MedPAC calls for fewer pay models, cutting Medicare Advantage spending

April 1, 2021Garrett SchmittNo CommentsMA, Medicare Advantage, MedPAC, SNFs

The Medicare Payment Advisory Commission, at its meeting on Thursday, approved several Medicare policy recommendations that will appear in its June report to Congress. The congressional advisory panel will recommend that CMS simplify its approach to alternative payment models. Commissioners approved an updated version of the recommendation presented by MedPAC’s staff at last month’s meeting….

Treat ACOs And MA Plans Equally? By All Means

November 13, 2019Garrett SchmittNo CommentsMA, Medicare Advantage

The Centers for Medicare and Medicaid Services (CMS) recently announced that Accountable Care Organizations (ACOs) saved Medicare $739.4 million in 2018, up from $314 million in savings the year before. Those savings were achieved despite policies that Rooke-Ley and colleagues argue in a recent Health Affairs Blog post disadvantage ACOs relative to Medicare Advantage (MA) plans. Their analysis concludes that ACOs cut costs…

Medicare Advantage And The Future Of Value-Based Care

July 3, 2019Garrett SchmittNo CommentsMA, Medicare Advantage

The Medicare Advantage (MA) program, which allows Medicare beneficiaries to voluntarily enroll in a private plan that administers health benefits, was established by the Balanced Budget Act (BBA) of 1997 as a vehicle to bring private-sector competition and innovation to Medicare beneficiaries. When the program was announced, the goal was to create greater competition on…

Medicare Advantage industry sees slower growth for 2019

January 16, 2019Garrett SchmittNo CommentsMA, Medicare Advantage

Medicare Advantage insurers added 1.4 million members to their rosters for 2019 coverage, as they looked to grow membership in a market known for being politically safe and predictably lucrative. But Advantage membership is growing at slower pace compared with previous years. According to the latest federal data showing enrollment as of this month, 22.4…

How to Address Medicare Advantage Beneficiary Disenrollment

July 26, 2018Garrett SchmittNo CommentsDisenrollment, MA, MADP, Medicare Advantage

Medicare Advantage is a growing market and an attractive opportunity for payers to offer quality plans to older beneficiaries.  Competition is increasing in the MA environment, and beneficiaries have more options than ever to meet their coverage needs. With more choice comes higher rates of disenrollment as members select the most valuable plans for their…

CMS to Waive MIPS for Providers in At-Risk Medicare Advantage Plans

July 2, 2018Garrett SchmittNo CommentsAPM, APMs, MACRA, MAQI, Medicare Advantage, MIPS

CMS recently announced that it advanced a demonstration that would waive Merit-Based Incentive Payment System (MIPS) requirements for eligible clinicians participating in at-risk Medicare Advantage plans. If approved, the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration would apply to eligible clinicians sufficiently involved in Medicare Advantage plans that resemble Advanced Alternative Payment Models (Advanced…

New Medicare Advantage rules hold big potential for pop health

June 13, 2018Garrett SchmittNo CommentsCMS, MA, Medicare Advantage

Payers will now be able to work with companies like Uber or Lyft to provide transportation, for example, as part of a more complete set of benefits for the quickly growing MA population. CMS issued a final rule in May giving MA plans more flexibility in determining the types of supplemental benefits they can offer chronically…

How Payers Can Add More Value to Medicare Advantage Health Plans

April 17, 2018Garrett SchmittNo CommentsCCM, Chronic Care Management, CMS, MA, Medicare, Medicare Advantage, Payers, Preventive Medicine

Payers striving to compete in the Medicare Advantage (MA) market can add more value to their health plans by taking advantage of regulatory changes established under a new final rule. Starting in plan year 2019, payers can offer a greater variety of Medicare Advantage plans with more variation of health benefits, specialized cost-sharing designs, and…

Medicare Advantage Holds the Key to Reforming the ACO Program

March 20, 2018Garrett SchmittNo CommentsMedicare Advantage

The movement to value-based care is alive and well, with the Trump administration eager to put their own stamp on the program. In one of his first major speeches as Secretary of Health and Human Services, Alex Azar said value-based care “needs to accelerate dramatically.” This reprises the administration’s draft 2018–2022 strategic plan for HHS…

CMS proposes 1.84% rate increase for Medicare Advantage plans, other policy changes

February 2, 2018Garrett SchmittNo CommentsCMS, Medicare Advantage

The federal government on Thursday proposed a 1.84% average rate increase for Medicare Advantage plans in 2019, along with other policy tweaks that officials said are designed to strengthen the MA and Medicare Part D programs. The rate increase is a good deal higher than the 0.45% increase the agency approved for 2018. However, it…

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