Tag Archives: Medicare Advantage

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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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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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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2017 CMS Call Letter: Implications for MA and PDP plans

With CMS releasing the 2017 Final Rate Announcement for Medicare Advantage (MA) and Part D plan sponsors (PDP), plans must take the next steps to determine how the proposed changes will affect them financially and operationally. Doing so can help plans identify goals and prepare implementation strategies with respect to benefit strategy, operational compliance and […]
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Changing reimbursement models requires changes to physician compensation models – 5 fundamental pillars

As noted in my previous blog, “Changing Reimbursement Models Requires Changes to Physician Compensation Models – The Basics,” as provider organizations move to risk-bearing contracts they need to answer key questions in the areas of goals, governance and physician engagement. There are five pillars provider organizations need to build a strong value-based physician compensation model […]
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Provider engagement has a major impact on quality, costs and outcomes

Health care market dynamics now impose risk adjustment and quality standards on financial performance across all market segments — Medicare Advantage, Managed Medicaid and commercial plans. To balance risks, improve quality and decrease costs, plans must move beyond retrospective claims analysis and basic assessments. Improving plan performance also hinges on provider engagement. A changing market […]
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