Too Many Medicare Pilots
A great article in the Health Affairs Forefront Blog discussing the proliferation of traditional Medicare pilots testing alternative payment schemes. The authors find that there are more than 30 different payment program schemes, including accountable care organizations (ACOs). They also note that the Congressional Budget Office (CBO) finds that, of the $7.9 billion spent to operate pilot health care payment models between 2011 and 2020, only $2.6 billion in savings were realized.
The authors point out the government and system take on huge administrative complexity each time a new pilot is added. They recommend simplifying Part B payment model options and streamlining into a limited set of whole-person, population-based models.
Well said. I have argued the same on these pages.
(Article may require a subscription.)
#acos #medicare #providers #cms
KFF Says Medicare Advantage Star Bonus Payments Declined in 2024
A new report from Kaiser Family Foundation (KFF) finds that bonus payments to Medicare Advantage (MA) plans dropped by about 8% in 2024 compared to 2023. Payments dropped by about $1 billion to $11.8 billion in 2024. This is the first decline since 2015 and was tied to the fact that COVID flexibilities went away and requirements have become more stringent. 2025 Stars will be announced in October. A given year’s Star rating impacts the next year’s rates. Thus, the 2024 payments were based on Star Year 2023.
UnitedHealthcare and Humana will receive about 50% of total bonus payments in 2024. Bonus payments increased by more than 400% between 2015 and 2023.
Additional articles: https://www.beckerspayer.com/payer/medicare-advantage-bonus-payments-decline-for-first-time-since-2015.html and https://www.beckerspayer.com/payer/payers-ranked-by-medicare-advantage-star-bonuses-in-2024.html
#stars #medicareadvantage
Trump May Still Repeal Obamacare
During the presidential debate, former President Trump said he still may want to repeal Obamacare again, but he is much more tempered than he has been in the past. He indicates he will not do so unless he has an alternative that makes healthcare better. The problem: he doesn’t have a plan to replace it. “We are working on things. We’re going to do it. We’re going to replace it,” Trump said. Trump and the GOP have never had a credible plan, except a massive devolution-to-states scheme that would have added demonstrably to the list of the uninsured.
#obamacare #aca #exchanges #trump #election2024
https://thehill.com/policy/healthcare/4873254-trump-debate-obamacare-replacement
Women Skip Or Delay Care Due To Costs And Experience
A new Deloitte report concludes that half of all women in the U.S. skip or delay medical care due to affordability, access challenges, and past negative experiences with their healthcare. The results are based on a 2024 survey that reached more than 2,000 U.S. consumers. Women are 35% more likely to skip care than men.
#coverage #uninsured #underinsured
Kaiser Exiting Skilled Nursing
Nationwide integrated delivery system Kaiser Permanente is exiting the nursing home business, shuttering the only home it has in California. Kaiser has had a steady decline in bed days at the facility and an emphasis on home care.
(Article may require a subscription.)
#kaiserpermanente
Fitch Says State Revenue Slowing, Which Will Impact Healthcare Spending
With COVID and major federal dollars waning, states are moving from booming to slowing, with revenues expected to be flat or slowly growing in fiscal 2025. This is the conclusion of Fitch, a bond rater. At the same time, states see rising costs, especially with Medicaid. This will complicate rate pictures for Medicaid managed care plans.
(Article may require a subscription.)
#medicaid #managedcare
Elevance Buys IUHealth
Elevance Health will acquire IUHealth Plans, the insurance unit of Indiana University Health, for an undisclosed sum. The entity has 31,000 members in Medicare Advantage (MA) and fully insured employer plans.
(Article may require a subscription.)
#elevancehealth #medicareadvantage
CVS Aetna To Automate To Expedite Care And Reduce Admin
CVS Aetna announced that it plans to automate about one-third of its prior authorization (PA) approvals to expedite care and reduce administrative obstacles. Aetna says this will aid providers and patients alike. Aetna says it is using technology in a positive sense and will avoid the current controversy over AI-driven PA and claims denials.
(Article may require a subscription.)
#cvshealth #aetna #priorauthorization #claimsdenials
— Marc S. Ryan
