Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Medicare Advantage

Humana, Aledade Bring Value-Based Care to Medicare Advantage Members

February 12, 2019 - Humana and Aledade have announced a value-based care agreement that will increase access to value-based care for Medicare Advantage members. The partnership will enable physicians in Aledade’s accountable care organizations (ACOs) in Louisiana, Pennsylvania, and West Virginia to deliver quality care to Humana’s Medicare Advantage members. “We’re delighted to be...


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Cigna Value-Based Care Participation Tops 50%, Saving $600M

by Jennifer Bresnick

Cigna has surpassed its goal of having 50 percent of its Medicare and commercial health reimbursements tied to value-based care models in top markets by the end of 2018, the payer announced. Between 2013 and 2017, value-based care...

Lyft Expands Work with BCBS, Humana Medicare Advantage Plans

by Jennifer Bresnick

Rideshare company Lyft is expanding its collaboration with the Blue Cross Blue Shield (BCBS) Institute to offer non-emergency medical transportation (NEMT) to Medicare Advantage members. In a blog post on the company website, Lyft also...

CMS to Expand Tailored Benefits for Medicare Advantage Plans

by Jennifer Bresnick

CMS is proposing significant changes to Medicare Advantage geared towards expanding choice and increasing competitiveness in a highly lucrative market. The proposals would increase the number and scope of supplemental benefits available...

86% of Payers Fail to Deliver Readable Medicare Communications

by Jennifer Bresnick

Most documents intended for Medicare and Medicare Advantage members do not meet accessibility standards for the average reader, according to a new report from VisibleThread, a text analysis company. More than 86 percent of payers offering...

CMS Tackles Drug Costs with New Medicare Advantage, Part D Models

by Jessica Kent

CMS’s Center for Medicare and Medicaid Innovation has launched a new payment model and updated an existing model aimed at helping Medicare Part D and Medicare Advantage plans to lower drug prices and better serve...

Apple Floats Idea of Subsidizing Watches for Medicare Advantage

by Jennifer Bresnick

Apple has approached several Medicare Advantage plan providers to discuss the idea of subsidizing its Apple Watch for at-risk seniors, according to industry reports. CNBC reporter Christina Farr states that at least three Medicare...

Anthem Medicare Advantage Members Can Use OTC Allowance at CVS

by Jennifer Bresnick

Anthem Blue Cross (Anthem) Medicare Advantage members in California will now be allowed to purchase over-the-counter products at CVS Pharmacy stores using their health plan allowance. The partnership, launched on January 1, is intended to...

Change Healthcare, Health Fidelity Apply AI to Risk Adjustment

by Jennifer Bresnick

Change Healthcare and Health Fidelity have announced a collaboration to offer AI-driven risk adjustment coding solutions for Medicare Advantage, ACA commercial, and Medicaid payers. The tool leverages natural language processing (NLP) and...

60% of Medicare Advantage Members Feel Little Motivation from Plans

by Jennifer Bresnick

Medicare Advantage (MA) plans are not doing enough to motivate their members to improve their personal health, according to a new survey from HealthMine. Sixty percent of members participating in the poll said that their MA plans do not...

Does Medicare Advantage Bidding Hold the Key to Reducing Costs?

by Kyle Murphy, PhD

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...

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...

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