Topic: Star Ratings

Aetna Offers a Playbook for Evolution in the Golden Age of Government Programs

John Gorman

Ralph Giacobbe of Credit Suisse got another terrific “get” hosting Aetna’s management team for an insightful discussion last week.  I found the takeaways offer a playbook for how to adapt and evolve in the new Golden Age of government-sponsored health programs:

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Follow the Leader: United Health Group’s Outlook on Government Health Programs

John Gorman

Ralph Giacobbe at Credit Suisse is a leading health industry analyst and is doing the best work of his career.  Today he produced a fantastic recap of his discussion with United Health Group CEO Steve Hemsley and several of his top executives.  It included some fascinating insights into the market leader’s strategy for government health programs:

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Member Engagement and Experience are the New Risk Adjustment

John Gorman

In this new era of Star Ratings in Medicare Advantage and Part D, where a 4+ score is now do-or-die, health plan survival comes down to two things: member engagement and the member experience.  They’re the new risk adjustment when rates in 2014-2015 will be at their lowest levels in more than a decade, and a low-quality rating is a kiss of death in government programs.  Plans that can’t evolve into kinder, gentler, more coordinated and Member-Centric service providers are already beginning to disappear.

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Lighting the Path in the Golden Age of Government-Sponsored Health Programs: Join Us for the GHG Client Forum

John Gorman

More than 300 guests will convene on May 1-2 at the Red Rock Casino in Las Vegas for the 2014 Gorman Health Group Forum, our annual strategic retreat for leaders in government-sponsored health programs. This year’s gathering promises to be the most actionable, content-packed conference you could attend on how to succeed in this new Golden Age of government business. And when the learning and planning is done for the day, we will celebrate this unique moment in health care history as only GHG can in Vegas.  Here’s what’s happening this year and why you’ve got to join us: Read more

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Innovating in 2014

Regan Pennypacker

CMS has developed an Innovation Center to address health care payment and service delivery models. It is a great site to find information about current Innovation Model Partners, and a place to share your ideas on how care can be delivered and paid for in ways that will lower care cost and improve quality of care. As always, the service to beneficiaries is at the heart of these initiatives, and for the program to continue, partners must be innovative.

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2015 Medicare Advantage Draft Rate Notice is a Bear: Messy, Noisy, and Smells Like Roadkill

John Gorman

Friday after the close of business, CMS released the draft 2015 “call letter”, the rate announcement for Medicare Advantage.  As expected, it’s a bear: messy, noisy, and smells like roadkill.  It’s just about a worst-case scenario for flabby, distracted, uncommitted health plans in Medicare — the roadkill to come. The table is now heavily tilted against low performers who can’t keep up. Some topline observations: Read more

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Reading the Stars in Medicare in 2014-2015

John Gorman

Whatever you may think of healthcare.gov, CMS is killing it on the Medicare Star Ratings Quality Demonstration.

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