Medicare

By Nicholas Johnson, Andrew M. Keeley  |  21 August 2018

This paper examines Minimum Data Set frequency reports and U.S. Census Bureau American Community Survey population data to compare nursing home usage in states with managed long-term services and supports (MLTSS) to states without MLTSS.

By Colleen Norris, Cory Gusland, Charlie Mills, Hugh Larson  |  20 August 2018

This paper provides a summary of the Centers for Medicare and Medicaid Services’ sweeping proposed regulations that will significantly change the Medicare Shared Savings Program.

By Pamela M. Pelizzari  |  24 July 2018

A discussion about alternative payment methods, bundled payment, ACOs, and more.

By Jonah Broulette, Noah Champagne, Kathryn V. Fitch  |  26 June 2018

This brief explains how benchmark year 3 risk scores affect the benchmark calculation for Medicare Shared Savings Program (MSSP) renewals, presents an overview of the prior and new MSSP benchmark calculations, and illustrates how the change can affect an accountable care organization’s benchmark under various scenarios.

By Todd M. Wanta  |  20 June 2018

With significant changes to Medicare Part D from the Bipartisan Budget Act of 2018 and the Centers for Medicare and Medicaid Services Final Rule, one provision from the Patient Protection and Affordable Care Act that has gone largely unnoticed is the forthcoming TrOOP Cliff in 2020, for which plan sponsors should prepare.

By Christopher J. Giese, Allen J. Schmitz  |  12 June 2018

There are a number of factors that may influence how Medicare Advantage plans offer and price new long-term care benefits.

By Christopher S. Girod, Shyam Kolli  |  30 April 2018

This paper focuses on one relatively narrow area of rules that is sometimes loosely referred to as actuarial compliance, and serves as a primer for actuaries or other professionals who are tasked with understanding and following these rules.

By Kathryn V. Fitch, Cory Gusland  |  16 April 2018

This article describes the changes in the historical benchmarks and performance expenditures for a number of Medicare Shared Savings Program accountable care organizations and also explains the possible impact of these changes.

By Pamela M. Pelizzari  |  13 March 2018

This paper outlines the major provisions of the newly announced Bundled Payments for Care Improvement Advanced model.

By Julia M. Friedman, Brett L. Swanson  |  28 February 2018

This report highlights key changes in beneficiary premiums and benefits for the 2018 Medicare Advantage (MA) market as well as the reasons for and the magnitude of the decrease in value added within the MA market between 2014 and 2016 and the increases in value added in 2017 and 2018.

By Kelly S. Backes, Julia M. Friedman, Dustin J. Grzeskowiak, Elizabeth Phillips, Patricia A. Zenner  |  23 February 2018

Organizations entering the Medicare Advantage market should be aware of the current star rating climate as well as short- and long-term star rating and revenue considerations.

By Adam Barnhart, Gabriela Dieguez, David R. Mike  |  16 February 2018

Key changes to the Medicare Part D program will affect the donut hole in 2019, and this paper discusses the implications for stakeholders.

By Deana Bell, David Koenig, Charlie Mills  |  09 February 2018

In 2017, many changes came to Medicare Advantage risk adjustment as the transition continued from Risk Adjustment Processing System data to Encounter Data System data.

By Deana Bell, Tracy A. Margiott  |  29 January 2018

As direct and indirect remuneration continues to increase, it is important for Medicare Part D sponsors to consider the effect of potential regulatory changes on plans’ bottom lines and operations.

By Pamela M. Pelizzari, Harsha Mirchandani  |  08 January 2018

This paper combines data from the report of Performance Year 1 (PY1) results and other publically available sources to compare hospitals that received payments in the Comprehensive Care for Joint Replacement model PY1 to those that did not.

By Christopher Kunkel, Lynn F. Dong, Nicholas Johnson, Adam Barnhart  |  04 January 2018

A discussion of some of the most important considerations for Medicare Advantage risk-sharing arrangements that include Part D coverage.

By Annie Man, Hugh Larson, Timothy J. Wilder, Coleen Young  |  22 December 2017

This paper discusses first year Medicare Shared Savings Program Track 3 performance and possible drivers of success.

By Thomas D. Snook  |  20 December 2017

This paper provides a high-level guide on risk adjustment within the broader scope of four Centers for Medicare and Medicaid Services episode-based payment models.

By Pamela M. Pelizzari  |  01 December 2017

This paper explores key clinical and financial considerations that need to be addressed in a robust alternative payment model proposal.

By Pamela M. Pelizzari  |  21 November 2017

Given the many drivers of change in payment and service delivery reform recently, providers that have been working to redesign their care delivery to align with the value-based payment goals of Medicare are asking themselves if value-based payment is here to stay and whether it is worth the continued investment.