Topic: Prospective Evaluations

Takeaways from the Gorman Health Group 2016 Client Forum

John Gorman

The Gorman Health Group 2016 Forum concluded last week with over 200 of our closest clients and partners. There was great news and rough news, so here are a few takeaways: Read more

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There’s a Lot to Like and to Fear in the 2017 Medicare Advantage Call Letter

John Gorman

On Friday after the close, the Centers for Medicare & Medicaid Services (CMS) released the 2017 Medicare Advantage (MA) Call Letter with proposed policy and payment changes. There’s a lot to like ‒ and much to fear. On payments, CMS came in with higher-than-expected rates that make clear the long walk in the desert from cuts in the Affordable Care Act (ACA) is over. But on compliance, they are rolling out the firing squad with a broad mandate, and the Administration will leave its mark long after Obama has left office.

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Government Sends Stark Reminders that Insurers’ Biggest Customer is Still the Regulator

John Gorman

Since we opened our doors 19 years ago, we’ve preached to health insurers to think of the government as your business partner.  This week, we got several reminders that insurers’ biggest customers — Medicare, Medicaid, and ObamaCare — are still the regulator.  As business conditions improve for health plans across these business lines, government expectations are rising, and scores are about to get settled, as they always are in the second term of a Democratic administration.

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Takeaways from Accountable Physician Groups’ Annual Summit

John Gorman

Twice a year I get the honor of speaking to the California Association of Physician Groups’ (CAPG) annual summit and DC policy meeting.  CAPG represents accountable, capitated physician groups, and now has members in 39 states.  They’re always among my favorite speeches given how sophisticated the audiences are.  Here’s a few takeaways from my talk last week on “The Future of Government Programs”: Read more

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You’re Doing it Wrong in Care Management

John Gorman

An important paper recently released in the American Journal of Managed Care shattered the notion that care management can save money on high utilizers. The article reviewed recent studies of the effectiveness of health plan care management programs and found that, while many studies show significant savings, more rigorous studies concluded that savings were “limited or nonexistent.”  Mind. Blown.

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Gorman Health Group Client Forum Takeaways: Government Programs are Booming, Bar is Rising

John Gorman

We just wrapped our best-ever Gorman Health Group 2015 Client Forum at National Harbor with over 200 of our closest clients and partners.  There was both great and tough news, so here’s a few takeaways, including a couple stunners: Read more

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Industry Ducks Bullets in 2016 Medicare Advantage Rate Proposal

John Gorman

Friday, February 20th after close of business, the Centers for Medicare and Medicaid Services (CMS), released its 2016 Advance Notice of Medicare Advantage Payment, known affectionately as “the call letter.”

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