Vertical Integration Raises Spending for Medicare Advantage Plans
Owning related businesses was associated with higher healthcare expenditures for Medicare Advantage plans, pointing to some of the consequences of vertical integration, a report from the USC-Brookings...MA Beneficiaries Satisfied With Coverage but Face Financial Barriers
Medicare Advantage beneficiaries face more financial barriers than Medicare Supplement beneficiaries, but plan satisfaction is high for both groups, an eHealth report found. The report reflects survey...OIG Finds CMS Overpaid Geisinger Medicare Advantage Plan by Over $566K
The Office of the Inspector General (OIG) found that most of the audited diagnosis codes that Geisinger Health Plan sent to CMS for its Medicare Advantage plan were non-compliant. The office audited...MedPAC Calls on Congress to Modify Medicare Advantage Payment Policies
As Medicare Advantage enrollment grows, the Medicare Payment Advisory Commission (MedPAC) is calling on Congress to address payment and coding differences between Medicare Advantage and Medicare...Growing ESRD Enrollment Prompts MA Plans to Form Value-Based Arrangements
Beneficiaries with end-stage renal disease (ESRD) are increasingly shifting from Medicare fee-for-service (FFS) to Medicare Advantage, leading more Medicare Advantage plans to form value-based...Stakeholder Groups Oppose Medicare Advantage Risk Adjustment Changes
Since CMS released the 2024 Medicare Advantage Advance Notice in February, healthcare stakeholders have not been silent about their concerns with the proposed risk adjustment model changes. CMS...BMA Asks CMS to Rethink Medicare Advantage Risk Adjustment Model Changes
Better Medicare Alliance (BMA) has urged the Centers for Medicare and Medicaid Services (CMS) not to finalize its proposed changes to the Medicare Advantage risk adjustment model, stating that they...Humana Collab Expands Value-Based Care for Medicare Advantage Members
Humana has partnered with an independent primary care network to enhance access to value-based care for Medicare Advantage members. The 10-year collaboration with Aledade will allow Humana’s...Medicare Advantage Beneficiaries See Lower Hospitalization Rates
Medicare Advantage beneficiaries with ambulatory care sensitive conditions (ACSCs) experienced lower rates of hospitalizations but higher rates of emergency department (ED) direct discharges and...Humana Will Leave Employer Group Insurance Business to Focus on Public Plans
Humana has announced plans to leave the employer group insurance business and direct its focus toward its government-funded health plan offerings. The payer’s employer group commercial medical...Hospice Enrollment from Community Setting More Common in Medicare Advantage
Medicare Advantage beneficiaries were more likely to enroll in hospice from a community setting rather than a hospital or nursing home setting compared to traditional Medicare beneficiaries, according...AHIP: Proposed 2024 Medicare Advantage Advance Notice Cuts MA Rates
AHIP is pushing back on the proposed 2024 Medicare Advantage advance notice because it presents a dramatic rate cut that would impact beneficiaries, Matt Eyles, president and chief executive officer of...AHIP Asks CMS to Reconsider Proposed Medicare Advantage Policy Changes
AHIP is urging CMS to consider the potential adverse impacts of its proposed rule for Medicare Advantage policy and technical changes, specifically raising concerns about the star rating changes, new...Humana Maintains Primary Care Access for Medicare Advantage Members
Humana has signed a five-year agreement with ChenMed, solidifying access to in-network, senior-focused primary care for Medicare Advantage members. The agreement continues the decades-long...The Future of Medicare Advantage Risk Adjustment Data Validation
Around four years passed between when CMS proposed the new rule on Medicare Advantage risk adjustment and when the Medicare Advantage Risk Adjustment Data Validation final rule was published. As stakeholders review the long-awaited final...Medicare Advantage Plans Rejected 2M Prior Authorization Requests in 2021
Medicare Advantage plans denied 2 million prior authorization requests in 2021 and just 11 percent of those requests were appealed, according to an issue brief from the Kaiser Family Foundation...Sponsored Article
