ACCESS Program To Expand
The new tech-based chronic disease management ACCESS program will expand the diseases and conditions eligible for enrollment. The Centers for Medicare and Medicaid Services (CMS) announced that new clinical tracks will be added next Spring, including heart failure and substance use disorders. CMS Administrator Dr. Mehmet Oz also said he eventually wants the model adopted in Medicare Advantage (MA) and Medicaid. Right now, it services traditional Medicare enrollees.
The initiative has CMS contracting with technology organizations, which team up with Medicare physicians to use tech to track and improve outcomes for people with certain cardio-kidney-diabetes disease states, anxiety and depression, and musculoskeletal conditions. The new disease states include health failure, chronic obstructive pulmonary disease, substance abuse, and tobacco cessation.
Additional article: https://www.modernhealthcare.com/health-tech/mh-cms-access-model-chronic-care-tracks/
#medicare #chronicdisease #caremanagement #access
https://www.beckershospitalreview.com/finance/cms-expanding-access-model-4-things-to-know/
Younger Gens Do Not Trust Insurers
A new survey finds that member trust in insurers is on the decline among Gen Z and Millennials. Trust is down 10.5% between 2023 and 2026, says Accenture. The trust gap could cost $3 billion in future member lifetime value for the largest commercial payers over the next decade.
#healthplans #enrollment
GLP-1 Bridge Enrollment Anxiety
More than 500,000 Medicare enrollees accessed weight-loss drugs during the first two months of the Medicare GLP-1 Bridge program, which is meant to increase usage for those with obesity but not other qualifying disease states. The problem: health plans worry that they will need to pick up the cost when Bridge expires at the end of 2027. The Centers for Medicare and Medicaid Services (CMS) would like to launch the BALANCE program, which was suspended due to lack of plan interest. At least 3.8 million of 70 million or so in Medicare could qualify for the GLP-1 expansion.
In other news, roughly 1,000 pages of documents produced by CMS show that the AI prior authorization program for traditional Medicare for certain services is off to a rocky start, with delayed approvals, miscommunication, and provider frustration.
Additional article: https://www.fiercehealthcare.com/regulatory/delays-tech-failures-abound-cms-wiser-ai-prior-auth-pilot-documents-show
#glp1s #weightlossdrugs #medicareadvantage #partd #medicare #priorauthorization
https://www.modernhealthcare.com/insurance/mh-medicare-glp-1-bridge-program/
Uninsured Rate Steady
The uninsured rate held at 7.9% in 2025, but hospitals have reported rising uncompensated care costs. Medicaid coverage declined to 17.1% in 2025, down from 17.6% in 2024.
In other news, Exchange insurers are requesting a median rate increase of 15% for 2027, according to a Peterson-KFF Health System Tracker. Some regulators are pushing back.
Additional article https://www.beckerspayer.com/payer/aca/5-states-finalize-2027-aca-rates/
#uninsured #coverage #healthcare #exchanges
https://www.modernhealthcare.com/providers/mh-uninsured-rate-hospitals-uncompensated-care/
OIG Wants MA To Tackle DME Fraud
The Health and Human Services Office of the Inspector General (HHS OIG) is targeting fraud in durable medical equipment (DME) suppliers. In a report, it suggests Medicare Advantage (MA) plans are not adequately overseeing suspect vendors and suspect billing, especially out-of-network suppliers.
In other news, OIG says Humana received $130.9M in MA overpayments.
Additional article: https://www.beckerspayer.com/payer/medicare-advantage/humana-received-130-9m-in-medicare-advantage-overpayments-oig/ and https://www.healthcaredive.com/news/oig-urges-crackdown-on-equipment-suppliers-in-medicare-advantage/830387/
#fwa #medicare #medicareadvantage #overpayments
— Marc S. Ryan
