Topic: Star Ratings

The survey says…

RaeAnn Grossman.

In May, GHG conducted several marketplace surveys. The initial survey highlighted our clients’ top priorities. Here is what the ranking showed as our clients’ focal points: Read more

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Drugs and Patient Safety – the Disconnect

Debra Devereaux

The recent Washington Post piece published May 11, 2013,  on the prescription drug dangers for Medicare patients raises some interesting points about the current prescribing habits of some outlier physicians/prescribers,  as well as the lack of a coordinated effort to exclude those same prescribers from participating in Medicare.

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Strange Bedfellows Come to Medicare Advantage’s Rescue

John Gorman

If you can say anything about Medicare Advantage (MA), it definitely makes for strange bedfellows in both the private sector and in the halls of Congress.  Last Friday the full lobbying fury of the industry was in evidence as three separate groups of legislators appealed to the Centers for Medicare and Medicaid Services (CMS) on its 2014 rate proposal.

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CMS Advance Notice for 2014: This Is What Austerity Looks Like

John Gorman

CMS’s Advance Notice for Medicare Advantage and Part D for 2014 was released after the close on Friday and tanked health plan stocks on Tuesday. It is a shocking, stark portrait of what austerity looks like.  There’s nothing but bad news in it, and it’s worse than anyone expected. Start with an average cut in payments of 6% (combined impact of ACA, proposed trend, and increase in coding adjustment); now add the likelihood of sequestration taking effect on March 1 — another 2% cut; add the impact of draconian changes in risk adjustment and the 2014 industry tax for another point or two. All in, CMS could cut as deep as 9-10% if the proposed rates become final on April Fool’s Day. The industry has little more than 5 weeks to howl, lobby, mobilize and cajole CMS to its senses before the meat-axe falls.

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What Health Care Federalism Looks Like

Gorman Health Group

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.

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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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Open Enrollment and Star Ratings for 2013

Jean LeMasurier

Open enrollment season has started and CMS has posted the star ratings for each Medicare Advantage (MA) plan and Prescription Drug Plan (PDP) on the Medicare.gov website, which is the official site beneficiaries use to get information on their plan choices. Five star plans get a special gold star icon and have special enrollment periods. Higher performing MA plans also receive higher bonuses. Low performing plans are also designated by a special icon on the Medicare website. Most MA plans whose rating fell will see a decrease in their payments in 2014.

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