Managed Care Friday

Feb 21, 2020 | Managed Care Friday

77: Percent of employers in our poll of 219 small, midsize, and large companies who say the time to diagnosis for pain and orthopedic issues is “excruciatingly slow” and “wasteful,” and has led to issues with “presenteeism, productivity” and ultimately higher health cost spend per employee. “Not just low back pain, but neck pain, knee pain, upper back, elbow – we have been pressing in recent years to use PT first for several weeks but sometimes an X-ray is needed right away to rule out issues,” says Dave Simmons, a medical director consultant for self-insured employers. Palliative Care:...

CMS Proposes 2021 Medicare Advantage Rates of +4.49%, Finalizes MA/Hospice Demo

Feb 20, 2020 | Hospice, Medicare, Medicare Advantage

CMS released the 2021 Medicare Advantage Advance (MA) Notice on February 5, 2020. The proposed rate updates are estimated to increase MA plan payments by +0.93%, with another +3.56% increase due to plan risk coding behavior. CMS also published more details on the voluntary demonstration program that allows Medicare Advantage plans to cover the Medicare hospice benefit. Specific capitation rate detail are expected to be released shortly. Click to read more.

Supreme Court Lifts Stay on ‘Public Charge Rule’, Likely Affecting Medicaid Enrollment

Feb 19, 2020 | Medicaid

On January 27, the U.S. Supreme Court lifted a nationwide injunction on implementation of the Trump administration’s ‘Public Charge Rule’, which increases the government’s ability to reject green cards for individuals deemed dependent on government assistance, including Medicaid. The Supreme Court did not opine on the legality of the rule itself, and litigation to address that issue is ongoing. Click to read more.

Number of ACOs and Enrollees Rebounds in 2020 Enrollment Data

Feb 17, 2020 | Medicare

Following a decrease in both participating Accountable Care Organizations (ACOs) and assigned beneficiaries in 2019, CMS released 2020 enrollment data that showed participating ACOs making up ground to 2018’s high (517 v. 561) and assigned beneficiaries surpassing 2018’s 10.5M, rising to 11.6M. Click to read more.