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Public Payers News

CMS Highlights Drug Price Transparency Data Dashboards

May 16, 2018 - CMS has released redesigned drug price dashboards to provide information about manufacturer drug costs and advance the agency’s goals of promoting consumer price transparency. Patients, providers, and researchers are able to explore data that shows the growth rates of drug prices by pharmaceutical companies based on Medicaid and Medicare-reported data. The dashboards complement the  America’s...


Articles

MD Extends All-Payer Model, Targets $1B in Medicare Savings

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Maryland Governor Larry Hogan and CMS have announced a five year extension of the state’s All-Payer Model, targeting an additional $1 billion in Medicare savings over the coming years, according to a public statement from Hogan’s...

Medicaid Spending Drops When Members Transition to Community Care

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Medicaid spending declined when beneficiaries transitioned from long-term institutional care into community care, a new report conducted by Mathematica Health Policy found. Researchers observed cost outcomes of Medicaid’s Money Follows...

Medicare Diabetes Prevention Program Offers Model for Chronic Care

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CMS’s Medicare Diabetes Prevention Program (MDPP) aims to address diabetes prevalence within the Medicare program, and may help other payers develop a model for chronic care, based on the MDPP’s promising initial results. Diabetes...

CMS Value-Based Payment Programs Show Satisfactory Performance

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CMS value-based payment programs, including Medicare accountable care organization (ACO) initiatives, have met many of their goals in recent program years, although some work remains to accelerate growth and achieve federal targets, according...

Humana Launches Bundled Payment Model for Maternity Care

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Humana has launched a bundled payment model to improve outcomes and lower costs of maternity by partnering with OBG-YNs across the country. Humana’s Maternity Episode-Based Model bundles payments that covers the cost of a mother’s...

HHS Must Address Adverse Selection in Medicaid, Medicare Renal Care

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AHIP is urging HHS secretary Alex Azar to address adverse selection related to Medicaid or Medicare end stage renal disease (ESRD) in order to ensure that vulnerable beneficiaries continue to receive appropriate healthcare services. AHIP asserted...

Health Plan Variety Does Not Boost Managed Medicaid Performance

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Managed Medicaid performance does not increase as state Medicaid programs introduce more health plan variety, but a single health plan with value-based characteristics may be more effective in improving performance, a new JAMA commentary...

Medicaid Coverage Creates Significant Healthcare Opportunities

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Medicaid coverage led to significant healthcare opportunities that rivaled commercial health insurance care quality, according to a new study from AHIP. Nearly 74 million adults and children who receive Medicaid were found to have significantly...

CMS: Payers Must Make Claims Data Available to Beneficiaries

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CMS Administrator Seema Verma recently called on healthcare payers to make claims data available to their beneficiaries. The agency also announced a new initiative called MyHealthEData to give patients control of their healthcare data. Verma...

Medicare Wellness Programs Promise Better Health Outcomes

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Medicare wellness programs have the potential to improve physical and mental health for beneficiaries with chronic conditions, according to a new report from the Center for Medicare and Medicaid Innovation (CMMI). Medicare members that participated...

IN Medicaid Waiver Uses Work Requirements, Tobacco Penalties

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Indiana is the second state to receive approval for a 1115 Medicaid demonstration that adds work requirements as a condition of beneficiary eligibility.  The demonstration also adds premium penalties for tobacco use as well as financial...

NQF Aims to Improve Medicaid Use of Social Determinants Data

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Collaborating with public health and community organizations to foster informed decision-making can help Medicaid entities better address the social determinants of health (SDOHs), says new guidance issued by the National Quality Forum (NQF)....

Top 10 Highest Performing Medicare, Medicaid Health Plans

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The top-performing Medicare and Medicaid health plans for the 2017-18 plan year earned exceptional quality scores based on the plans’ customer satisfaction, preventive care, and treatment outcomes of beneficiaries, according to the most...

AMGA: Align Quality, Performance across Medicare Advantage, ACOs

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CMS should work to align quality and performance standards across all Medicare programs, including Medicare Advantage (MA) and the Medicare accountable care organization (ACO) initiatives, says AMGA. In a letter issued in response to proposed...

2016 Healthcare Spending Growth Slowed, Totaled $3.3 Trillion

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US healthcare spending totaled $3.3 trillion in 2016, representing a 4.3 increase in the spending growth rate since 2015. While spending continued to rise, the rate of increase was actually slower than the 5.8 percent growth rate between...

Medicare Advantage Consumers Seek New Plans as Risk Scores Rise

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Medicare Advantage (MA) consumers who switch to new health plans may have higher risk scores than beneficiaries who are content with their current options, indicates a Congressional Budget Office (CBO) report.   Payers who are actively recruiting...

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

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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...

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...

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