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MedHOK Strategic Insights Blog

HHS Secretary Endorses Value-Based Healthcare Transformation

When Donald Trump took office as President in January 2017, many (including this blogger nonetheless) predicted the end of (at least the intense threat to) a quiet transformation to value-based care. There was the following:

  • The intense dislike for government healthcare program expansions in general.
  • The attack on anything Obamacare.
  • The push by the GOP House to “reform” Medicaid by stripping it of the entitlement as well as applying a growth factor to the remake that would have spelled...

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Two Changes Will Have a Major Impact on Medicare Advantage and Part D

Reforms on the horizon mean big changes to financing and service delivery.

If adopted, Medicare Advantage and Part D plans will see two reforms happen on the near-term horizon that will mean major changes to financing and service delivery:

- Overhaul of aspects of Part D retail drug delivery

- Greater flexibility in benefits and services

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2019 CMS Call Letter Is Treasure Trove of New Polices

Due to recent mandate by Congress, the Centers for Medicare and Medicaid Services (CMS) is releasing the Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2019 Call Letter in two draft notices. The first came in late December and the second in early February. Click Here to review the official release for both Call Letters.

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The Three Wise Men (Warren, Jeff and Jamie) To The Rescue?

Large healthcare plans and other health-related stocks took a tumble last week on word that three very powerful men may be planning to transform the future of healthcare. Visionaries Warren Buffet of Berkshire Hathaway, Jeff Bezos of Amazon, and Jamie Dimon of JP Morgan Chase announced that they are creating an independent company focused on improving employee satisfaction and reducing healthcare costs for their respective companies and employees.

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Provider Network Review: The Next Great Compliance Bogey

Another compliance headache hits plans! The Centers for Medicare and Medicaid Services (CMS) completed its second round of Medicare Advantage (MA) online provider directory reviews between September 2016 and August 2017. The review looked at the accuracy of 108 providers and their locations selected in 64 MA plans’ directories (about 1/3 of MA plans, 6,841 providers, and 14,869 locations). 

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Did You Get Your Timeliness Monitoring Notice Yet?

Back in mid-December, we told you to get ready for the return  of  Timeliness Monitoring in the Medicare Advantage and Part D programs.  The first wave of notices did indeed go out this month. Some of our clients have submission deadlines this week.

As noted by the Centers for Medicare and Medicaid Services (CMS), monitoring will be conducted in three waves. Below is a re-publishing of our table from December showing what you can expect to submit in the coming months if you have not...

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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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