CMS Quality Conference Opens
The Centers for Medicare and Medicaid Services (CMS) Quality Conference began today with some major addresses by CMS Administrator Dr. Mehmet Oz and other top officials. I will have a blog on the major addresses soon. In the meantime, some key points that were addressed:
At the HIMSS conference in Las Vegas last week, Oz went all in on the use of AI, agentic AI, and digital health. Opening the CMS conference, Oz raised some of the same themes, saying CMS is devoted to a tech-first transformation, interoperability, and patients engaging digitally. He said technology was a solution to controlling disease exacerbation, rural health access, and driving annual wellness visits.
Oz also noted the following:
- Bad quality care is our biggest problem.
- Digital expansion models have been approved, including ACCESS, ELEVATE, and TEMPO, but such tech models must show outcomes.
- Rural health can be transformed with technology.
- Reducing drug costs and expanding GLP-1s are a key goal.
- Fraud will remain center stage.
- Payment transformation is necessary.
- The Exchange benefits are being transformed.
- He called out prior authorization reform across all lines of business as an achievement.
In related news, announced grant applications for the ELEVATE Model in Medicare. The model will offer Medicare coverage to functional and lifestyle medicine providers. Interested participants seeking grants under the model must submit a Letter of Intent by April 10, with the final application deadline set for May 15. CMS is planning to select 30 participants for the model to receive a collective $100 million of funding. CMS said that these participants will be split into two cohorts, one for the 2026 model year and one for 2027.
Further, CMS has announced that all brand drug makers that manufacture the fifteen drugs selected for Medicare drug price negotiations in the third round have chosen to participate.
Additional article: https://www.cms.gov/newsroom/fact-sheets/cms-announces-manufacturer-participation-third-cycle-medicare-drug-price-negotiation
#cms #quality #primarycare #technology #maha #digitalhealth
Diabetes Tech Increasing In MA
Continuous glucose monitors (CGMs) are increasing among Medicare Advantage members with Type 2 diabetes. A study published in the Journal of Managed Care & Specialty Pharmacy from the Humana Healthcare Research team and Joseph Ross, MD, of the Yale School of Medicine looked across plan data for MA beneficiaries with Type 2 diabetes who were using insulin. By December 2023, about 1 in 6 MA members with Type 2 diabetes and confirmed insulin use had CGMs, up from 1.4% in January 2021. Out of the evaluated beneficiaries in 2023, patients with an endocrinology visit during the year were over four times as likely to have a CGM device.
#chroniccare #medicareadvantage #diseasemanagement
Medicaid Woes For Insurers
While Medicaid health plans have assured investors that a recovery is just over the horizon for that line of business, state budget challenges may tell a different story. Medicaid managed care companies are counting on rate hikes to be granted due to rising risk in the program as many drop off the rolls. But Medicaid cuts begin in 2027, which will mean states will need to come up with more state dollars to generate federal match. In addition, the work requirement change will raise administrative expense.
(Article may require a subscription.)
#medicaid #workrequirements #coverage #healthcare #managedcare #healthplans
https://www.modernhealthcare.com/insurance/mh-centene-molina-medicaid-work-requirements
Wakely Details Exchange Non-Network Proposal
Actuarial and consulting firm Wakely has issued a great white paper discussing the Trump administration’s proposal to allow non-network offerings as qualified benefit plans under the Affordable Care Act.
#exchanges #aca #obamacare #coverage
https://www.wakely.com/wp-content/uploads/2026/03/ACA-Non-Network-Plans-How-Big-of-a-Disruption.pdf
— Marc S. Ryan
