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MedHOK Strategic Insights Blog

A Few Changes Between the Final Call Letter and the January Proposal

The release of the final Centers for Medicare and Medicaid Services (CMS) 2019 Call Letter for Medicare Advantage and Part D revealed a few significant changes from the draft of the February Call Letter previously released. In this blog, we focus only on the significant changes identified between the previous draft and the proposed final. Read the original blog on the draft letter here

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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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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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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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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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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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Health Plans And Their Members Win in Medicare Advantage and Part D

With uncertainty over the state of Medicaid in the long term and the looming collapse of the Exchanges, health plans are seeking refuge to meet financial goals and membership growth in the Medicare Advantage (MA) and standalone Part D (PDP) programs.

Rates in the MA program were realigned with the passage of the Affordable Care Act (ACA) in 2010, but MA and PDP plans remain significant moneymakers for health plans large and small.

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Mixed Star News for Medicare Advantage and Standalone Part D Plans

With its announcement of Star ratings for the 2018 enrollment season this week, the Centers for Medicare and Medicaid Services (CMS) can continue to be happy about the progress it has made in improving healthcare quality outcomes in the Medicare Advantage (MA) and Part D (PDP) programs. However, the 2018 Star announcement shows that many plans continue to struggle with quality. This is the case not only in terms of achieving 4-Star-or-greater performance but also maintaining those levels. 

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With Price Out, What To Expect Next In Healthcare

The meteoric rise and swift fall of Health and Human Services (HHS) Secretary Tom Price shocked many in the healthcare community, which is now asking what this means for the future of healthcare policy.  A number of policy experts are being touted as the next HHS Secretary.  The prospects range from those with a more moderate voice on healthcare policy to a continuation of Price’s conservative ideological approach.   Those in contention include current Centers for Medicare and Medicaid...

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Our Hearts Go Out To The People of Puerto Rico

For many in the United States, Puerto Rico is a sunny destination point to fly in and out of on vacation.  But today, Puerto Rico is literally in crisis. 

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