- An end to manufacturer rebates as we know them today?
By Deana Bell, Jennifer Carioto, Matthew Hayes | 15 February 2019
The proposed rule to make drug manufacturer rebates no longer protected under the Anti-Kickback Statute has broad impacts to federally funded prescription drug programs, especially Medicare Part D.
- Pathways to Success MSSP final rule: Winners and losers
By Anders Larson, Cory Gusland | 14 February 2019
This paper examines the Medicare Shared Savings Program’s (MSSP) final rule from the perspective of different accountable care organization (ACO) situations to help readers understand how the MSSP rule might affect different ACOs.
- LTSS services in Medicare Advantage Plans
By Pedro Alcocer, Robert Eaton, Pamela Laboy | 12 February 2019
This article addresses how the Medicare Advantage marketplace responded in 2019 to the Centers for Medicare and Medicaid Services’s expanded definition of primarily health-related benefits, including which supplemental benefits plans are offering and where these benefits are offered.
- Including dementia in the Part C Medicare risk adjuster: Health services issues
By Bruce S. Pyenson, Charles Steffens | 11 February 2019
The Centers for Medicare and Medicaid Services released its proposed 2020 risk score methodology for Medicare Advantage plans in December, and it describes proposed updates to the existing Hierarchical Condition Category (HCC) risk adjustment model and suggests an alternative model, which includes two HCCs for dementia.
- Changing the rebate game: A primer on the HHS proposed rule to shift drug rebates to POS
By Maggie Alston, Carol Bazell, David R. Mike | 08 February 2019
This paper discusses the implications of recently proposed rebate regulation to various Medicare Part D program stakeholders.
- Analysis of insurers’ Solvency and Financial Condition Reports
By Joanne Buckle, Tanya Hayward, Kevin Manning, Judith Houtepen, Ankush Aggarwal, Kishan Desai | 07 February 2019
This analysis compares information provided in the Qualitative Reporting Templates and the Solvency and Financial Condition Reports and draws conclusions about the balance sheets and risk exposures of European health insurers.
- The uncertainties and benefits of gene and cell therapies: A payer's dilemma
By Elizabeth Anne Jackson, Jessica Naber | 06 February 2019
When it comes to gene and cell therapies, there are a number of risks and benefits that payers should consider.
- Brief study of UK health insurers' second SFCRs
By Joanne Buckle, Kevin Manning, Tanya Hayward, Ankush Aggarwal, Kishan Desai | 31 January 2019
This analysis compares information provided in the Quantitative Reporting Templates and Solvency and Financial Condition Reports and draws conclusions about the balance sheets and risk exposures of 15 UK private medical insurance and health cash plan providers.
- Seven key challenges for Medicaid states considering alternative payment models
By Anders Larson, Rebecca L. Johnson, Zach Hunt | 29 January 2019
This article focuses on some of the challenges that Medicaid payers (including states and managed care organizations) face when trying to establish alternative payment models with providers.
- IFRS 17: Considerations for health insurers
By Joanne Buckle, Neha Taneja | 23 January 2019
While IFRS 17 aims to bring increased transparency in the financial reporting by insurers, the complexities related to some aspects of it need to be carefully considered for short-term health insurers when esimating the financial, operational and business impact within the organisation’s governance frameworks.