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MedHOK Strategic Insights Blog

Effort to Rein In Drug Costs Means Major New Initiatives in Medicare Advantage and Part D

While drug costs have been relatively moderate of late, the Centers for Medicare and Medicaid Services (CMS) is ever mindful of the drug world’s increasing share of overall drug costs, especially as Americans age. As such, CMS and its parent, the Department of Health and Human Services (HHS), have announced two key initiatives to reduce overall drug costs and trends in Medicare Advantage and Part D.

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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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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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Major Reporting and Universe Changes Again From CMS

Our blog has been ripe with information lately regarding Centers for Medicare and Medicaid Services (CMS) Civil Monetary Penalties (CMPs), Program Audit Findings, as well as, the focus on Independent Review Entity (IRE) Auto-Forwards. The compliance regime and changes are not slowing as is evidenced by the proposal from CMS to significantly overhaul universe submission formats, changes in audit protocols and major changes to annual reports. All this comes on top of major changes and...

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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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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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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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