McKinsey & Company Releases Three Briefers On Medicare Advantage’s Future
McKinsey and Company has three important briefers on the future of Medicare Advantage. This is a must read. Among the recommendations in the extremely thorough document include:
- Star measures have increased over the last decade and enrollees are attracted to higher-performing plans. But Star measures will get harder.
- Star performance focus areas are shifting and clinical and pharmacy performance become key.
- Partnering with providers to maximize performance, lower costs, and ensure member satisfaction is key. Value-based arrangements can pay dividends.
- Health equity is a key theme for Medicare in the future and focusing on social determinants is key.
- MA plans have huge opportunities in the Special Needs Plan (SNP) world.
- There are major rate and regulatory pressures hitting plans.
- A focus on member experience is critical.
Briefers here: https://www.mckinsey.com/industries/healthcare/our-insights/the-future-of-medicare-advantage
#medicareadvantage #partd
Could Medicare Advantage Support Be Eroding?
Growing evidence that Medicare Advantage support could be eroding somewhat in Congress. Both political parties appear to be open to MA reforms. Prominent healthcare policy officials say this should be a warning sign to MA plans, which need to respond. AHIP, the health plan lobby, is creating a seven-figure marketing and lobbying campaign in response. Democrats and populist Republicans are questioning the program’s value and are upping scrutiny.
#medicareadvantage #election2024
https://www.fiercehealthcare.com/payers/medicare-advantage-consensus-waning-2024-election
Humana Settles Fraud Allegations In Part D
Humana will pay $90 million to settle a whistleblower lawsuit by a former actuary who said the MA plan overcharged Medicare for prescription drugs. A whistleblower alleged Humana overstated in bids the level of benefits it was providing and kept the difference. Humana said it did nothing wrong but settled to avoid a trail. The federal government did not intervene in the case.
Based on this outcome, will MA plans see similar allegations related to bid for supplemental benefits and actual utilization?
#medicareadvantage #partd #supplementalbenefits
Federal Judge Strikes Hospital Funding Formula
A Texas district court overturned a Biden administration regulation that sought to rewrite what hospitals were eligible for the disproportionate share hospital (DSH) program. The DSH prorgam seeks to reimburse hospitals that serve large shares of low-income populations. The administration sought to remove certain hospitals that previously qualified. The court said that the administration did not have the unilateral authority to do so as the law allowed these hospitals to be included.
#hospitals #coverage
https://www.healthcaredive.com/news/texas-disproportionate-share-hospital-court-ruling-hhs/724463
Medicare Drug Price Negotiations Overview
A good overview in the Health Affairs Forefront blog on the recent Medicare drug negotiations announcement of the ten drugs getting prices for 2026, the underlying law, Big Pharma’s opposition, and where the candidates stand.
(Article may require a subscription.)
#ira #drugpricing #partd #medicare #branddrugmakers
— Marc S. Ryan
