Tag Archives: actuarial consulting

Anticipating MACRA and Medicare Advantage impacts

MACRA continues to evolve and while its impacts may have been somewhat softened over the last several months, MACRA’s intent is still to have an impact on care costs and quality over short and long term. While many providers are concerned and strategizing about the financial and administrative implications of MACRA, payers should also consider […]
Read More »

Viewpoint: Part 1 of the 2019 CMS Advance Notice

By: Rich Gamret, FSA, MAAA, Director, Actuarial Consulting, Optum CMS recently released Part 1 of the 2019 Advance Notice of Methodological changes for Medicare Advantage. This was a first for the industry — this information has historically been released in February. As required by the 21st Century Cures Act, CMS is focused on improving the […]
Read More »

2018 Bid submission: Best practices for aligning bid strategy and operational execution

The Centers for Medicare & Medicaid Services (CMS) released its 2018 Advance Notice and Draft Call Letter in February, proposing numerous changes for Medicare Advantage (MA) and Part D plan sponsors. The combination of benchmark, risk adjustment, quality Star rating, cost sharing and benefit design requirements, coupled with uncertainty of several 2018 payment variables and […]
Read More »

Prepare for bundled payments by focusing on these six areas

As one year ends and another begins, we sometimes take stock of what’s changed or developed in the last 12 months. The online news site HealthPayerIntelligence.com did just that for the health insurance market by defining the top trends of 2016. Bundled payment models made the list.  Take 5 minutes to explore bundled payments in […]
Read More »

Best practices for analyzing the Medicare Advantage revenue cycle

The Medicare Advantage market is in the midst of change. Contractions in capitation rates continue to pressure health plans to improve operations and tighten their financial management. For payers offering Medicare Advantage products, Part C and Part D, the risk-adjustment cycle represents a significant challenge to achieve both transparency in operational processes and forward visibility […]
Read More »