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CMS To Recalculate 2024 Medicare Advantage Star Ratings

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

National Healthcare Spending Projections

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

(Some articles may require a subscription.)

 #healthcare #costs

https://www.fiercehealthcare.com/finance/cms-projects-national-health-spending-grew-75-2023-48t

More Information On Elevance Health Star Lawsuit Win

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

(Some articles may require a subscription.)

#medicareadvantage #stars #cms

https://www.fiercehealthcare.com/payers/elevance-health-earns-partial-win-legal-fight-over-ma-star-ratings

Elevance Wins Star Lawsuit

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 Continues Good Performance, Lays Out Strategy

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

https://www.fiercehealthcare.com/payers/oscar-health-growth-ambitions-doubling-its-footprint-planned-ichra-products-launch-and-more