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June 17, 2024

Scan CEO Right On MA and FFS

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

More On CMS’ Recalculation Of MA Stars

Additional information is coming out on the recalculation of Medicare Advantage (MA) Stars for 2024.  CMS is expected to have to pay out at least $1.3 billion in additional bonus payments in 2025 for 2024 Stars.

(Article may require a subscription.)

#medicareadvantage #stars #cms

https://www.modernhealthcare.com/medicare/2024-medicare-advantage-star-ratings-elevance-aetna-scan

House GOP Grills Medicare Innovation Director

House Energy and Commerce Committee Republicans grilled the Centers for Medicare and Medicaid Services (CMS) innovation center director on the financial track record of Medicare reform pilots.

(Article may require a subscription.)

#cms #medicare #healthcarereform

https://insidehealthpolicy.com/daily-news/house-gop-grills-cmmi-director-model-successes-eyes-cuts

CalOptima Increases Medi-Cal Rates Dramatically

Medi-Cal plan CalOptima Health will increase provider rates by some $526 million.

#providers #rates #medicaid #healthplans  

https://www.beckerspayer.com/payer/california-payer-boosts-medicaid-rates-by-526m.html

BCBS Units Report Medicare Advantage Headwinds

Blue Cross Blue Shield plans are reporting the same headwinds that many national health plans have seen. The poor financial trends stem from poor rate hikes (due to a new risk adjustment model), poor Star results, new regulatory burdens (especially prior authorization changes), and a return of utilization.

#medicareadvantage

https://www.beckerspayer.com/payer/medicare-advantage-headwinds-hit-bcbs.html

— Marc S. Ryan

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