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MedHOK Strategic Insights Blog

2019 Policy Rule Means Host of Changes for Medicare Plans

While plans look predominantly at the annual Call Letter for guidance on policy changes, this year’s Centers for Medicare and Medicaid Services (CMS) policy rule had a host of changes that plans needs to be aware of for 2019. Some major items are noted below.

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CARA Act Implementation Gives Medicare Plans Additional Opportunities to Impact Drug Abuse

In early March, the Centers for Medicare and Medicaid Services (CMS) announced its final rule related to policy changes for Medicare Advantage and Part D plans in 2019. One key point in the rule was implementation of aspects of the Comprehensive Addiction and Recovery Act of 2016 (CARA).

The final rule’s CARA provision seeks to provide an additional tool to help Medicare Advantage (MA) and standalone Part D plans (PDP) to combat the growing opioid epidemic in America.

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Amazon Makes Its Mark in Healthcare

The long-rumored entry of Amazon into the drug world became reality when the online retail behemoth bought PillPack for about $1 billion in late June. While the size of the entity is comparatively small, it does immediately (well, when the deal closes toward the end of the year) put Amazon on the map with the ability to sell drugs in all 50 states.

Now, retail drug chains and Pharmacy Benefit Managers (PBMs) need not worry too much for quite some time, except perhaps for the hit taken on...

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You’ve Got Mail: CMS Boldly Goes Digital

Just out -- the Centers for Medicare and Medicaid Services (CMS) has endorsed a digital strategy for Medicare Advantage and Part D plans. This will be a game changer and mean huge savings for health plans over time.

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Thoughts on Universal Coverage from Across the Pond

I am still vacationing in the United Kingdom for my daughter’s college graduation and coincidentally have been here during the 70th anniversary celebration of the National Health Service. 

As many of you know, the UK has a form of socialized medicine. Well, partially so. The federal government finances it from a tax on wages with employer contributions as well (looks a bit like the Social Security tax we have in America.) It runs great swathes of the care system, while also contracting with...

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What Scottish History and Obamacare Have In Common

Some of you may be thinking, ‘This man’s gone crazy. What can Scottish history have in common with Obamacare?’  It’s easy. While here in Scotland for my daughter’s college graduation, I have learned a great deal about the country’s history. The intrigue, the battles, and, indeed, the torture. One man, Scottish hero William Wallace (of Braveheart fame), was captured by the English and suffered an unseemly death in 1305 (I am much too polite to recount it here).

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Plans Need Efficiencies To Maintain Margin

With the advent of much stricter bidding rules in almost all lines of business, as well as the introduction of minimum medical loss ratios (MLRs), plans are struggling to maintain margins. The poorly financed Exchanges resulted in notorious losses for many plans in most states, hence the plan pullouts over the last few years. As it applies to the Medicaid line, state-hired actuaries generally peg a margin at a paltry two-percent (2%). However, depending on how good or bad “actuarially sound...

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Insights from the MedHOK 2018 User Conference


MedHOK held its 2018 User Conference earlier this month in St. Petersburg, Florida. The four-day affair featured a series of healthcare insight panels, as well as some fun time and collaboration between our great client plans.

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2017 Program Audit Results Show Continued CMS Enforcement Regime and Rigor

A few blogs ago we told you about major Centers for Medicare and Medicaid Services (CMS) Civil Monetary Penalty (CMP) activity in 2017. Recently, CMS released its annual Program Audit Report for the prior year and, as we told you then, it shows enforcement and rigor are not slowing down.

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Medicare Drug Changes in Store

The Secretary of Health and Human Services (HHS), Alex Azar, indicated recently that major changes in how drugs are administered in Medicare may come soon. The Centers for Medicare and Medicaid Services (CMS) has been increasingly concerned about the high-cost of pharmaceuticals in the program. While drug inflation has tempered, both Part B and Part D drugs are viewed as a major threat to the sustainability of the program over time.

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