Deep Dive Medicare Advantage Advance Notices Part I and II
|
|
|
- Sharon Foster
- 5 years ago
- Views:
Transcription
1 Deep Dive Medicare Advantage Advance Notices Part I and II
2 Noah Champagne, FSA, MAAA Noah Champagne is a consulting actuary in Milliman s New York office. Noah has a breadth of Medicare experience working with a variety of MA plans as well as a number of ACOs. Additionally, Noah has a large amount of experience working directly with providers to facilitate risk arrangements, contracting discussions, and benchmarking. Margaret Peterson Margaret Peterson is the Director of Federal Affairs at APG. Previously, Margaret served on the health policy team for Senator Joni Ernst (R-IA), focusing on ACA reform and MACRA implementation. Valinda Rutledge, MBA Valinda Rutledge is currently the Vice President of Federal Affairs at America s Physician Groups. She previously worked as a member of the leadership team (Senior Advisor and Group Director) at CMMI
3 America s Physician Groups (APG) Purpose of our Organization Resources Advocacy Representation on Capitol Hill Healthcare and the Hill Federal comment letters Education Standards of Excellence Risk Evolution Task Force Regional meetings Mission Statement The mission of America s Physician Groups is to assist accountable physician groups to improve the quality and value of healthcare provided to patients. America s Physician Groups represents and supports physician groups that assume responsibility for clinically integrated, comprehensive, and coordinated healthcare on behalf of our patients. Simply, we are taking responsibility for America s health. Strategic Vision America s Physician Groups and its member groups will continue to drive the evolution and transformation of healthcare delivery throughout the nation.
4 Membership 44 states, D.C. and Puerto Rico
5 Agenda MA 2020 BID TIMELINE HIGHLIGHTS FROM MA ADVANCED NOTICE AND CALL LETTER PART I AND PART II PART C TAKEAWAYS FOR PRACTICES, SSBCI, STAR AND QUALITY MEASURES ADVOCACY & SIGN ON LETTER QUESTIONS
6 MA 2020 Bid Timeline MA Advance Notice Part I released December 20, 2018 MA Advance Notice Part II released January 30, 2019 Deadline for comments on MA Advance Notice Parts I and II March 1, 2019 Final rate announcement released by April 1, 2019 Deadline for 2020 Bid Submission June 3, 2019
7 The proposed updates will continue to modernize and maximize competition among Medicare Advantage and Part D plans, as well as include important actions to address the nation s opioid crisis.
8 CMS s Estimated Net Payment Impact Impact on Payments Relative to 2019 Effective Growth Rate +4.59% Change in Star Ratings -0.14% MA Coding Intensity Adjustment % Risk Model Revision +0.28% Encounter Data Transition -0.06% EGWP Payment Policy +0.00% Normalization -3.08% Expected Average Change in Revenue % 1 Note that this reflects the 5.9% difference in coding patterns between MA plans and FFS (same as 2019) 2 Excluding the impact of the rebasing of benchmarks (available in Rate Announcement)
9 County-Specific MA Benchmark Payments 2020 MA Benchmark Payments will be released in Rate Announcement on April 1, 2019 No change in Quality Bonus Payments for 2020 Preliminary 2020 FFS rate increase of 4.52% from the 2019 Rate
10 County-Specific MA Benchmark Payments - Calculation Calculated as the lesser of: Pre-ACA Amount (Applicable Amount) ACA Amount (Specified Amount) Pre-ACA Amount (Applicable Amount) Calculated as the greater of: The 2019 Pre-ACA amount increased by the 2020 MA growth percentage (4.84% for non-esrd) The 2020 FFS amount (unknown) ACA Amount (Specified Amount) Calculated as: (2020 FFS Rate) x (applicable percentage + applicable percentage quality increase) Most notable this amount includes the Quality Bonus Payment (QBP) A majority of MAOs received some form of QBP bonus in 2018 (new contract or based on star rating)
11 Part C Risk Score Changes 50%/50% blend of 2020 and 2017 risk score models Sizable increase in FFS Normalization Factor (lowers risk scores) Risk Scores will be calculated as a 50%/50% Blend of EDS and RAPS 5.9% Coding Pattern Adjustment (Same as 2019)
12 Part C Risk Model Changes 2020 Risk Scores 50% 2020 CMS-HCC model with Payment Condition Count (1.069 FFS Normalization Factor) 50% 2017 CMS-HCC Model (1.075 FFS Normalization Factor) 2019 Risk Scores 50% 2019 CMS-HCC model without Payment Condition Count (1.038 FFS Normalization Factor) 50% 2017 CMS-HCC Model (1.041 FFS Normalization Factor)
13 Payment Condition Count (PCC) Model Proposed Payment Condition Count (PCC) model Coefficient added variable that counts the number of condition(s) a beneficiary has (among those included in the payment model) Materially improved predictive power of risk model Same model proposed in Part I of the 2019 Advance Notice, released December 27, 2017 Little impact on overall average risk scores but variation by beneficiary: 0-3 HCCs: No impact 4-5 HCCs: Slightly lower 6+ HCCs: Slightly higher 10+ HCCs: Largest impact (only 3% of population) Minimal impact by gender, age group, race/ethnicity, census region, plan type (HMO, PPO, POS), EGWPs CMS estimated 1.1% increase in MA individual plans average risk score 2 but Avalere estimated a 0.6% increase 1 Source: 2 Source:
14 Part C Normalization Factor Increase Accelerated increase in underlying risk scores driven by: Changes in demographics Changes in the reported health status in the FFS Population Implementation of ICD-10
15 Part C Risk Scores EDS/RAPS Transition Year EDS Weighting RAPS Weighting % 90% % 75% % 85% % 75% 2020 (Proposed) 50% 50% EDS Encounter Data System RAPS Risk Adjustment Processing System
16 Part C Risk Scores EDS/RAPS Transition Based on payment year 2017 risk scores, EDS risk scores are on average 2.5% lower than RAPS risk scores 1 General enrollment plans: 2.2% lower Special Needs Plans (SNPs): 5.2% lower Risk score comparison: 89% had same Part C, 9% RAPS higher, 2% EDS higher Revenue impact will grow in future as EDS becomes larger portion of risk score and for SNPs where EDS risk scores are much lower than RAPS risk scores Member-level comparison of EDS and RAPS Part C risk scores by plan type 1 Source:
17 Part C Risk Scores Coding Pattern Adjustment Adjustment to plan payments to reflect differences in diagnosis coding between MA organizations and FFS providers Year Coding Pattern Adjustment % %
18 Health Insurer Provider Fee (HIPF) HR 195 Passed into law January 22, 2018 One year moratorium on the Health Insurance Providers Fee (HIPF) Set to expire for 2020 service year Service Year At least 3 bills that were introduced in January of 2019 that could repeal or further delay the HIPF
19 Employer Group Waiver Plans (EGWPs) 2019 Bids Administratively set rates for Retiree Plans CMS waive the bidding requirement for all MA EGWPs 2020 Bids CMS will continue to waive the bidding requirements for all MA EGWPs
20 Proposals to Address the Opioid Epidemic Encourage lower cost-sharing for naloxone as well as promoting co-prescribing of naloxone when clinically appropriate Encourage plans to offer medicallyapproved non-opioid pain management as supplemental benefit Implement Pharmacy Quality Alliance (PQA) opioid overuse measures for 2020 STAR Rating
21 Puerto Rico Specific Changes Adjust FFS rates in Puerto Rico to be based on beneficiaries who are enrolled in both Part A and Part B Adjust FFS rates in Puerto Rico to account for differences in the % of beneficiaries with zero claims versus nationwide (this was done in 2019) CMS is not anticipating adjusting Puerto Rico s FFS Rates to account for the 2017 hurricane
22 Additional Part C Items Included in Advance Notice No change to rebate percentages by star rating from 2019 Total beneficiary cost measure (TBC) will be maintained at $36 PMPM Minor updates to the measures included in 2020 Star Ratings Minor Increases to 2020 in-network cost sharing limits
23 Part C Takeaways for Practices Increase in Normalization Factors will decrease risk scores approximately 3% FFS Population Risk Score Growth has Accelerated
24 2019 Expansion of Supplemental Benefits IN 2019 CALL LETTER CMS EXPANDED DEFINITION OF HEALTH CARE SUPPLEMENTAL BENEFIT TO INCLUDE : DIAGNOSE, COMPENSATE FOR PHYSICAL IMPAIRMENTS OR ACT TO AMELIORATE THE FUNCTIONAL/PSYCHOLOGICA L IMPACT OF INJURIES THESE ITEMS INCLUDED FALL PREVENTION OR OTHER DEVICES, THEY DID NOT INCLUDE ITEMS ADDRESSING SDOH OR CAN T BE USED TO INDUCE ENROLLMENT MUST BE ORDERED BY LICENSED PROVIDER
25 2020 Special Supplemental Benefits for the Chronically Ill (SSBCI) BBA 2018 allowed supplemental benefits not primarily health expanded in 2020 to chronically ill Definition of Chronically ill: one of more co-morbid and medically complex chronic condition, high risk of hospitalization, requires intensive care coordination MA plans must document mechanism to identify enrollees and maintain records. Can use CBO to provide benefits Types of Supplemental Benefits: Home Delivered Meals Transport for non Medical Needs Must be detailed in EOC (Evidence of Coverage) Must be able to show reasonable expectation of improving or maintaining the health
26 CMS is soliciting SSBCI Guidance Should Plans have flexibility to determine what is chronic disease (will convene a Technical Advisory Panel to update list) Should these supplemental benefits have limits Should financial need be considered
27 Proposed Star Rating Changes ADULT BMI PROPOSED FOR REMOVAL MEDICATION ADHERENCE TO BE ADJUSTED FOR SDS ALL CAUSE READMISSION- ADDED OBSERVATION STAYS MEDICATION RECONCILIATION- RETIRE MEASURE AS STANDALONE BUT REPORTED THROUGH TRANSITIONS OF CARE MEASURE CONTROLLING BP- TEMPORARY REMOVAL DUE TO NEW AHA GUIDELINES
28 Request for Comments on New Measures Pain Management ( use of non opioid therapies and PRO for patients for chronic pain) Antibiotic Utilization Measures in the Ambulatory Setting PROM (Patient Reported Outcome Measures) 2 global measures: physical and mental health Physician /Plan Interactions-survey Interoperability- Measures plans progress to exchange info with providers
29 Summary Of Part I and II Changes Part I Rate Notice Changes Implement Payment Condition Count Encounter Data Transition from 75/25 to 50/50 Part II Rate Notice Changes 1.59% net average rate increase Normalization Chronically Ill definition of Supplemental benefits Minimal changes in Star Rating measures
30 MA 2020 Bid Timeline - Repeated MA Advance Notice Part I released December 20, 2018 MA Advance Notice Part II released January 30, 2019 Deadline for comments on MA Advance Notice Parts I and II March 1, 2019 Final rate announcement released by April 1, 2019 Deadline for 2020 Bid Submission June 3, 2019
31 Sign on Letter PHYSICIAN-LEAD COALITION EXPRESSING SUPPORT FOR MA ANNUAL TRADITION LAST YEAR S LETTER HAD 340 SIGNEES APG WILL BE BEGIN CIRCULATING LETTER FOR SIGNATURES WEEK OF FEB. 25
32 Questions? NOAH CHAMPAGNE MARGARET PETERSON VALINDA RUTLEDGE
33
Understanding the 2020 Medicare Advantage Advance Notice Part I
Understanding the 2020 Medicare Advantage Advance Notice Part I Jennifer Carioto, FSA, MAAA Jennifer Carioto is a consulting actuary with the New York office of Milliman. She specializes in Medicare Advantage
The 2018 Advance Notice and Draft Call Letter for Medicare Advantage
The 2018 Advance Notice and Draft Call Letter for Medicare Advantage POLICY PRIMER FEBRUARY 2017 Summary Introduction On February 1, 2017, the Centers for Medicare & Medicaid Services (CMS) released the
2019 ADVANCE NOTICE: CHANGES TO MEDICARE ADVANTAGE PAYMENT METHODOLOGY AND THE POTENTIAL EFFECT ON MEDICARE ADVANTAGE ORGANIZATIONS
February 6, 2014 GLENN GIESE FSA, MAAA KELLY BACKES FSA, MAAA 2019 ADVANCE NOTICE: CHANGES TO MEDICARE ADVANTAGE PAYMENT METHODOLOGY AND THE POTENTIAL EFFECT ON MEDICARE ADVANTAGE ORGANIZATIONS February
Better Medicare Alliance Webinar: Medicare Advantage and Part D 2019 Advance Notice and Draft Call Letter. February 8, 2018
Better Medicare Alliance Webinar: Medicare Advantage and Part D 2019 Advance Notice and Draft Call Letter February 8, 2018 RATE NOTICE CRASH Opening COURSE Remarks PAGE http://bettermedicarealliance.org/campaigns
2018 Medicare Advantage and Part D Rate Announcement and Call Letter, and Request
2018 Medicare Advantage and Part D Rate Announcement and Call Letter, and Request for Information Date 2017-04-03 Title 2018 Medicare Advantage and Part D Rate Announcement and Call Letter, and Request
Medicare Advantage (MA) Proposed Benchmark Update and Other Adjustments for CY2020: In Brief
Medicare Advantage (MA) Proposed Benchmark Update and Other Adjustments for CY2020: In Brief February 7, 2019 Congressional Research Service https://crsreports.congress.gov R45494 Contents Introduction...
2016 ADVANCE NOTICE: CHANGES TO MEDICARE ADVANTAGE PAYMENT METHODOLOGY AND THE POTENTIAL EFFECT ON MEDICARE ADVANTAGE ORGANIZATIONS AND BENEFICIARIES
February 6, 2014 GLENN GIESE FSA, MAAA KELLY BACKES FSA, MAAA 2016 ADVANCE NOTICE: CHANGES TO MEDICARE ADVANTAGE PAYMENT METHODOLOGY AND THE POTENTIAL EFFECT ON MEDICARE ADVANTAGE ORGANIZATIONS AND BENEFICIARIES
March 1, Dear Mr. Kouzoukas:
March 1, 2019 Mr. Demetrios L. Kouzoukas Principal Deputy Administrator and Director Center for Medicare Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 Re: Advance
BMA Ally Call: Medicare Advantage 2018 Advance Notice and Draft Call Letter. February 8, 2017
BMA Ally Call: Medicare Advantage 2018 Advance Notice and Draft Call Letter February 8, 2017 2018 Advance Notice and Draft Call Letter On February 1, 2017, CMS released the Medicare Advantage (MA) 2018
CMS 2016 Call Letter Summary
CMS 2016 Call Letter Summary Annual Calendar (Page 70) combined calendar listing of side-by-side key dates and timelines for operational activities that pertain to Medicare Advantage (MA), Medicare Advantage-
Employer Group Waiver Plans Financial Impact Based on the 2017 Advance Notice Summary
Employer Group Waiver Plans Financial Impact Based on the 2017 Advance Notice Summary Prepared for: U.S. Chamber of Commerce Prepared by: Milliman, Inc. Brett L. Swanson, FSA, MAAA Principal and Consulting
Medicare Advantage star ratings: Expectations for new organizations
Medicare Advantage star ratings: Expectations for new organizations February 2018 Kelly S. Backes, FSA, MAAA Julia M. Friedman, FSA, MAAA Dustin J. Grzeskowiak, FSA, MAAA Elizabeth L. Phillips Patricia
CMS Medicare Advantage 2018 Advance Notice Summary
CMS Medicare Advantage 2018 Advance Notice Summary KEY HIGHLIGHTS February 2017 Risk Adjustment Part C Coding Intensity Adjustment: 5.91% Part C Normalization Factor: 1.017 Adjusted Effective Growth Rate
Estimated Federal Impact of a Proposal to Shift Hospice Spending to Medicare Advantage
To: National Hospice and Palliative Care Organization From: Avalere Health Date: Re: Estimated Federal Impact of a Proposal to Shift Hospice Spending to Medicare Advantage Summary The National Hospice
Uniformity Requirements Flexibility (from the CMS Reinterpretation of the Uniformity Requirement memo )
Uniformity Requirements and Benefit Flexibility Changes Highlights Updated 4/30/18 (Key excerpts from CMS MA rule, 2019 ANCL and CMS guidance memos issued 4-27-2018.) Uniformity Requirements Flexibility
Session 33 TS, Medicare Risk Scores for Beginners with Intermediate Topics. Moderator/Presenter: Joseph Saul Flaks, FSA, MAAA
Session 33 TS, Medicare Risk Scores for Beginners with Intermediate Topics Moderator/Presenter: Joseph Saul Flaks, FSA, MAAA Presenter: Christine Sue Bach, ASA, MAAA, FCA 2015 SOA Health Meeting Session
Sent via electronic transmission to:
March 3, 2017 Patrick Conway, MD Acting Administrator Centers for Medicare and Medicaid Services US Department of Health and Human Services 200 Independence Avenue, SW Washington, DC 20201 Sent via electronic
2020 Medicare Advantage
www.wakely.com 2020 Medicare Advantage Summary of Advance Rate Notice Part 2 February 7, 2019 page i Table of Contents Executive Summary... 1 Attachment I: Preliminary Estimates of the National Per Capita
The Medicare Advantage program: Status report
C H A P T E R12 The Medicare Advantage program: Status report C H A P T E R 12 The Medicare Advantage program: Status report Chapter summary In this chapter Each year the Commission provides a status
Medicare Advantage: Program Overview and Recent Experience. James Cosgrove, Ph.D. Director, Health Care U.S. Government Accountability Office
Medicare Advantage: Program Overview and Recent Experience James Cosgrove, Ph.D. Director, Health Care U.S. Government Accountability Office January 15, 2009 01/15/2009 1 In 2008, About 22 Percent of Medicare
State of the 2018 Medicare Advantage industry: Stable and growing
State of the 2018 Medicare Advantage industry: February 2018 Julia M. Friedman, FSA, MAAA Brett L. Swanson, FSA, MAAA Table of Contents I. EXECUTIVE SUMMARY... 1 II. BACKGROUND... 3 III. OVERVIEW... 4
Overview of New Benefit Flexibilities in Medicare Advantage
Overview of New Benefit Flexibilities in Medicare Advantage State Councils for Home and Hospice September 11, 2018 Jane Galvin Managing Director, Regulatory Affairs Blue Cross Blue Shield Association is
New Options in Medicare Advantage: Addressing the Social Determinants of Health and More
New Options in Medicare Advantage: Addressing the Social Determinants of Health and More Over the last year, new laws, regulations, and guidance from the Centers for Medicare & Medicaid Services (CMS)
March 5, Dear Mr. Kouzoukas and Ms. Lazio:
Demetrios Kouzoukas, Principal Deputy Administrator and Director, Center for Medicare Jennifer Wuggazer Lazio, F.S.A., M.A.A.A., Director, Parts C & D Actuarial Group, Office of the Actuary Centers for
NOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and Other Interested Parties
April 3, 2017 NOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and Other Interested Parties SUBJECT: Announcement of Calendar Year (CY) 2018 Medicare Advantage Capitation Rates
RISE RAPS-EDS Collaboration Research Project Executive Summary
RISE RAPS-EDS Collaboration Research Project Executive Summary Christie Teigland, Ph.D. 1.26.17 Avalere Health T 202.207.1300 avalere.com An Inovalon Company F 202.467.4455 1350 Connecticut Ave, NW Washington,
Session 8L, Future of Medicare Advantage: Trends of an Expanding Market. Moderator/Presenter: Gregory V. Sgrosso, FSA, MAAA
Session 8L, Future of Medicare Advantage: Trends of an Expanding Market Moderator/Presenter: Gregory V. Sgrosso, FSA, MAAA Presenters: Haitham Aly David Hayes, FSA, MAAA Gregory V. Sgrosso, FSA, MAAA SOA
Session 98 L, Medicare Advantage Risk Adjustment: Past, Present and Future. Presenters: Adrian L. Clark, FSA, MAAA David Benjamin Koenig, FSA, MAAA
Session 98 L, Medicare Advantage Risk Adjustment: Past, Present and Future Presenters: Adrian L. Clark, FSA, MAAA David Benjamin Koenig, FSA, MAAA SOA Antitrust Disclaimer SOA Presentation Disclaimer Medicare
Risk Adjustment User Group
Risk Adjustment User Group Thursday, December 5, 2013 3:00 pm - 4:00 pm ET Agenda Purpose Guidance for MAOs System Updates Highlights and Reminders Example Risk Score Calculation for PY 2014 Upcoming Events
San Francisco Health Service System Health Service Board
San Francisco Health Service System Health Service Board Medicare Advantage Marketplace Overview December 13, 2018 Prepared by: Health & Benefits Medicare Advantage Marketplace Overview Agenda Medicare
MEDICARE ADVANTAGE INSIGHTS
Consulting Actuaries Volume 1 FALL 2018 MEDICARE ADVANTAGE INSIGHTS 2019 OPEN ENROLLMENT AND PREPARING FOR 2020 AND BEYOND From October 15, 2018 through December 7, 2018, nearly 60 million seniors and
March 4, Dear Acting Administrator Slavitt:
March 4, 2016 Mr. Andrew Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health & Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 Dear Acting Administrator
March 4, Dear Mr. Cavanaugh and Ms. Lazio:
Sean Cavanaugh, Deputy Administrator, Centers for Medicare & Medicaid Services, Director, Center for Medicare Jennifer Wuggazer Lazio, F.S.A., M.A.A.A., Director, Parts C & D Actuarial Group Centers for
Medicare Advantage s New Supplemental Benefit for 2019: Plan Views and Responses. Executive Summary
Medicare Advantage s New Supplemental Benefit for 2019: Plan Views and Responses Executive Summary There has been considerable interest in recent years to find ways that the Medicare program could cover
Medicare Advantage and Part D Reform under the Patient Protection and Affordable Care Act (PPACA)
Medicare Advantage and Part D Reform under the Patient Protection and Affordable Care Act (PPACA) Presented by Matt Chamblee Tampa, FL 813-282-9262 June 16, 2010 Scope of Presentation Medicare Advantage
Session 64PD, Risk-Sharing Arrangements in Medicare Advantage
Session 64PD, Risk-Sharing Arrangements in Medicare Advantage Presenters: Adam J. Barnhart, FSA, MAAA Hillary H. Millican, FSA, MAAA Simon J. Moody, FSA, MAAA SOA Antitrust Disclaimer SOA Presentation
Part One: FEDERAL POLICY AND MEDICARE S IMPACT ON THE ECONOMY
Introducing the first in a three-part series of white papers designed to explore 1) Why the nation s health system is facing a financial crisis, 2) How providers that accept Medicare Advantage plans and
stabilize the Medicare Advantage Program
March 4, 2016 The Honorable Sylvia Burwell Secretary, U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 Dear Secretary Burwell: The U.S. Chamber of Commerce
Risk Adjustment User Group
Risk Adjustment User Group May 15, 2014 3:00 p.m. 4:00 p.m. ET Agenda Purpose Policy Updates Guidance and Examples for MAOs and Other Entities Highlights and Reminders Upcoming Events and Resources Questions
TRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for April 2007
TRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for April 2007 Prepared by Stephanie Peterson and Marsha Gold, Mathematica Policy Research Inc. as part of work commissioned by the Kaiser
Provisions of the Medicare Modernization Act
Provisions of the Medicare Modernization Act Medicare Prescription Drug Modernization and Improvement Act of 2003 (MMA) Todd Whitney, FSA, MAAA Wakely Consulting Group Highlights of New Act New Rx Benefit
Medicare s different models for caring for beneficiaries with chronic conditions. Mark E. Miller, PhD March 11, 2015
Medicare s different models for caring for beneficiaries with chronic conditions Mark E. Miller, PhD March 11, 2015 Medicare beneficiaries with chronic care needs In 2010, more than two-thirds, or 21.4
CMS 1701 P UnityPoint Health. October 16, 2018
CMS 1701 P UnityPoint Health 1776 West Lakes Parkway, Suite 400 West Des Moines, IA 50266 unitypoint.org October 16, 2018 Seema Verma, Administrator Centers for Medicare & Medicaid Services Department
Developing Your Value Proposition. Timothy P. McNeill, RN, MPH
Developing Your Value Proposition Timothy P. McNeill, RN, MPH What is a Value Proposition A value proposition is the service or feature that makes an organization attractive to potential customers The
Medicare-Medicaid Alignment Initiative CY 2015 Final Rate Report March 20, 2015
The Illinois Department of Healthcare and Family Services (HFS), in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing the Medicaid and Medicare components of the CY 2015
RISE RAPS / EDS Collaboration: Comments for the Advance Notice February 21, 2017 Webinar Presentation at 10:30 a.m. P.T/ 1:30 p.m. E.
RISE RAPS / EDS Collaboration: Comments for the Advance Notice February 21, 2017 Webinar Presentation at 10:30 a.m. P.T/ 1:30 p.m. E.T We are the How To people Meet the Panel Christie Teigland, PhD, Avalere
MEDICARE ADVANTAGE MA Plans. to $28 per month 46% HOW HEALTH SYSTEMS CAN THRIVE WITH. Developing Your Medicare Advantage Strategy PRODUCT
HOW HEALTH SYSTEMS CAN THRIVE WITH MEDICARE ADVANTAGE The 2019 Medicare Advantage (MA) plan year began on January 1st and once again more Americans enrolled in MA plans than the year before. Fueled by
The Alliance of Community Health Plans (ACHP) appreciates the opportunity to comment on the 2018 Advance Notice and Call Letter.
Cynthia Tudor, PhD Acting Director, Center for Medicare Centers for Medicare and Medicaid Services 7500 Security Boulevard Baltimore, MD 21244-1850 Submitted via email to: AdvanceNotice2018@cms.hhs.gov
Utilizing Predictive Models to Target for Clinical and Diagnosis Gaps. Predictive Modeling Summit September 16, 2016 Presented by Scott Weiner
Utilizing Predictive Models to Target for Clinical and Diagnosis Gaps Predictive Modeling Summit September 16, 2016 Presented by Scott Weiner Agenda Who is EMSI? Risk Adjustment Primer Historical Predictive
Volume to Value The Great Transformation of American Medicine
Volume to Value The Great Transformation of American Medicine 2010-2020 Richard I. Fogel, MD FHRS Chief Clinical Officer St. Vincent Health October 2015 Fee for Service You get paid for what you do The
Medicare-Medicaid Alignment Initiative CY 2016 Final Rate Report November 1, 2016
The Illinois Department of Healthcare and Family Services (HFS), in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing the updated Medicare component of the CY 2016 rates
Are You Optimizing Your Provider-Sponsored Medicare Advantage Plan?
Are You Optimizing Your Provider-Sponsored Medicare Advantage Plan? April 2016 WRITTEN BY: TYRONNE JOLLY, RICH TREMBOWICZ The Medicare market is swelling as the nation s aging population continues to grow.
Medicare Advantage Value-Based Insurance Design Model Test. Responses to Stakeholder Inquiries. Last updated: November 10, 2015
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 CENTER FOR MEDICARE AND MEDICAID INNOVATION Medicare Advantage Value-Based
The Future of the Medicare Advantage Employer Group Waiver Plan Market
The Future of the Medicare Advantage Employer Group Waiver Plan Market aetna.com The Future of the Medicare Advantage Employer Group Waiver Plan Market Approach and Key Findings To evaluate the trends
Released: February 19, Comments Due: March 4, 2016
SUMMARY AMCP Summary: Advance Notice of Methodological Changes for Calendar Year (CY) 2017 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter Released:
a HealthcareWebSummit Event, 1PM Eastern, Wednesday, February 22, 2017
Webinar: Medicare Advantage Risk Score Transition a HealthcareWebSummit Event, 1PM Eastern, Wednesday, February 22, 2017 Individual Registration Fee: $195. Post-Event Materials: $45 for attendees; $260
Medicare payment policy and its impact on program spending
Medicare payment policy and its impact on program spending James E. Mathews, Ph.D. Deputy Director, Medicare Payment Advisory Commission February 8, 2013 Outline of today s presentation Brief background
The Road to Value. Aric R. Sharp, MHA, CMPE, FACHE Vice President Accountable Care UnityPoint Health February 3, 2017
The Road to Value Aric R. Sharp, MHA, CMPE, FACHE Vice President Accountable Care UnityPoint Health February 3, 2017 1,500 Physicians UnityPoint Clinic 17 hospitals + 15 rural network hospitals 35,000
MEDICARE ADVANTAGE IN RURAL AREAS: EXPERIENCE UNDER THE MMA
MEDICARE ADVANTAGE IN RURAL AREAS: EXPERIENCE UNDER THE MMA by Marsha Gold, Sc.D. Senior Fellow Mathematica Policy Research October 10, 2007 For presentation at a briefing for the Senate Finance Committee
Overview. Procure.shtml
Statewide Medicaid Managed Care (SMMC) Cost Proposal Magellan Complete Care (Florida MHS Inc., dba Magellan Complete Care) Actuarial Memorandum and Certification Overview The purpose of this memorandum
Risk Adjustment Webinar
Risk Adjustment Webinar July 1, 2014 11:00 a.m. to 3:00 p.m. ET Risk Adjustment Webinar Introduction Operations Updates Overview and Policy Risk Score Calculation Operations Overview Summary Risk Adjustment
SUBJECT: Contract Year 2019 Medicare Advantage Bid Review and Operations Guidance
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Center for Medicare 7500 Security Boulevard Baltimore, Maryland 21244-1850 MEDICARE DRUG & HEALTH PLAN CONTRACT ADMINISTRATION
Submitted via Federal e-rule making Portal: April 5, 2019
1 Submitted via Federal e-rule making Portal: http://www.regulations.gov April 5, 2019 Aaron Zajic Office of Inspector General Department of Health and Human Services Cohen Building, Rm 5527 330 Independence
Public sector employers already face growing financial. How Public Sector Employers Can Manage Retiree Health Liabilities. Retirement Strategies
Retirement Strategies How Public Sector Employers Can Manage Retiree Health Liabilities Changes in the Governmental Accounting Standards Board (GASB) reporting requirements will increase the liabilities
CHRONIC Care Act: Making the Case for LTSS in Medicare Advantage Supplemental Benefits
Slide 1 The SCAN Foundation (logo) CHRONIC Care Act: Making the Case for LTSS in Medicare Advantage Supplemental Benefits Anne Tumlinson, Anne Tumlinson Innovations Nicholas Johnson, Milliman @TheSCANFndtn
TRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for October 2007
TRACKING MEDICARE HEALTH AND PRESCRIPTION DRUG PLANS Monthly Report for October 2007 Prepared by Stephanie Peterson and Marsha Gold, Mathematica Policy Research Inc. as part of work commissioned by the
OPEN ENROLLMENT GUIDE
OPEN ENROLLMENT CONTENTS UNDERSTANDING THE NEW MEDICARE CARD 3 UNDERSTANDING 4 UNDERSTANDING THE DIFFERENCE BETWEEN TRADITIONAL MEDICARE AND MEDICARE ADVANTAGE 9 UNDERSTANDING THE DIFFERENCE BETWEEN MEDICARE
Medicare Comprehensive ESRD Care (CEC) Initiative
Medicare Comprehensive ESRD Care (CEC) Initiative May 2013 Avalere Health LLC Avalere Health LLC The intersection of business strategy and public policy Background On February 4, 2013, the Center for Medicare
Plan Management Navigator
Plan Management Navigator Analytics for Health Plan Administration September 2016 Healthcare Analysts Douglas B. Sherlock, CFA sherlock@sherlockco.com Christopher E. de Garay cgaray@sherlockco.com Erin
Cal MediConnect CY 2014 Rate Report
The State of California, in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing draft rates for the California Demonstration to Integrate Care for Dual Eligible Beneficiaries,
Risk adjustment is an important opportunity to ensure the sustainability of the exchanges and coverage for patients with chronic conditions.
RISK ADJUSTMENT Risk adjustment is an important opportunity to ensure the sustainability of the exchanges and coverage for patients with chronic conditions. If risk adjustment is not implemented correctly,
National Conference of State Legislatures
National Conference of State Legislatures Retiree Health Benefits Medicare Advantage Plans Ward Brigham, FSA Vice President and Actuary, UnitedHealthcare Retiree Solutions (952) 406-3178 ward_brigham@uhc.com
What Risk Adjustment Looks Like Today
What Risk Adjustment Looks Like Today The Start Of Risk Adjustment In 1997, the Balanced Budget Act (BBA), was the first year that Risk Adjustment methodology for Medicare Advantage (formerly Medicare
Session 108 L, Medicare Advantage MLR: Year Two. Moderator/Presenter: Scott O Neil Jones, FSA, MAAA
Session 108 L, Medicare Advantage MLR: Year Two Moderator/Presenter: Scott O Neil Jones, FSA, MAAA SOA Antitrust Disclaimer SOA Presentation Disclaimer Medicare Advantage MLR: Year Two 2016 SOA Annual
Medicare Updates n4a Aging Policy Briefing April Ben F. Belton Center for Medicare Advocacy
Medicare Updates 2018 n4a Aging Policy Briefing April 2018 Ben F. Belton Center for Medicare Advocacy MedicareAdvocacy.org The Center for Medicare Advocacy is a national non-profit law organization founded
Medicare Payment Advisory Commission (MedPAC) January Meeting Summary
Medicare Payment Advisory Commission (MedPAC) January Meeting Summary The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional agency established by the Balanced Budget Act of
SAVINGS GENERATED BY PHARMACY BENEFIT MANAGERS IN THE MEDICARE PART D PROGRAM
February 6, 2014 GLENN GIESE KELLY BACKES SAVINGS GENERATED BY PHARMACY BENEFIT MANAGERS IN THE MEDICARE PART D PROGRAM June 26, 2017 GLENN GIESE RANDALL FITZPATRICK KEVIN MEYER CONTENTS Findings... 1
Draft Released: February 1, Final Released: April 2, Effective Date: January 1, 2019
AMCP Summary: Announcement of Calendar Year (CY) 2019 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter Draft Released: February 1, 2018 Final
AHLA. L. Medicare Advantage New Developments and Key Legal Issues. Anne W. Hance McDermott Will & Emery LLP Washington, DC
AHLA L. Medicare Advantage New Developments and Key Legal Issues Anne W. Hance McDermott Will & Emery LLP Washington, DC Institute on Medicare and Medicaid Payment Issues March 26-28, 2014 Recent Developments
Florida Social Services Estimating Conference
Florida Social Services Estimating Conference Statewide Medicaid Managed Care Rate Setting Summary John Meerschaert, FSA, MAAA Principal and Consulting Actuary Andrew Gaffner, FSA, MAAA Consulting Actuary
Fact Sheet Part C and D Star Ratings
Fact Sheet - 2018 Part C and D Star Ratings Note: The information included in this Fact Sheet is based on the 2018 Star Ratings published on Medicare Plan Finder (MPF) on October 11, 2017. For details
Medicare Advantage Benefit Flexibility (Supplemental Benefits and Uniformity)
Medicare Advantage Benefit Flexibility (Supplemental Benefits and Uniformity) Heather Kilbourne Division of Policy, Analysis, and Planning, Medicare Drug and Health Plan Contract Administration Group,
CF Health Advisors: Partner Biographies
The Evolving Healthcare Landscape C F H E A LT H A D V I S O R S S E P T E M B E R, 2 0 1 6 CF Health Advisors: Partner Biographies CHARLENE FRIZZERA President and CEO JEREMY BROWN Managing Partner Former
AFFORDABILITY REVIEW. Mysteries of the Medical Loss Ratio
AFFORDABILITY REVIEW Mysteries of the Medical Loss Ratio NANCY DJORDJEVIC DIRECTOR, HEALTHCARE ANALYTICS APRIL 2016 WHO IS GORMAN HEALTH GROUP? Gorman Health Group is the leading solutions and consulting
Understanding Private- Sector Medicare
Understanding Private- Sector Medicare A primer for investors Updated June 27, 2013 This presentation is intended for informational purposes only to give the reader a basic understanding of the Medicare
The Advantage of Medicare in Puerto Rico, in Crisis Urgent Action Required. June 9, 2016
The Advantage of Medicare in Puerto Rico, in Crisis Urgent Action Required June 9, 2016 1 Contents 1. The Advantage of Medicare in PR What has MA meant for PR? 2. MA Cliff, MA Crisis, PR Crisis 3. Proposals
Medicare Advantage Special Needs Plans on the Rise
Medicare Advantage Special Needs Plans on the Rise 3/28/2013 by Debra A. Donahue As of March 1, 2013 nearly 1.668 million people were enrolled in Medicare Special Needs Plans (SNPs) nationwide, up 18%
A Practical Discussion of Value and Quality Based Payments What Do I Do Now?
Emerging Challenges in Primary Care: 2016 A Practical Discussion of Value and Quality Based Payments What Do I Do Now? Modified from AHLA Physicians and Hospitals Law Institute 2016 Faculty Ellie Bane
First a word about the rising cost of retiree healthcare
Medicare Trends First a word about the rising cost of retiree healthcare The average 66-year-old couple is expected to spend nearly 60% of their Social Security income on medical bills, according to a
Session 1: Mandated Report: Medicare Payment for Ambulance Services
Medicare Payment Advisory Committee Meeting, Nov. 1 2 Session 1: Mandated Report: Medicare Payment for Ambulance Services Session 2: Reducing the Hospitalization Rate for Medicare Beneficiaries Receiving
State of New Jersey. State Health Benefits Program. Plan Year 2019 Rate Renewal Recommendation Report. State Employee Group
State of New Jersey State Health Benefits Program Plan Year 2019 Rate Renewal Recommendation Report State Employee Group September 2018 Table of Contents Subject Page Executive Summary 3 Plan Year 2019
Providing Meaningful Oversight of Risk Adjustment Programs. February 1, 2016
Providing Meaningful Oversight of Risk Adjustment Programs February 1, 2016 Presented by: Richard Lieberman Chief Data Scientist TODAY S AGENDA A brief history of Medicare-Advantage rate-setting and risk
Why a Successful Population Health Strategy Must Include Medicare Advantage
Health Care Advisory Board Why a Successful Population Health Strategy Must Include Medicare Advantage Assessing the Attractiveness of Medicare Advantage Contracts 2445 M Street NW Washington DC 20037
ACO Essentials Series
ACO Essentials Series How to Use Health Endeavors Technology January, 2017 1/11/2017 1 Agenda Day 1&2 Interactive Analytic Tools Define ACO Goals- Success Plan Organizational Structure Executive TIN and
Medicare Overview. James Cosgrove, Director U.S. Government Accountability Office (GAO) February 8, 2013
Medicare Overview James Cosgrove, Director U.S. Government Accountability Office (GAO) February 8, 2013 Presentation Outline General Structure, Eligibility, and Beneficiaries Medicare Providers Medicare
a HealthcareWebSummit Event, 1PM Eastern, Wednesday, March 29, 2017
Webinar: MACRA and Medicare Advantage a HealthcareWebSummit Event, 1PM Eastern, Wednesday, March 29, 2017 Individual Registration Fee: $195. Post-Event Materials: $45 for attendees; $260 for non-attendees
Cal MediConnect CY 2014 Final Joint Medicare-Medicaid Rate Report October 2017
The State of California (California), in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing final calendar year (CY) 2014 rates for the California Demonstration to Integrate
January 16, Seema Verma Administrator Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244
Seema Verma Administrator Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 RE: CMS-4182-P: Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare
Affordable Care Act Repeal and Replacement Legislation
Affordable Care Act Repeal and Replacement Legislation Timeline/ Actions to Date In February 2017, draft legislation aimed at repealing and replacing the Affordable Care Act (ACA), or Obamacare, was informally
The Medicare Advantage and Part D Programs
The Medicare Advantage and Part D Programs American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues March 25, 2015 1 Agenda The Medicare Advantage Program Medicare Part D Research