The GHG Blog is just the tip of the iceberg. Check out the Point for complete access to all content from GHG experts.
- After Hours
- Agent Oversight
- Brain Food
- Health Insurance Exchanges
- Part D
- Performance Optimization
- Policy & Health Reform
- Prospective Evaluations
- Provider Relations
- Risk Adjustment
- Sales & Marketing
- Star Ratings
- Janet on What Sequestration Could Mean to Medicare Advantage Claims Payment
- Kristina on What Sequestration Could Mean to Medicare Advantage Claims Payment
- Curt Black on What Sequestration Could Mean to Medicare Advantage Claims Payment
- Margaret on What Sequestration Could Mean to Medicare Advantage Claims Payment
- Jane Wall Medicare Health Benefits Inc on Strange Bedfellows Come to Medicare Advantage’s Rescue
Tag Archives: gorman health group
With all the activity underway across the states, you’d think we were less than 10 months away from when health plans in the Exchanges begin enrolling or something. Oh wait…HOLY CRAP we’re less than a year from launch! The game is on, friends: Read more
In at least 23 states, governors are allowing a “Federal takeover” in the form of a federally facilitated exchange (FFE). Now, CMS has published the first draft of the application that health plans need to complete to become a qualified health plan (QHP) in the CMS FFE. To be sure, the exchange regulation allows individual exchanges flexibility in defining rules and operations, provided they meet the basic requirements. This flexibility applies equally to how CMS interprets its role in operating exchanges in the FFE states.
Outside the Beltway Bubble it must look like we’re about to go all Thelma & Louise off the fiscal cliff. In fact, each day the path to a deal becomes clearer, as brilliantly displayed by our friends at WaPo’s WonkBlog. The one thing that is crystal-clear: the final deal will piss off everyone.
Predictably, the “Doc Fix” has become a political football in the fiscal cliff discussions here in Washington, and it continues to have huge bearing not just on physicians but Medicare Advantage plans as well. You could say MA plans need the “Doc Fix” more than docs do.
The New York Times reports that Hospitals fear they may bear the brunt of Medicare cuts. I should hope so! But not because they are wildly profitable at the expense of efficiency and innovation elsewhere.
Insurers are beginning to grumble about the state-by-state variation in Exchange design as implementation bears down on the industry. Fierce Health Payer has a quick summary of the griping here. While I can’t blame them for their frustrations (hey, we have to figure out all 50, too!) I do wonder how they would feel about the alternative: a national exchange whose model may not adequately recognize the dramatic differences in how care is delivered by geography, demography, provider culture, et al. Just look to the Medicare Advantage program and its challenges thus far in creating a quality rating system that does not properly account for the challenges in caring for a rural population.
As you have likely heard, Romneycare no, Obamacare, no, the ACA has been upheld by the Supreme Court, with Chief Justice Roberts casting the deciding vote with the liberal block. Health policy implications aside, there are some truly delicious politics here: