October 29, 2024

CMS Touts ACO Savings

Touting its efforts to reform the Medicare fee-for-service (FFS) program by using value-based payments and care, the Centers for Medicare and Medicaid Services (CMS) announced that the Medicare Shared Savings Program (MSSP) saved Medicare $2.1 billion in 2023, the largest yearly savings in the program’s history. The MSSP is also known as Accountable Care Organizations (ACOs).

While this may have been the largest net savings, the reality is that there is at best a mixed record on the value-based care programs in the traditional system. Some studies suggest that the administrative costs of all of the programs exceed any savings. And the savings over time have been largely small. ACOs are perhaps the most successful, though.

Additional articles: https://insidehealthpolicy.com/daily-news/cms-aco-stakeholders-tout-record-mssp-savings and https://www.cms.gov/newsroom/press-releases/medicare-shared-savings-program-continues-deliver-meaningful-savings-and-high-quality-health-care

(Some articles may require a subscription.)

#medicare #vbc #valuebasedcare

https://www.fiercehealthcare.com/payers/mssp-acos-saves-medicare-21-billion-2023-largest-savings-program-history

States and Medicaid Managed Care Plans Disagree on Rates

While large Medicaid managed care plans have told investors they are optimistic about rate increases later in 2024, states appear to be pushing back on these plans’ claims that there is a mismatch between rates and risk of the remaining populations post Medicaid redeterminations.

While 25 of 41 states surveyed have increased Medicaid capitation payments for fiscal 2024 and fiscal 2025 to reflect rising acuity, some state officials are skeptical that rates are falling short this year as plans are arguing. As well, most-rate-setting systems use a blend of prior years, which may mask current trends and create an impediment for states to respond more even if they wanted to.

(Article may require a subscription.)

#medicaid #managedcare #coverage #rates

https://www.modernhealthcare.com/medicaid/state-medicaid-pay-california-colorado-pennsylvania

Employers Fear High Medical Costs Could Lead To Greater Shift To Workers

Recent evidence would say that employers have tried hard not to shift too much of the rising healthcare costs to workers. But a new survey suggests that that could happen. As well, the survey says salary or wage increases could be impacted.

About three-quarters (74%) of those surveyed said they feel healthcare costs drive trade-offs for wage or salary increases. In addition, 74% said they believe that rising costs will force them to shift more expenses to workers.

The survey found that prescription drugs, high-cost claims and hospital prices are the three biggest cost concerns for employers. About 99% believe drug prices are a “significant threat” to affordability. Fifty-two percent say they may change pharmacy benefits managers.

The average premium in fully insured plans was $8,435 for individuals and $23,968 for family coverage.

#employercoverage #commercial #healthcare #coverage

https://www.fiercehealthcare.com/payers/survey-employers-fear-rising-health-costs-could-force-trade-offs-wages-salaries

Medicare Doc Pay Cut Reversal Being Pushed

A bipartisan group of lawmakers are seeking to reverse the 2.9% rate cut that will go in effect for CY 2025 for Medicare physicians. What’s more, the proposal could be converted into a 1.8% increase (or a 4.7% reversal). Still, no one is talking about a permanent fix to the ongoing doc fix saga that has played out for decades.

Additional articles: https://www.modernhealthcare.com/politics-policy/medicare-physician-reimbursement-bill-pay-cuts-2025 and https://insidehealthpolicy.com/health-insider/big-pay-rules-deck-election-nears and https://insidehealthpolicy.com/daily-news/bipartisan-bill-proposes-473-physician-payment-hike-offset-looming-medicare-cut

(Some articles may require a subscription.)

#medicare #physicians #rates

https://www.medpagetoday.com/publichealthpolicy/medicare/112640

Ten MA Plans With Highest Payments From HRAs

Becker’s reported on the ten Medicare Advantage (MA) plans with the highest payments in risk adjustment stemming from Health Risk Assessments (HRAs) and HRA-linked chart reviews where the reported diagnoses were never captured as a service event from a treating provider. The Health and Human Services Office of Inspector General just published a new analysis on the issue. I will have a blog on this issue on Thursday.

#medicareadvantage #riskadjustment #fwa

https://www.beckerspayer.com/payer/what-10-medicare-advantage-insurers-earn-from-health-risk-assessments.html

— Marc S. Ryan

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