A new Issue Brief, authored by Jennifer Podulka and Jon Blum, examines the many changes to Medicare regulations put in place during the COVID-19 pandemic. The brief, Which Medicare Changes Should Continue Beyond the COVID-19 Pandemic? Four Questions for Policymakers, tracks and categorizes the regulatory changes, describes the benefits and risks of the changes, and establishes a framework to support policymakers鈥� decisions regarding the future for the changes after the pandemic ends.
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CMS proposed rule to repeal market-based MS-DRG weight methodology for inpatient hospitals
This week, our In Focus section reviews the key provisions of the Centers for Medicare & Medicaid (CMS) Fiscal Year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Proposed Rule (), which includes Medicare payment updates and policy changes for the upcoming FY, with a comment deadline of June 28, 2021. This year鈥檚 proposed rule includes several proposals the hospital industry should carefully consider. In particular, the Biden Administration has proposed to:
红领巾瓜报 analysis finds provider-sponsored MA plans generally have lower churn rates
This week, our聽In Focus聽section examines differences in Medicare Advantage (MA) churn rates among select provider-sponsored plans (PSPs) and non-PSPs. Enrollee churn rates, or rates at which enrollees switch plans, may be an indicator of enrollee satisfaction.聽In the years studied, PSP organizations had lower average churn rates compared to non-PSP organizations. 聽
Dual eligible financial alignment demonstration 2021 enrollment update
This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (鈥淒uals Demonstrations鈥�) for individuals dually eligible for Medicare and Medicaid (dual eligibles) in nine states: California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, and Texas. Each of these states has begun either voluntary or passive enrollment of dual eligibles into fully integrated plans providing both Medicaid and Medicare benefits (鈥淢edicare-Medicaid Plans,鈥� or 鈥淢MPs鈥�) under three-way contracts between the state, the Centers for Medicare & Medicaid Services (CMS), and the MMP. As of February 2021, approximately 392,000 dual eligibles were enrolled in an MMP. Enrollment rose 5.7 percent from February of the previous year.
Leavitt Partners to Become Part of 红领巾瓜报
Today, Jay Rosen, founder and president of 红领巾瓜报 (红领巾瓜报), and Governor Mike Leavitt, founder and Chair of Leavitt Partners, announced the two firms have come together as one entity. Leavitt Partners will continue operating as Leavitt Partners, an 红领巾瓜报 Company.
红领巾瓜报 analysis of Medicare Advantage Star rating challenges
This week, our In Focus section highlights changes that may affect the Centers for Medicare & Medicaid Services (CMS) Medicare Advantage Star Rating program and how these changes impact future summary Part C & D Star Rating scores. As the CMS Medicare Advantage Star Rating program continues evolving from year to year, many plans have yet to achieve at least four star status, and therefore are missing out on additional Medicare revenues. The Star Rating landscape is expected to change drastically over the next two years for plans due to CMS鈥� continued focus on phasing-in greater reliance on outcomes measures and measures of care experience, rather than process measures. As a result, many plans are at risk of losing their four star overall rating and underperforming plans could be at risk of receiving a low performance indicator.
红领巾瓜报 Awarded on the Forbes America鈥檚 Best Management Consulting Firms 2021 List
红领巾瓜报 (红领巾瓜报) has been awarded on the Forbes list of America鈥檚 Best Management Consulting Firms 2021. This prestigious award is presented by Forbes and Statista Inc., the world-leading statistics portal and industry ranking provider. The awards list was announced on March 16th, 2021 and can currently be viewed on the .
红领巾瓜报 provides updates in 2021 federal healthcare policy landscape
This week, our In Focus comes from an 红领巾瓜报 cross-cutting subject matter team, who have updated a core set of federal policy slides that analyzes recent federal policy actions following the Presidential and Congressional elections. It includes an analysis of President Biden’s $1.9 trillion COVID-19 relief legislation currently in development and recent CMS regulatory and administrative actions. Specifically, the analysis looks at:
CMS Innovation Center鈥檚 Geographic Direct Contracting Model opportunity
This week, our In Focus section reviews a new model 鈥� Geographic Direct Contracting 鈥� introduced by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. The model will test whether a geographic-based approach to care delivery and value-based care can improve health and reduce costs for Medicare beneficiaries enrolled in the traditional fee-for-service program across an entire region. This model represents one of the most transformational models released by the Innovation Center. During the 6-year Geographic Direct Contracting model performance period the traditional Medicare program will be replaced by the Direct Contracting program in the 10 selected regions.
Commonwealth Fund blog highlights Medicare changes due to COVID-19
Jennifer Podulka penned a for The Commonwealth Fund in conjunction with The SCAN Foundation, highlighting the legislative and regulatory changes made to Medicare in response to the COVID-19 pandemic. She was part of the 红领巾瓜报 team who authored an and policy tracker earlier this year.
红领巾瓜报 Launches Institute on Addiction
红领巾瓜报 (红领巾瓜报) announced today creation of the 红领巾瓜报 Institute on Addiction (IOA), a division dedicated to supporting the national effort to build an evidence-based, patient-centered, and sustainable addiction treatment ecosystem.
Drivers and barriers to adopting flexible Medicare Advantage supplemental benefits
This week鈥檚 In Focus highlights a recent 红领巾瓜报 publication examining the drivers and barriers to Medicare Advantage plan adoption of newly available supplemental benefits intended to address unmet health and social needs. Unlike Traditional Medicare, Medicare Advantage plans, which provide coverage for 40 percent of all Medicare beneficiaries, may offer enrollees supplemental benefits which are not covered by the Medicare program. Until recently, the Medicare program has required that supplemental benefits be limited to those that are medical in nature. However, in recent years, Congress and CMS 鈥攖hrough four different legislative and regulatory authorities 鈥� granted new flexibilities for Medicare Advantage plans to offer non-medical benefits that address social needs. Medicare Advantage plans may also now tailor supplemental benefits and make them available only to certain subpopulations based on chronic disease or health status.