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MedHOK Strategic Insights Blog

Work Requirements and Waivers Could Lead To Medicaid Reform Compromise

The Trump administration’s announcement that it will entertain work requirements for eligibility for Medicaid is just one small example of the huge political gulf that exists on reforming Medicaid policy nationally. But it could eventually lead to compromise on Medicaid.

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Risk Adjustment Changes Outlined In Additional 2019 Advanced Call Letter

While the Medicare Advantage and Part D Advance Notice Call Letter is usually done early each calendar year, plan actuaries and finance executives were treated to a late December additional notice a few days ago. The notice was triggered by the 21st Century Cures Act and directed the Centers for Medicare and Medicaid Services (CMS) to make several changes to the Hierarchical Condition Categories (HCC) Risk Adjustment Model used in the Medicare Advantage program.

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Look For Both Vertical and Horizontal Healthcare Integration in 2018

In this first week of this new year, I share a few insights regarding acquisitions and consolidations in healthcare. The short answer: expect a great deal of both horizontal and vertical integration.

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What a Healthcare Year It Has Been!

The year is just about over and activity was robust for healthcare in 2017. Here is a quick recap about what happened and what we think we might see in 2018. Happy New Year to all!

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Timeliness Monitoring is Back, Putting a Cramp in Holiday Plans

As everyone suspected but perhaps hoped wouldn’t happen, the Centers for Medicare and Medicaid Services (CMS) announced in a recent Health Plan Management Systems (HPMS) memo that timeliness monitoring will be done in 2018 for the second year. For the compliance and business folks, this puts a bit of a cramp in people’s holiday schedules.

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Healthcare Round Up 2017

Healthcare Trends Slowed But Still Marching On

Recently, the Centers for Medicare and Medicaid Services (CMS) Actuary announced 2016 healthcare cost statistics. It is a bit of a mixed bag for the United States.

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The Healthcare Consolidation Craze and Tax Reform

Consolidation Reshaping Healthcare

There was blockbuster news this weekend when it was confirmed that CVS Health will buy Aetna in the largest ever healthcare deal. The recent rumors have spawned talk of many other mergers.

Why would CVS want to buy Aetna? It’s simple. It is all about the numbers and the future of healthcare.

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Keep Puerto Rico in Your Thoughts This Thanksgiving Holiday, and the Mandate Repeal in Your Sights

As you sit down with family and friends this Thanksgiving and as we get into the Christmas Holiday season, keep in mind our American friends in Puerto Rico. Just after the devastation of hurricanes Irma and Maria, we wrote an extensive blog on the island’s precarious state. Sadly, much of what we wrote remains true today. Most people still lack power. Some are still without potable water and telecommunications. The health crisis has deepened. While few want to deal with the fact, a few ...

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Can Trump Undertake Medicaid Overhaul Without Changing the Law?

With healthcare reform changes dead on Capitol Hill for now, many are asking: Can the President essentially do Medicaid reform on his own using executive authority? The sheer mention of such sends shutters down the backs of advocates’ spines.

The short answer is Yes and No. And you know this blogger is never short, so here is the rather lengthy explanation.

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Plans Must Get Ready For Comprehensive Management Measures

The recent 2018 Star score announcement shows that Medicare Advantage (MA) plans continue to struggle with the high-performing system that the Centers for Medicare and Medicaid Services (CMS) has set up. If you read our recent blog analyzing the announcement, you know that it is has been tough going for many plans. A few facts from our recent analysis:

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