Scan Execs Frame What Needs To Be Done With Stars
A great Healthcare Forefront blog by Scan CEO Sachin Jain and his chief legal officer discussing the current state of Medicare Advantage (MA) Stars, the various litigation, what is wrong with the Centers for Medicare and Medicaid Services’ (CMS) approach, and what the agency should do about it.
They argue CMS has made the program such that sophisticated plans cannot reliably reconstruct how a score is produced. It notes the legal quandary CMS finds itself in post the Clover decision.
The Scan execs argue that CMS needs to step back and remake the system based on a smaller number of clinical measures and member experience. As they note, CMS is moving toward this with the SY 2029 restructure. CMS now needs to correct the legal and regulatory deficiencies.
#medicareadvantage #stars #quality #cms
CMS Pushing Exchange Disenrollments
The Centers for Medicare and Medicaid Services (CMS) has disenrolled 1.5 million health insurance Exchange customers and it continues what it says is a campaign against fraud.
Enrollment lists of suspect enrollees continue to be sent to plans, asking that members be investigated. CMS says it will disenroll people if it does not hear back. This is causing major membership losses, revenue hits, and risk selection changes. After a few years of record premium increases, more of the same is coming for 2027.
The administration says the declines, a total of 4M, are linked to fraud and improper enrollments. It says another 1.6M remain on the road improperly.
Oscar Health says as much as 10% of its enrollment will be lost.
#exchanges #enrollment #coverage #healthcare
https://www.modernhealthcare.com/insurance/mh-cms-fraud-aca-marketplace-oscar-centene
Aetna Ends Some MA Broker Commissions
CVS Health’s Aetna will stop paying broker commissions on certain Medicare Advantage plans beginning Sept. 15 and still more on Jan. 1. The insurer’s standalone prescription drug plan has been non-commissionable since 2025.
Stripping away commissions has the effect of deeply reducing new enrollments without a formal exit.
#medicareadvantage #enrollment #aetna
— Marc S. Ryan
