MedPAC to Congress: Change MA Benchmarks, Slow Down on APMs

June 18th 2021, 12:15pm


The Medicare Payment Advisory Commission (MedPAC) suggested several changes to Medicare Advantage (MA) plan benchmark calculations, with the intent to generate yield savings for Medicare, and urged CMS to streamline alternative payment model (APMs) where it can.

Supreme Court Tosses Challenge to ACA for Lack of Standing

June 17th 2021, 4:23pm


In a 7 to 2 decision, the Supreme Court ruled Thursday that the Affordable Care Act (ACA) will stand, as plaintiffs seeking to declare the law unconstitutional did not have standing.

Softer Alignment of Medicare ACOs May Still Lead to Higher Prices for Office Visits

June 7th 2021, 8:00pm


The researchers created a model that simulated what would happen when health systems and providers began working together in Medicare accountable care organizations (ACOs) in arrangements that did not extend to outright mergers or acquisitions.

Dr Davey Daniel on Lower Cost of Care Seen in Clinical Trials for OCM Enrollees

June 4th 2021, 6:01pm


Davey Daniel, MD, hematology/medical oncology specialist, Tennessee Oncology, discusses findings of an abstract presented at ASCO 2021 showing a lower total cost of care paid by Medicare for episodes of care for patients in the Oncology Care Model (OCM) enrolled in clinical trials vs those receiving routine care.

Variability of COPD Inhaler Coverage in Medicare Part D

May 11th 2021, 1:00pm


Although most Medicare Part D plans cover guideline-recommended outpatient chronic obstructive pulmonary disease (COPD) inhalers, the utilization controls applied to these therapies vary by plan type.

Quality, Health, and Spending in Medicare Advantage and Traditional Medicare

May 6th 2021, 1:00pm


In a review of literature published since the Affordable Care Act’s passage, more than half of analyses find that Medicare Advantage outperforms traditional Medicare on quality, health, and cost outcomes.

Medicare APMs at a Crossroads

April 21st 2021, 1:00pm


To be sustainable and successful, Medicare alternative payment models (APMs) have to attract and retain high and low performers. That requires a different approach to pricing and evaluation.

CMMI Remains Dedicated to Value-Based Care Despite Pause to Some Models, Fowler Says

April 20th 2021, 7:11pm


During her opening plenary at the NAACOS Spring 2021 Conference, Liz Fowler, PhD, JD, deputy administrator and director of the Center of Medicare and Medicaid Innovation, highlighted how the center is taking a pause to reassess its models and what is coming next.

Post-SNF Outcomes and Cost Comparison: Medicare Advantage vs Traditional Medicare

April 15th 2021, 1:00pm


Patients enrolled in Medicare Advantage had better outcomes and lower cost following skilled nursing facility (SNF) discharge than patients enrolled in traditional fee-for-service Medicare.

Comparing Apples With Oranges: Administrative Expenses and Finances in Medicare Systems

April 1st 2021, 1:00pm


In the debate of administrative expenses for public and private Medicare, we show incompatibility and extend the analysis to income, benefits, and loss ratio comparisons.