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Public Payers News

Next Generation ACO Model Saved Medicare $62M in 2016

August 28, 2018 - Next Generation Accountable Care Organizations (ACO) saved the Medicare program $62 million during their first year of operation in 2016, encouraging CMS to expand downside risk models across Medicare. Next Generation ACOs accept the highest risk of any current CMS accountable care programs, which emphasizes the achievement of reducing costs while maintaining high quality of care, said...


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CMS Processes State Medicaid Requests, Approvals 23% Faster

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CMS has announced that an agency initiative to streamline state Medicaid approvals and state plan amendments (SPAs) has increased approval processing speed by 23 percent. In 2017, CMS sent a bulletin to state Medicaid programs informing...

OH Medicaid Adopts Pass-Through Model for Managed Care Drugs

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Ohio’s Medicaid program has issued a mandate that requires managed care health plans to re-negotiate pharmacy benefit manager (PBM) contracts to transition from a spread-pricing drug purchasing model to a pass-through model. The...

Managed Care Accounted for 38% of Medicaid Spending in 2012

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Medicaid managed care accounted for 38 percent of total Medicaid spending in 2012, according to a Congressional Budget Office analysis. The report found that the majority of states in the US have implemented some form of a managed care...

Medicare Part D Premiums Expected to Decline in 2019

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CMS has announced that monthly Medicare Part D premiums are expected to fall from $33.59 in 2018 to $32.50 in 2019 as new policies to reduce Medicare’s drug costs take effect. Earlier in 2018, CMS issued a final rule that made...

Generic Drugs Could Have Saved $3B for Medicare Part D Program

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Using generic drugs instead of their brand-name equivalents could have saved the Medicare Part D program approximately $3 billion in 2016 alone, according to new data from HHS. A relatively small number of brand-name therapies is...

CMS Proposed Rule Cuts State Authority to Divert Medicaid Payments

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CMS has proposed a new rule that would eliminate a state’s authority to divert Medicaid payments away from providers. The rule is intended to ensure beneficiaries have adequate access to healthcare services through direct...

Medicare, Medicaid Home Health Benefits Stabilize Care Costs

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Providing extended home health benefits for Medicare beneficiaries is likely to stabilize care costs for public payer programs, according to a new analysis from the Commonwealth Fund. Researchers from the Hilltop Institute and Johns...

Aetna Takes Amerigroup Spot in Kansas Managed Medicaid Contract

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Aetna has received a Managed Medicaid contract from the state of Kansas for plan year 2019 and will replace Amerigroup as one of the state’s three managed care payers. The state received six bids from commercial payers and...

How to Drive Enrollment in the ACA Health Plan Marketplaces

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Payers and states wishing to increase enrollment in the ACA health plan marketplaces should  create targeted advertisements, benchmark silver-tier plans as their primary exchange plan, and help consumers navigate health plan...

MedPAC: Value-Based Payment, Post-Acute Care Boost Medicare Savings

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MedPAC has advised Congress that value-based payment reform and encouraging the use of post-acute care can help the Medicare program increase savings and improve beneficiary outcomes, the group said in a new report. Revisions to payment...

CMS Offers Opioid Coverage, Health IT Guidance for Medicaid Plans

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CMS has issued new opioid coverage strategies and health IT guidance to help states improve opioid safety within Medicaid plans. The guidelines include advice for state programs about treating infants with neonatal abstinence syndrome...

Medicare Bundled Payment Programs Primed to Produce Savings

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Medicare’s bundled payment programs are in an opportune position to produce additional savings and create a more cost-effective public payer program with certain revisions, a new white paper from USC Brookings explains. CMS’s...

Unstable Future Predicted for Medicare, Depletion by 2026

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The Medicare Board of Trustees (MBT)’s latest report anticipates that Medicare’s Hospital Insurance (HI) Trust Fund will deplete by the year 2026 as Medicare spending continues to outgrow the trust’s collective...

HHS Made Nearly $90B in Improper Payments to Medicaid, Medicare

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HHS made approximately $90 billion in improper payments to Medicaid and Medicare programs during 2017 and may require updated payment evaluation procedures to address improper payments, a new Government Accountability Office (GAO) report...

MSSP ACOs Taking on Downside Risk See Smaller Savings

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Medicare Shared Savings Program (MSSP) ACOs that take on downside risk generate smaller savings than upside risk ACOs, according a Center for Healthcare Quality and Payment Reform (CHQPR) analysis. In 2016, the average annual cost of care...

Medicaid Plans More Cost Effective, Stable than Exchange Plans

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Medicaid health plans are more cost effective than federal exchange plans and could offer beneficiaries more affordable coverage options, according to a UnitedHealth Group analysis. UnitedHealth Group said that federal healthcare agencies...

CMS Highlights Drug Price Transparency Data Dashboards

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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...

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...

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...

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