Topic: Star Ratings

Marketplaces – Your Stars are coming

Steve Balcerzak

The Centers for Medicare & Medicaid Services (CMS) has been aggressively working in the background to establish the Star Ratings program for the Marketplaces, thus consumers will have their first quality information by 2017.  Selecting a Marketplace health plan will no longer be based only on price or provider.  As such, quality ratings will have a bearing on market share.

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High Value Network: Generation 4.0

John Nimsky

When it comes to healthcare, two truism’s are that medical costs are going up along with demand for healthcare services. And when it comes to organic growth of healthcare volume and expenses, government programs represent a major driver, particularly when considering that on a daily basis thousands of baby boomers age into Medicare. During the last several years CMS has published a number of demonstration programs which are intended to improve the quality of Medicare patient outcomes while promoting financial efficiency on a unity cost or per procedure basis.

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Another Flood of Good News for Medicare Advantage

John Gorman

Last week the Centers for Medicare and Medicaid Services (CMS) did its annual data dump for the 2015 Medicare Advantage (MA) and Prescription Drug Plan (PDP) bids.  Even with MA plans sailing into the worst rate environment in over 15 years, the data offered another flood of good news for the industry.

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Bombshells from MedPAC on Medicare Advantage Retention

John Gorman

The Medicare Payment Advisory Commission (MedPAC ), the nonpartisan blue-chip Congressional uber-nerds on our favorite entitlement program, met this week and the staff report presented a couple bombshells on retention rates in Medicare Advantage (MA).

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CMS’s Star Ratings Firing Squad Gets Squirt Guns

John Gorman

Last week, in a surprise move, the Centers for Medicare and Medicaid Services (CMS) reversed its threat to terminate all Medicare Advantage and Part D health plans with 3 or fewer Stars for more than 3 consecutive years.  Roughly a dozen health plans were lined up in front of the firing squad as an example to the industry for months — and then CMS issued squirt guns to the executioners. 

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Why Medicare ACOs Were Always a Bad Deal, and Why They Need an Exit Strategy

John Gorman

Last week, the tenth of 32 Medicare Pioneer ACOs dropped out of the program.  Others are expressing reservations about entering or continuing given the experience of Pioneers and the hundreds participating in the Medicare Shared Savings Program (MSSP).  To be clear, it’s not all bad news…but most ACOs will need an exit strategy, fast.

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The Medicare ACO Demos Are a Mess. Here’s What it Means for Health Plans.

John Gorman

This week, another Medicare Pioneer Accountable Care Organization Demonstration site, longtime GHG client Sharp Healthcare in San Diego announced it was dropping out.  It was the tenth Pioneer to quit the trail, and not for lack of trying.  Many of the Pioneers did great on improving quality and reducing costs — the issue is not the performance of Pioneers.  It’s CMS’ methodology, with its requirement for Pioneers to bear risk in the third year, and benchmarks calculated to make any gainsharing impossible.

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