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ºìÁì½í¹Ï±¨ Insights: Your source for healthcare news, ideas and analysis.

ºìÁì½í¹Ï±¨ Insights – including our new podcast – puts the vast depth of ±á²Ñ´¡â€™s expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our podcast, blogs, webinars, case studies, reports and more.

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Webinar

Webinar replay: summary and implications of the 2023 Medicare Advantage advance notice

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This webinar was held on February 22, 2022.Ìý

The Centers for Medicare & Medicaid Services (CMS) recently released the 2023 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part C/D Payment Policies, which proposes important changes in plan payments, risk adjustment, Star Ratings, and other key financial and regulatory requirements for 2023.

During this webinar, consultants from Wakely Consulting Group, an ºìÁì½í¹Ï±¨ Company, provided an overview of the proposed changes, with an emphasis on the likely impact that the new rates and policies will have on Medicare Advantage bids, membership growth, quality, and strategy. Speakers also touched on other recent public statements from federal regulators that could point to additional future changes for Medicare Advantage plans.

Learning ObjectivesÌý

  • Understand how the proposals in the Advance Notice will impact Medicare Advantage payment rates in 2023.
  • Learn about updates to payment models and risk-adjustment methodologies, including a new effort to engage Medicare Advantage plans in value-based models that transform care.
  • Find out how new initiatives to account for how well plans address equity and social determinants of health will impact Star Ratings.
  • Understand the growth prospects for Medicare Advantage, including a look at how COVID-19 continues to affect plan membership growth, financial risk, and profitability.

ºìÁì½í¹Ï±¨ Speakers

Thomas Grivakis, Senior Consulting Actuary, Wakely

Rachel Stewart, Consulting Actuary, Wakely

Blog

CMS payment notice signals shift in COVID-19 policies for Medicare Advantage, Part D

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This week our In Focus section reviews the Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies by the Centers for Medicare & Medicaid Services (CMS) on February 1, 2022. The Advance Notice includes proposed updates to MA payment rates and guidance to plan sponsors as they prepare their bids for CY 2023. It also shows CMS’ updates to Part D benefit parameters. Comments are due by 6:00 PM EST on March 4, 2022. The final Rate Announcement will be published by April 4, 2022.

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Blog

CMS seeks new direction for Medicare Advantage and Part D on health equity and dual eligible integration

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This week, our In Focus section highlights the Centers for Medicare & Medicaid Services (CMS) proposed changes to the Medicare Advantage (MA) and Part D programs for contract year 2023 and how these changes may impact plan applications, bid submissions, and market dynamics for future years. The analysis and insight reflect the combined expertise of ºìÁì½í¹Ï±¨ and its companies including the Wakely Consulting Group and The Moran Company.

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Blog

CMS changes boost overall Medicare Advantage star ratings

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This week, our In Focus section highlights a Wakely white paper titled, . Authored by Suzanna-Grace Sayre and Dani Cronick and published January 2022, this paper outlines the CMS modifications to the 2022 Star Ratings due to COVID-19, quantifies the estimated impact on 2023 MA spending, and discusses how these changes could influence the MA market in 2023.

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ºìÁì½í¹Ï±¨ News

Former DoD Health Official Joins ºìÁì½í¹Ï±¨

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Former Assistant Secretary of Defense for Health AffairsÌýÌýhas joined the (ºìÁì½í¹Ï±¨) team of expert healthcare consultants. McCaffery joins the national healthcare consulting firm as a principal in its Washington, D.C. office after serving as the senior civilian leader in the Department of Defense (DoD) Military Health System (MHS).

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Brief & Report

ºìÁì½í¹Ï±¨ experts evaluate differences between Medicare Advantage and Fee-For-Service Medicare responses to the challenges of the COVID-19 pandemic

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In aÌýnew reportÌýreleased by the Better Medicare AllianceÌý(BMA),ÌýºìÁì½í¹Ï±¨ colleagues Zach Gaumer and Elaine HenryÌýconcluded that the greater flexibility of the Medicare Advantage plan model enabled plans to offer providers additional support during 2020ÌýthatÌýwere not found within theÌýFee-For-Service (FFS)ÌýMedicareÌýprogram. The report’s findings were previewed in a recent panel discussion during theÌýBMA’sÌý.Ìý

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Blog

New issue brief recommends strategic shifts for CMMI’s future: insights on Medicare innovation, balancing goals, and enhancing model success

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This week, our In Focus highlights a recent issue brief, Center for Medicare and Medicaid Innovation: Recommendations for Future Direction, revisits questions raised in a previous ºìÁì½í¹Ï±¨ report and offers potential answers to guide progress and changes for demonstrations within the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (CMMI) or the Innovation Center.

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Blog

2022 Star Ratings, An Historical Year

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This week, our In Focus provides an analysis of 2022 Medicare Advantage (MA) Star Ratings, including a look at how regulatory changes during the COVID-19 pandemic resulted in a record number of Medicare plans receiving historically high scores.  ºìÁì½í¹Ï±¨ Managing Director Anthony Davis and Principal Sarah Owens  rely on data from the Centers for Medicare & Medicaid Services (CMS) to take a deep dive into ratings for nearly 500 Medicare plans serving 26.8 million members. 

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Brief & Report

Center for Medicare and Medicaid Innovation: Recommendations for Future Direction

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A recent issue brief, Center for Medicare and Medicaid Innovation: Recommendations for Future Direction, revisits questions raised in a previous ºìÁì½í¹Ï±¨ report and offers potential answers to guide progress and changes for demonstrations within the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (CMMI) or the Innovation Center.

The brief examines options for how CMMI could refine their approach to testing ideas for improving the Medicare program. ºìÁì½í¹Ï±¨ colleagues Jennifer Podulka, Yamini Narayan, and Lynea Holmes wrote the brief which was supported by Arnold Ventures.

±á²Ñ´¡â€™s earlier brief examined the progress the Innovation Center has made in learning from Medicare-focused models during its first decade and raised questions to guide policymakers as they plan for the next phase of the Innovation Center’s work. In the new report, the team returns to those questions and offers potential answers.

The brief outlines seven pairs of competing goals and offers four recommendations that may, in part, help to balance these competing goals, as they are designed to increase the transparency of Innovation Center efforts and improve the likelihood that more models succeed in decreasing spending or improving quality. The recommendations include:

  • The Department of Health and Human Services (HHS) should establish a National Healthcare Transformation Strategy
  • CMMI should articulate a vision for how different models work together
  • CMMI should tailor models to test ideas that address the largest areas of spending growth and key areas of quality concerns, including
    • Include Part D in models
    • Include Part C in models
    • Promote primary care as a counterbalance to excessive low-value care
    • Address social determinants of health and other drivers of quality and access disparities
  • Congress and HHS should revisit the Physician-Focused Payment Model Technical Advisory Committee (PTAC)
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