Tag Archives: CMS

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 […]
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Learn why to participate in the next-gen CMS BPCI Program

The Centers for Medicare and Medicaid Services (CMS) delivered the next generation of the Bundle Payment for Care Improvement (BPCI) program on January 9, 2018. CMS refined the original program definitions focusing on volume episodes and expanded the eligibility to include physician group practices including surgical centers. Medicare data for applicants over the past four […]
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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 […]
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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 […]
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Do bundled payments encourage more procedures? New study offers answer

New research aims to determine whether a claim that bundled payments may actually increase costs rather than control them holds any weight. Becker’s Hospital Review and McKnight’s reported on the study from the Centers for Medicare and Medicaid Services and the Altarum Institute. At issue was whether bundled payments — also known as episode-based payments […]
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MACRA requires knowledge of qualities of “good” data

Medicare is allowing physicians and group practices to set their own course toward compliance with the Medicare Access and CHIP Reauthorization Act, or MACRA. But regardless of the path chosen, accurate measurement is key. That’s because the most basic level of participation requires physicians to submit data on one quality measure and one improvement activity […]
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Medicare Advantage competitive positioning in 2018: Analyzing the market landscape and plan offerings

For the seventh year in a row, Medicare Advantage (MA) plan enrollment is projected to increase to a new, all-time high.1 In this growing market, in order to maintain favorable competitive position in the marketplace, MA plans need to compete on an increasingly complex array of product features and plan attributes including premiums, benefits, quality […]
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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 […]
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Care transitions can feel like changing the tires while driving

While providers may now see population health programs as key to value-based care success, many are struggling with implementing change in a way that affects outcomes. “It’s like the proverbial changing of the tires while driving down the road at 90 mph,” says Steve Griffiths, senior vice president of Health Care Analytics Consulting at Optum. […]
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MACRA is big for doctors. What about hospitals?

With the Medicare Access and CHIP Reauthorization Act replacing the sustainable growth rate, changes are coming for physicians. But will MACRA impact facility providers? Consultants at Optum say yes. Specifically they say hospitals and health systems should prepare for changes to referral patterns and readmission rates. Jay Hazelrigs, vice president and lead actuary at Optum, […]
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