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Public Payers News

More Choices for Federal Health Plans Doesn’t Spread Market Share

November 7, 2017 - The federal health plan market contracted under the Office of Personnel Management (OPM) has remained heavily concentrated over the last decade, despite OPM’s efforts to improve health plan choice for employees enrolled in the Federal Employees Health Benefits Program (FEHBP), a new GAO report found. OPM has attempted to increase the number of HMO and fee-for-service (FFS) plans over...


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ACA Open Enrollment Rate Expected to Drop Up to 13% in 2018

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Analysts expect up to a 13 percent drop in open enrollment on the ACA marketplace exchange in 2018,  according to Standard and Poor’s Global (S&P Global). Only 10.1 million to 11.4 million individuals are expected in enroll in...

Michigan MSSP Accountable Care Org Saves $8M for Medicare

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The Physician Organization of Michigan Accountable Care Organization (POM ACO), a Medicare Shared Savings Program (MSSP) ACO, helped the state save $8 million dollars on Medicare expenses by reducing unnecessary ED utilization, preventing unneeded...

Top Commercial Payers Offering Medigap, MA, and Medicaid Plans

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The top payers with the highest enrollment numbers for Medigap, Medicaid, and Medicare Advantage (MA) are a unique mix of some of the largest commercial payers as well as smaller to mid-size insurers, a new report from AHIP reveals. These three...

CMS Releases 2018 Medicare Advantage Star Ratings for Health Plans

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CMS has updated the 2018 Medicare Advantage star ratings on health plans, allowing consumers to explore options that will best suit their individual needs.   The star ratings are based on several consumer engagement and care quality criteria,...

90% Medicare Supplemental Plan Members Report Satisfaction

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Over 90 percent of Medicare supplemental plan beneficiaries cited satisfaction with their healthcare coverage, according to a recent AHIP study. Findings point out ways for payers to provide consumer-friendly health plans to a growing senior...

6 Ways VA Can Improve Administrative Management of Care Delivery

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Even though VA has taken steps to improve administration and management of its healthcare delivery systems, the Government Accountability Office (GAO) found six action items that allows the VA to adjust policies that improve data sharing and...

How Pharmacy Benefit Managers Lower Prescription Drug Prices

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Payers in both the private and public sectors require new strategies that offset the rising cost of prescription drugs. Pharmacy benefit managers (PBMs) are professionals that administer prescription drug plans for payers, employers, and CMS...

Arkansas Slips Up on Supplemental Medicaid Payments

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A lack of administrative oversight led Arkansas to miss supplemental Medicaid payments, make several payments to Medicaid-ineligible providers, and receive excess Medicaid dollars, found a report from the Office of the Inspector General (OIG)....

State Medicaid Orgs Struggle to Provide Behavioral Health Services

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State Medicaid organizations may need more than flexible funding in order to provide for the growing behavioral healthcare needs of their adult populations. In a report from the Government Accountability Office (GAO), six state Medicaid programs...

Competitive Bidding Curbs Medicare Durable Medical Equipment Costs

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A research team from the Health Care Cost Institute (HCCI) found that the Competitive Bidding Program (CBP) lowered Medicare costs on durable medical equipment (DME), bringing spending down to levels experienced by many commercial payers. The...

Medicaid Reform Requires Outcomes-Based Innovation, Better Data

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Medicaid has steadily provided low-income patients with quality healthcare coverage and could further improve by addressing problematic areas through outcomes-based innovation and data analytics infrastructure, according to commentary published...

Payers May Be Neglecting a Growing Medicare Advantage Market

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Payers may be able to secure more of the growing Medicare Advantage (MA) marketplace by expanding their member messaging efforts and improving consumer education about what the supplementary plan has to offer, according to a new J.D. Power survey....

Low Medicaid Payment Rates Decrease Residential Care Quality

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Low Medicaid payment rates discourage providers to serve Medicaid beneficiaries in residential care services (RCS) that in turn can cause beneficiaries to purchase more expensive long-term support services (LTSS) according to a new study from...

CMS Approves State Capitated Medicaid Program in Florida

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Florida received CMS approval to operate a state capitated Medicaid program and a low-income pool (LIP) to improve care for uninsured individuals, the federal agency announced. The state submitted a request to extend Florida’s Managed Medicaid...

Medicaid Tops Private Insurance in Consumer Satisfaction KPIs

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Medicaid critics have argued that enrollees are not receiving adequate care under the program, but recent consumer surveys indicate that beneficiaries are highly satisfied with their options.   According to a new J.D. Power poll, Medicaid...

Socioeconomic Data Improves Public Health, Payer Programs

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CMS programs recognize that the social determinants of health (SDOH) play a large role in the health of their beneficiaries and, when neglected, can create negative health implications for beneficiaries covered by Medicare, Medicaid, and CHIP....

CMS Proposes Medicare Home Health Agency Payment Changes

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CMS proposed Medicare home health agency payment changes in a new rule intended to reduce provider burdens and advance flexible, transparent payment models in the next two years. “CMS is committed to helping patients and their doctors make...

CMS to Host Summit on Behavioral Health Payment, Care Delivery

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CMS has opened registration for a one-day summit where healthcare experts can discuss ideas about innovative behavioral health payment models and related care delivery systems. The Behavioral Health Payment and Care Delivery Summit will take...

Medicare Hospital Insurance Trust Fund Depleted by 2029

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A statement released by HHS and CMS’s Medicare Board of Trustees (MBT) indicates that the Medicare Hospital Insurance Trust Fund is likely to be depleted by the year 2029. The report suggests that the difference between Medicare income...

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