MA Controls Healthcare Growth For Enrollees
While opponents of Medicare Advantage (MA) are on a campaign to strip MA of all sorts of revenue and bolster the future of the antiquated traditional fee-for-service (FFS) program, many studies show the value of MA from a cost and quality perspective. Now, the UCLA Center for Health Policy Research concludes that Californians enrolled in MA face slower growth in healthcare costs compared to those in FFS.
Between 2013 and 2023, average monthly healthcare costs were $269 in counties with MA enrollment above 20%, compared with $481 in counties below 20%, or a 44% lower cost. Counties with higher MA enrollment saw an 11% increase in monthly healthcare costs over the decade (from $245 to $273), while counties with lower enrollment saw a 54% increase (from $361 to $557).
#medicareadvantage #medicare
MA Star Lawsuit Wrap-up
This Modern Healthcare article tallies wins and losses for Medicare Advantage (MA) plans on Stars lawsuits vs. the Centers for Medicare and Medicaid Services (CMS). After high-profile losses over SY 2024 Star rating, CMS has assembled a much better record.
MA Plan Wins (full or partial):
- UnitedHealthcare
- Centene (CMS conceded after United decision – Centene withdrew after Stars recalculation)
- Alignment (partial win)
CMS Win:
- Elevance Health
- BCBSLA
- BCBSFL
- BCBSMN (withdrew case)
Undecided:
- Humana (refiled its case after a procedural dismissal)
- BCBSMA
(Article may require a subscription.)
#medicareadvantage #cms #stars #quality
https://www.modernhealthcare.com/insurance/mh-medicare-advantage-ratings-lawsuits-humana-elevance
Paragon Looks At Healthcare Inflation
The influential conservative healthcare think tank Paragon Institute has a good briefer on healthcare inflation. It notes that the Biden administration’s major healthcare outlays camouflaged normal healthcare inflation trends. With the Biden spending binge gone, healthcare price growth is resuming to being higher than other goods and services. Paragon says action is needed. Healthcare inflation must be tempered. Paragon calls out hospitals as the biggest culprit and reforms should be made, including antitrust actions, site neutral payments, and stopping Medicaid money laundering schemes.
#medicaid #medicare #hospitals #healthcare #antitrust
ACOs Continue Savings
Accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) reached another record savings high in 2024. The 476 ACOs last year generated $6.5 billion in gross savings, a major increase over the record $5.2 billion in 2023. About 75% of participating ACOs earned shared savings. ACOs saved Medicare $2.4 billion last year, after $4.1 billion in performance payments to them.
Additional article: https://www.modernhealthcare.com/politics-regulation/mh-medicare-shared-savings-program-acos-2024/
(Some articles may require a subscription.)
#acos #medicare
https://www.fiercehealthcare.com/regulatory/mssp-acos-saved-24b-2024-setting-new-record-program
Top Healthcare Legislation
Dozens of healthcare bills have been introduced for potential action. Top contenders for action include 340B reform, pharmacy benefits manager reform, Medicare Advantage reform and traditional Medicare augmentation, deeper healthcare cuts, site neutral payments, artificial intelligence oversight, additional interoperability, and cybersecurity prioritization.
#healthcare #healthcarereform #congress
https://www.healthcaredive.com/news/top-healthcare-legislation-to-watch-2025/758770
— Marc S. Ryan
