- The Medicare Advantage Value-Based Insurance Design Model: Overview and considerations
By Catherine M. Murphy-Barron, Pamela M. Pelizzari, Brian Regan | 19 February 2019
This research brief describes the Value-Based Insurance Design model for Medicare Advantage organizations (MAOs) and explores key considerations for eligible MAOs considering participation in the model.
- 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.
- 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.
- Pathways to Success MSSP final rule: Key revisions to the proposed rule
By Noah Champagne, Charlie Mills, Jason Karcher | 07 January 2019
This paper summarizes the key provisions of the final rule for the 2019 Medicare Shared Savings Program and highlights differences from the Centers for Medicare and Medicaid Services’s August proposal.
- Pathways to Success MSSP final rule: Faster movement to downside risk increases focus on reducing population costs
By Kathryn V. Fitch, Adam Laurin, Michele M. Berrios | 04 January 2019
Under the new Medicare Shared Savings Program’s new rule, there will be a more urgent need for accountable care organizations to reduce population costs.
- Proposed updates to actuarial soundness: Creating flexibility and strengthening the requirements
By Brad Armstrong, Marlene Howard, Christopher T. Pettit | 03 January 2019
The Centers for Medicare and Medicaid Services released proposed updates to Medicaid managed care regulations with the goal of easing some of the regulatory burdens while increasing the requirement for transparency.