Medicare business news on MA, PDP and related topics

The Quest for Better Health Outcomes
While health plans are preparing for change in today’s dynamic healthcare environment, the "Triple Aim" to achieve better health outcomes and an improved experience of care while controlling costs will be a constant, underlying goal shaping strategies and operations. In this quest, measures of quality will continue to play a key role in driving member health and physician performance. The Healthcare Effectiveness Data and Information Set (HEDIS®) is a collection of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare healthcare quality. HEDIS is widely used by health plans, physicians, and other organizations to evaluate and report healthcare performance on multiple dimensions of care and service. Performing well on HEDIS measurement and your broader population health goals requires a combination of deep industry experience, technologies, regulatory insight, and a wide range of data and analytics that support predictive modeling. "HEDIS in 2018: The Quest for Better Health Outcomes" describes the best practices many plans are adopting for this critical business process.
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According to a recent Kaiser Family Foundation analysis, in 7 of the 19 counties at risk of having no health insurers, there are no Medicare Advantage insurers, and in another 8 counties, there are two or fewer firms now offering a Medicare Advantage plan. 147 counties, across 14 states, have no Medicare Advantage insurer at all this year – nearly 8 times the number of counties that may not have a marketplace insurer in 2018.

Source: Kaiser Family Foundation

Medicare News

Medicare Reimbursement Add-On to Boost Palliative Care Revenue
RevCycle Intelligence, August 7, 2017
Medicare Advantage Spends Less on Care, So Why Is It Costing So Much?
The New York Times, August 7, 2017
Insurers Think They’ve Found the Perfect Patients for Profits
Bloomberg, August 4, 2017
Inpatient psychiatric facilities get $45 million raise from Medicare
Modern Healthcare, August 3, 2017
Humana raises earnings outlook, reports Medicare Advantage star-rating turnaround
Fierce Healthcare, August 2, 2017
Many More Counties Lack MA Plans Today than are at Risk for Lacking an ACA Insurer in 2018
Kaiser Family Foundation, August 2, 2017
Amerigroup Creates Risk-Based Partnerships for Medicare Advantage
HealthPayer Intelligence, August 1, 2017
Anthem: Insider theft exposes data of 18,000 Medicare members
HealthcareIT News, July 31, 2017
CMS proposes chopping $1 billion from home health reimbursement over two years
Modern Healthcare, July 25, 2017

Medicare Blogs

The Many Problems With Medicare’s MIPS Exclusion Thresholds
Health Affairs Blog, August 3, 2017

Yes, let’s get rid of Obamacare – with Medicare for all
The Modesto Bee, August 1, 2017

HealthcareWebSummit Events

Upcoming Webinars

The World of Health Plans, Managing Health Over Healthcare, August 29, 2017
Inside Medicare's Episode Payment Models - Major Provisions and Implications for 2018, August 30, 2017
Value Based Rx Contracting Tactics and Techniques, September 14, 2017

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MedicareHMO Web Site

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