Scan CEO Sachin Jain, MD is one of the brightest minds in healthcare. He has the right outlook on Medicare Advantage (MA) – it does a lot that is good but also needs reform. In addition, he rightfully is asking why the traditional fee-for-service (FFS) program does not face reasonable scrutiny for its over-utilization.
#scan #medicare #medicareadvantage
https://www.fiercehealthcare.com/payers/ahip-2024-cutting-through-nostalgia-traditional-medicare
A new study says the Federal Trade Commission’s (FTC) scrutiny of mergers is low and mergers lead to increased prices. Part of the issue is low funding for the FTC.
(Article may require a subscription.)
#ftc #manda #mergers #acquisitions #hospitals
After losing two lawsuits on their methodology, the Centers for Medicare and Medicaid Services announced it has recalculated 2024 Star measures for Medicare Advantage (MA) plans. It will give plans that saw increases a short window to revise 2025 plan bids and benefits that have already been submitted.
Additional article here: https://insidehealthpolicy.com/daily-news/scan-cms-recalculate-ma-star-ratings-rebidding-process-come
(Some articles may require a subscription.)
#medicareadvantage #stars #cms
https://www.beckerspayer.com/payer/cms-to-recalculate-medicare-advantage-star-ratings-report.html
The Centers for Medicare & Medicaid Services (CMS) Office of the Actuary released its annual re-estimates of spending over a 10-year horizon. While 2023 healthcare expenditures will be finalized in December, current estimates are that national healthcare spending grew by 7.5% in 2023 to about $4.8 trillion, or 17.6% of gross domestic product (GDP). Part of the costs were record coverage.
Medicare spending is projected to have grown 8.4% in 2023, with costs over $1 trillion. Private health insurance spending is expected to have increased 11.1%. Medicaid spending is expected to have grown by 5.7%. This is lower due to dropping enrollment.
National health expenditures will rise to $7.7 trillion and capture nearly one-fifth of the U.S. economy by 2032.
I will have a blog next week digging into all the stats.
Additional articles: https://www.modernhealthcare.com/policy/national-health-spending-projected-reach-77t-2032-cms and https://www.healthcaredive.com/news/national-healthcare-spending-growth-cms-report/718718/ and https://www.cms.gov/newsroom/press-releases/cms-releases-2023-2032-national-health-expenditure-projections
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#healthcare #costs
https://www.fiercehealthcare.com/finance/cms-projects-national-health-spending-grew-75-2023-48t
Yesterday we told you about Elevance Health’s win in court on the 2024 Star calculations. Other healthcare publications have written stories today. The pressure is on the Centers for Medicare and Medicaid Services (CMS) to respond. I have also linked the lawsuit below.
Additional articles: https://www.modernhealthcare.com/insurance/elevance-medicare-advantage-star-ratings-lawsuit-cms and https://www.beckerspayer.com/payer/elevance-health-gets-partial-victory-in-star-ratings-lawsuit.html#:~:text=The%20judge%20ruled%20partially%20in,only%20for%20BCBS%20of%20Georgia. and https://www.healthcaredive.com/news/elevance-wins-medicare-advantage-star-ratings-lawsuit-hhs/718550
Opinion: https://www.documentcloud.org/documents/24740919-elevance_becerra_6724_order
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#medicareadvantage #stars #cms
A second lawsuit has been decided in favor of a Medicare Advantage (MA) plan and against the Centers for Medicare and Medicaid Services (CMS) on the calculation of Star scores. In this case, Elevance Health won its suit and a judge declared that Georgia contract scores must be revised. It will be increasingly difficult for CMS to ignore these rulings. I will write on this on LinkedIn tomorrow.
(Article may require a subscription.)
#medicareadvantage #cms #stars #elevancehealth
https://www.modernhealthcare.com/insurance/elevance-medicare-advantage-star-ratings-lawsuit-cms
Oscar Health reports its first quarterly net profit and hit 1.5 million enrollees in the Exchanges. It plans on investing in individual coverage health reimbursement arrangements (ICHRA) in tandem with its Exchanges offerings as well as re-entering Medicare Advantage.
Additional article: https://www.beckerspayer.com/payer/oscar-health-plans-to-double-its-membership-5-things-to-know.html
#oscar #exchanges #aca #obamacare #ichra #medicareadvantage
More coverage of the challenges facing Medicaid managed care with dropping enrollments and rising risk. I pointed out this possibility in a recent blog here: https://www.healthcarelabyrinth.com/health-plan-economics-part-3-how-falling-medicaid-enrollment-is-impacting-health-plans-and-providers-alike/
(Article may require a subscription.)
#medicaid #redeterminations #healthplans managedcare
https://www.modernhealthcare.com/insurance/how-medicaid-redeterminations-process-affecting-insurers
President Biden’s pro-union nursing staffing mandate is now facing bipartisan opposition in Congress. The rule threatens to create a consolidation in the nursing home industry with small, independent firms selling to big chains because they cannot meet or afford standards. A lawsuit also seeks to challenge Biden’s authority to set such staffing requirements.
(Article may require a subscription.)
#nursinghomes #healthcare
A federal judge said the Centers for Medicare and Medicaid Services violated the Administrative Procedures Act when it deviated from current regulations to calculate Star scores for 2024. It was a significant win for Scan and Medicare Advantage (MA) plans in general. It also could throw 2025 bids and benefit designs as well as 2025 Star measure calculations into flux. I will have a blog on this on Thursday. In the meantime, check out my LinkedIn post on the issue here: https://www.linkedin.com/posts/marc-s-ryan-%F0%9F%87%BA%F0%9F%87%A6-1a99529_scan-wins-medicare-advantage-star-ratings-activity-7203759541530808320-CEd6?utm_source=share&utm_medium=member_desktop
Additional articles: https://www.beckerspayer.com/payer/scan-beats-cms-in-medicare-advantage-star-ratings-lawsuit.html and https://www.fiercehealthcare.com/payers/judge-sides-scan-health-plan-dispute-cms-over-medicare-advantage-star-ratings and https://www.healthcaredive.com/news/scan-health-plan-medicare-advantage-star-ratings-lawsuit/717976/
(Some articles may require a subscription.)
#stars #medicareadvantage #cms
https://www.modernhealthcare.com/law-regulation/scan-medicare-advantage-star-ratings-lawsuit-cms
