Medicare Advantage Inpatient Days Rising
Hospitals cry foul at every pass over Medicare Advantage (MA) plans’ efforts to control inpatient hospital utilization. But a new analysis from the Kaiser Family Foundation (KFF) shows that inpatient days attributable to MA have increased considerably over time.
Medicare Advantage’s share of inpatient days grew from 13% to 23% from 2015 to 2022. As of 2022, nearly half (48%) of all Medicare inpatient hospital days were attributable to MA. The MA penetration in that year averaged just short of 46%. There are numerous other great statistics in the analysis. This year, MA plans are required to follow traditional program standards for deciding whether a stay is required and thus the share will increase more.
#medicareadvantage #hospitals #priorauthorization
2020 Exchange Risk Adjustment Payment Data Published
The Centers for Medicare and Medicaid Services (CMS) published the annual risk adjustment reconciliation data today. Risk adjustment is used to ensure that plans serving sicker members receive additional revenue, which comes from plans with healthier cohorts. In the Exchanges, this reconciliation is done more than a year later, while in Medicare it is done prospectively.
Plans with healthier populations based on calculated risk scores will pay $10.3 billion as part of the risk adjustment program for 2022. These dollars will then be distributed to those with sicker enrollees. The transfers will decline in the aggregate in part due to larger enrollment, which tends to reduce risks at a given plan.
Aetna, United, Kaiser Permanente, Cigna and Oscar will be big payers, while Molina, Centene, and Blues plans (including Elevance Health and Health Care Service Corporation) will receive the most dollars.
The dynamics make sense. Historically, the big Blue brands have attracted sicker individuals as the plans are seen as more generous. As well, Molina and Centene are largely Medicaid-based plans. Sicker individuals likely shuttle between the Exchanges and Medicaid.
Additional article: https://www.fiercehealthcare.com/payers/cms-insurers-make-103b-2023-risk-adjustment-payments
(Some articles may require a subscription.)
#riskadjustment #exchanges
https://www.modernhealthcare.com/insurance/aetna-kaiser-oscar-health-cms-risk-adjustment-2024
Warren Proposes Bill To Put Chevron Deference Back In Regulatory Process
Sen. Elizabeth Warren, D-MA, has introduced legislation that would reverse the Supreme Court’s recent ruling striking down the Chevron deference precedent. The precedent for 40 years largely required courts to defer to regulatory agencies’ reasonable interpretations of law when issuing regulations to implement acts.
#chevrondeference #regulations
Humana To House Clinics In Shuttered Walmart Locations
Humana announced it would open 23 clinics in Walmart after the retailer announced it was shuttering Walmart Health. Humana will use both the CenterWell and Conviva brands in Florida, Georgia, Missouri and Texas.
Additional articles: https://www.fiercehealthcare.com/payers/humanas-centerwell-open-23-clinics-walmart-stores and https://www.modernhealthcare.com/providers/humana-centerwell-walmart-health-clinics
(Some articles may require a subscription.)
#humana #walmart #primarycare #retailmeetshealthcare
https://www.healthcaredive.com/news/humana-centerwell-primary-care-centers-walmart/722254
Criminal And Civil Charges Proposed For Rogue Exchange Agents
Finance Chairman Ron Wyden, D-OR, is proposing legislation that would create civil and criminal penalties for agents that fraudulently enroll or switch individuals in the nationwide Exchanges. The Centers for Medicare and Medicaid Services (CMS) is slowly attempting to get its arms around the problem.
(Article may require a subscription.)
#agents #brokers #exchanges #fwa
Suggestions To Close The Long-Term Care Gap
With America aging, a huge gap has arisen between those eligible for Medicaid services and those who do not. The Health Affairs Forefront blog offers suggestions to help close the gap, including Medicaid waivers to expand eligibility as well as state-funded programs. This is exactly what I did when I was state budget director and management secretary of CT, where I created the state’s long-term care continuum.
In addition, the Kaiser Family Foundation (KFF) has a great briefer on long-term care here: https://www.kff.org/medicaid/issue-brief/10-things-about-long-term-services-and-supports-ltss/ . It discussed that 6 million use Medicaid long-term care services and that the program pays more than half of the $415 billion spent on such services nationwide. There are also major Medicaid waiting lists for services.
(Article may require a subscription.)
#longtermcare #medicaid #aging
— Marc S. Ryan