percent, representing a bump of more than 443,000 individual members, according to a new analysis by Mark Farrah Associates. Individual Medicare...

Commercial, Managed Care Insurance Sectors Profits Boom in Q3

by Thomas Beaton

Commercial and managed care payers experienced significant third quarter profits, reductions in healthcare spending, and enrollment growth, according to the latest financial statements from insurance companies. Medicare Advantage (MA),...

CMS Extends Medicare Advantage Audit Program in 2019 Rule

by Thomas Beaton

CMS will be continuing its Medicare Advantage audit program, the agency indicated in a proposed 2019 rule, in an effort to ensure program integrity and reduce inappropriate payments to insurers. The changes are part of CMS’s new...

Venture-Funded Medicare Advantage Plans Launch into 2019 Market

by Thomas Beaton

Several Medicare Advantage (MA) plans entering the market for the 2019 plan year are backed by millions in venture capital funding and are planning to compete with established payers by promoting new health plan solutions. The recent...

Medicare Advantage Plans Proliferate in 2019, Raising Competition

by Thomas Beaton

Medicare Advantage (MA) payer competition is increasing significantly for plan year 2019 as more than 400 new options hit an already-crowded market, says a new report from the Kaiser Family Foundation (KFF).   More than 2700...

CMS Releases 2019 Medicare Advantage Health Plan Star Ratings

by Thomas Beaton

CMS has released its 2019 star ratings for Medicare Advantage (MA) health plans, noting that the Medicare Advantage market continues to grow in affordability and access for consumers. CMS estimates that 74 percent of MA beneficiaries will...

OIG Finds Profits to Blame for Denied Medicare Advantage Claims

by Thomas Beaton

Fifty-six percent of Medicare Advantage (MA) payers inappropriately denied claims from beneficiaries and providers to potentially profit from the capitated payment system, according to a report from the Office of Inspector General...

Medicare Advantage Premiums to Decrease by 6% in 2019

by Thomas Beaton

CMS officially announced a six-percent decrease in Medicare Advantage premiums in 2019 as the result of MA enrollment, health plan options, and benefits increase. All signs point to the MA marketplace continuing to be a lucrative...

Earning Top Medicare Advantage Ratings Requires Data, Ambitious Goals

by Thomas Beaton

Succeeding in the highly competitive Medicare Advantage (MA) market requires more than just a sense that there are financial gains to be had in this growing health insurance segment. Payers that wish to reap some of the many financial...

Payers, Providers Create New Medicare Advantage Partnerships

by Thomas Beaton

New Medicare Advantage plans, many born of innovative partnerships between payers and providers, are creating more options for beneficiaries to supplement their existing coverage with high-value offerings. Commercial payers operating in...

Top 10 Highest Performing Medicare Advantage Health Plans

by Thomas Beaton

Medicare Advantage (MA) plans are growing in popularity as an aging consumer population seeks comprehensive coverage for acute and chronic care needs. A competitive, lucrative market for high-performing plans has emerged, giving payers an...

Google Invests $375M in Oscar Health for Medicare Advantage

by Thomas Beaton

Google’s parent company, Alphabet, has invested $375 million in Oscar Health to help the tech-focused payer enter into Medicare Advantage markets by 2020, according to multiple news outlets, including Reuters. Oscar Health said in...

Medicare Advantage Part B Plans Can Use Drug Step Therapy

by Thomas Beaton

CMS is allowing Medicare Advantage (MA) health plans to implement step therapy protocols in order to decrease prescription drug spending. On January 1, 2019, MA health plans can apply step therapy guidelines for physician-administered...

Only 22% of Medicare Advantage Customers Aware of Star Ratings

by Thomas Beaton

Only 22 percent of Medicare Advantage (MA) beneficiaries are familiar with how star ratings work and increasing consumer awareness about star ratings would help beneficiaries choose high quality plans, according to a new Healthmine...

Centene, Ascension Partner for Medicare Advantage Offering

by Thomas Beaton

Centene and Ascension have partnered to offer a Medicare Advantage plan across multiple geographic markets in 2020.   Centene Chairman and CEO Michael F. Neidorff believes that the partnership will showcase effective strategies to...

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