multiplan

Major new Star measure changes slated by CMS The Centers for Medicare and Medicaid Services’ (CMS) 2026 Advance Notice had major changes and information related to the Medicare Advantage (MA) and Part D Star programs for Star Year (SY) 2026 and beyond. The advance notice provides information and updates on Star ratings as mandated by regulations and solicits input on future measures and concepts. All substantive measure specification changes, the addition of new measures, and methodological changes must go through rulemaking. The 2026 notice outlines non-substantive measure specification updates; solicits initial feedback on substantive measure specification updates and comments on new measure concepts as well as display measures; and solicits preliminary feedback on adding geography to the Health Equity Index (HEI) reward.  Here are the key advance notice highlights: Deadlines Final 2026 Star Year Measures Disasters for Star Year 2026 As well, starting with the 2026 Star Ratings CMS will

Some relief with positive hike, but rate increase still inadequate On Friday, the outgoing Biden administration released its Advance Notice for Medicare Advantage (MA) and Part D rates and other policy changes for 2026. I have reviewed the 180-page Advance Notice, CMS Fact Sheet, and CMS Press Release. Below are the key highlights. The advance notice will be finalized by early April. I will publish a comprehensive Stars roadmap blog on Thursday in conjunction with Lilac Software. This will detail all the proposed Star measure changes, updates, and information discussed in the advance notice. MA rate proposal It is likely that MA plans and investors will see the proposed rates for 2026 with some relief. After two years, it appears MA plans could see a real revenue increase rather than the decreases they saw in 2024 and 2025. But as plans and financial analysts take a deeper look, the proposal

Trump’s goal of extending the 2017 tax cuts could have major implications for healthcare In Monday’s blog, I told you that the incoming Trump administration will be dominated by budget matters in 2025, with an effort to find enough savings to extend the 2017 tax cuts. The proposed Department of Government Efficiency (DOGE) commission seems dedicated to a fundamental remake of government, programs, and regulations. While the Republican or GOP control of both Houses is tight, leaders and the rank-and-file seem ready to hitch their wagons to Trump and his agenda. But as I noted Monday, process and procedures could create challenges. With all this in mind, what might healthcare cut proposals look like? The DOGE, Trump, and congressional GOP lists will likely be culled from various sources including governmental authorities and outside conservative think tanks. The lists below include proposals from the Congressional Budget Office (CBO) and a number

What will the early months of a new Trump term mean for healthcare? President-elect Donald Trump is scheduled to take office on January 20 after coming back from the political dead. Trump will become just the second president to serve non-consecutive terms. For the politically curious, the first was Grover Cleveland in 1885 and then again in 1893. Cleveland beat Republican James Blaine in 1884, winning both the electoral and popular votes. He lost to Republican Benjamin Harrison in 1888. Harrison won the electoral vote, but Cleveland won the popular vote. Cleveland came back to beat Harrison in 1892, getting both the electoral and popular vote. A now more government-savvy Trump has come out fast to put together his agenda and personnel for his second term, a major difference than what occurred in 2017 when Trump looked flat-footed during the transition. Trump already has almost all of his nominees picked

Even a master seer would have problems predicting what will occur in healthcare in 2025 In my last blog, I gave you my healthcare year-in-review for 2024. After that, as I always do each year, I play Nostradamus to prognosticate about what will happen in the next twelve months in the world of healthcare. Despite my Irish last name, I do have French blood (well, 50% French Canadien, so I count it). But I don’t claim to be an oracle or seer like our 16th century physician, apothecary, and astrologer friend. I do take a page from Nostradamus, though, in that my healthcare predictions for 2025 (not really prophecies) will be sometimes deliberately vague (they include a lot of mays, coulds, shoulds, perhaps, likelys and possibles) so as to amass a reasonable record for those tracking and putting together my forecasting report card for the history books. It also tends to make my

A busy year in healthcare with insurer woes and a presidential election that brought changing political winds As is my tradition at year’s end, I reflect back on all that occurred in healthcare in the year. It was a big year in healthcare and the election portends another massive one next year. I will have my 2025 predictions blog on Thursday. So, here are the major healthcare happenings from 2024. You can go to various blogs at the blog tab to learn more. In a few instances, I call out good blogs to go back to as well. NHED shows robust healthcare growth National healthcare expenditure data (NHED) was published for 2023. Costs rose 7.6% from 2022 to 2023 and reached almost $4.9 trillion. This made spending on healthcare expeditures hit 17.6% of the gross domestic product (GDP). Healthcare expenditure will consume almost one-fifth of the economy by 2032. Insurer