glp1

Two Key CMS Announcements MA Plans Must Follow

Medicare Advantage (MA) plans are going to want to take note of two recent HPMS memos from the Centers for Medicare and Medicaid Services (CMS). Each touches on major areas of controversy for the program. Supplemental Benefits User Group CMS will host a user group to provide an overview of supplemental benefits data submission for encounter data records on September 26, 2024, 2:00 p.m. – 3:00 p.m. ET. You need to register in advance. See the flyer distributed with the September 10 HPMS memo on the topic. The issue of supplemental benefits is an explosive one right now. Opponents of MA say that MA plans are submitting bids that misrepresent supplemental benefit utilization and thereby inflating their margins. CMS has little to go by because encounter data for supplemental benefits is rarely submitted. CMS did two things to attack the controversial issue. First, it issued a memo requiring plans to submit

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Oliver Wyman Has Lessons For Today’s Medicare Advantage Plans

As management advisory firm Oliver Wyman noted in its recent study on Medicare Advantage’s (MA) woes, “history has a way of repeating itself.” And so it is with MA’s plight today. Oliver Wyman says MA plans can learn a great deal from what plans went through during the Medicare+Choice days almost thirty years ago. Oliver Wyman admonishes plans to avoid the Medicare+Choice mistakes lest MA plans suffer the same fate of many Medicare+Choice plans back then. What is Medicare+Choice and what happened? Medicare+Choice is the same program we have today but under its earlier name. While there was managed care in Medicare for a few decades, Medicare+Choice was formally established as Part C of the program via the Balanced Budget Act of 1997 (BBA). Plans were rolled out effective January 1, 1999. Medicare+Choice was renamed Medicare Advantage as part of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) in

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My Exhaustive Hunt For My GLP-1!

Your intrepid blogger is on a GLP-1. It was with great reluctance that I went on one. I have been a diabetic for about 17 years now. I tell everyone it runs in the family, which is indeed truthful. But I admit privately (and I guess publicly as of now) that a lot of my diabetes is tied to my poor eating habits and lack of exercise. I have tried a great deal over the years to keep my HbA1C below 7.0. It worked for a while with generic meds and then with one brand drug. But as I close in on my sixties, I began inching up and went above 7.0. I am a new drug skeptic. I don’t believe the Food and Drug Administration (FDA) or brand drug makers have the best interests of Americans at heart – the FDA because it is inept, the drug makers because

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