- The exclusion of some nursing facility visits from MSSP assignment has potential unintended consequences
By Tia Goss Sawhney, 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.
- An Overview of the Bundled Payments for Care Improvement Advanced Model
By Samuel Bennett, Pamela M. Pelizzari | 13 March 2018
This paper outlines the major provisions of the newly announced Bundled Payments for Care Improvement Advanced model.
- State of the 2018 Medicare Advantage industry: Stable and growing
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.
- Medicare Advantage star ratings: Expectations for new organizations
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.
- How will the Bipartisan Budget Act of 2018 impact Part D in 2019 and beyond?
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.
- Medicare Advantage’s transition from RAPS to EDS risk scores: 2017 impact
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.
- Medicare Part D DIR: Direct and indirect remuneration explained
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.
- Comprehensive Care for Joint Replacement Performance Year 1 results: Key considerations
By Pamela M. Pelizzari, Jocelyn Lau, 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.
- A risky prescription: Part D risk sharing arrangements
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.
- Medicare Shared Savings Program 2016 Track 3 financial results
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.