- Pathways to Success MSSP proposed rule: Beneficiary assignment
By Colleen Norris, Jason McEwen, Jonah Broulette | 07 September 2018
This paper explores the differences between the two beneficiary assignment methods, prospective or retrospective, and considerations for accountable care organizations as they evaluate their options.
- Pathways to Success: MSSP proposed rule: Financial benchmark
By Jill S. Herbold, Cory Gusland, Charlie Mills | 28 August 2018
This brief discusses “Pathways to Success” and the important implications in store for Medicare accountable care organizations.
- A comparison of nursing home usage in states with and without Medicaid Managed LTSS
By Nicholas Johnson, Andrew M. Keeley, Ali Khan | 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.
- Pathways to Success: MSSP proposed regulation: Summary white paper
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.
- Critical Point podcast, Episode 2: Alternative Payment Models 101
24 July 2018
A discussion about alternative payment methods, bundled payment, ACOs, and more.
- Why accurate claims coding for MSSP ACOs has become increasingly important
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.
- Don’t TrOOP off the cliff: True out-of-pocket amount poses challenges starting in 2020
By Van Phan, 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.
- Are Medicare Advantage plans ready for the high costs of long-term care?
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.
- Medicare Advantage and Part D: Compliance for actuaries
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.
- The exclusion of some nursing facility visits from MSSP assignment has potential unintended consequences
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.