Tag Archives: Dual-Eligible

Election Gives Health Reform the Kiss of Life

John Gorman

It’s hard to argue this wasn’t a decisive victory for the President and Democrats in the Senate.  What remains to be seen is whether intractable Congressional Republicans will come to the table to get stuff done.

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Time to Reauthorize Special Needs Plans

John Gorman

Special Needs Plans (SNPs) are a special type of health plan for America’s most vulnerable and complex seniors that are set to expire at the end of 2013. Over 500 SNPs serve more than 1.5 million Medicare beneficiaries across the United States. Done well, the SNP significantly improves outcomes and brings down costs thanks to personal care planning, care-transition assistance, disease management, and medication therapy management.  Not all SNPs are good at what they’re designed to accomplish, but there are many providing patient-centered, coordinated care to vulnerable populations showing signs of success — the program should be allowed to continue.

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Newbies Slow Dual Eligible Expansion in Key States

John Gorman

After last week’s AHIP conference on Medicare and Medicaid and MANY coffees and cocktails later, a picture emerged that the only thing slowing the movement of dual eligibles into health plans isn’t nervous advocacy groups or overstretched regulators — it’s newbies to the game of caring for the nation’s most vulnerable patients.

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Rising Chorus Urges CMS to Slow Down on Dual Eligibles

John Gorman

CMS and at least 20 states are moving hell-bent-for-leather toward enrolling as many as 3 million of the 9 million Dual Eligibles into health plans in the next two years, creating one of the biggest opportunities for payers in history.  Now a rising chorus including the Medicare Payment Advisory Commission, the American Medical  Association, some policy analysts and now at least one key Senator are urging CMS to hit the brakes.  I tend to think the movement of duals into plans is like the movement of water: it can be slowed but not stopped.

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Memo on CMS Advance Notice and Draft Call Letter for 2013

Jean LeMasurier

CMS continues to refine operational policy for Medicare Advantage and Part D plans.  View our summary of the 45-Day Advance Notice and Draft Call Letter for 2013 by clicking here.   I was disappointed CMS did not finalize their proposed regulations prior to issuing this document.  As a result some of the more significant policy changes will be reserved for the final rate announcement and final Call Letter.

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My Talk at AHIP’s Medicare Conference

John Gorman

I had the pleasure of addressing a standing-room-only crowd at the AHIP Medicare conference yesterday, sponsored by our friends at TMG Health, our 4th year together there.  That speech always keeps me on my toes, especially this year – a tough, smart audience that demands a tough, smart message on how to survive in the new Age of American Austerity.  Here are the main points of what I said: Read more

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Medicaid Managed Care = Risky (BIG) Business

John Gorman

The Washington Post printed a recent expose on the coming explosion in Medicaid managed care opportunities, coupled with the tremendous challenges of caring for lower-income, vulnerable beneficiaries, especially dual eligibles. 

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