Nov 3, 2020 | Home Health
For CY 2021, CMS finalized a +1.9% update to home health payments, resulting in an estimated $390 million payment increase. Click to read more.
Nov 2, 2020 | Medicare Advantage
CMS released the 2022 Medicare Advantage Advance (MA) Notice on October 30, 2020. The proposed rate updates are estimated to increase MA plan payments by +6.41%, assuming the same level of revenue increase from risk adjustment coding that CMS estimated last year. Click to read more.
Oct 31, 2020 | Managed Care Friday
$50: The cost of a new 12-week Embrace Wellness program offered by Carroll Hospital in Maryland for people going through cancer treatment. Participants have access to self-care activities, nutrition education, wellness classes, and weekly exercise classes. The program runs through November 24, 2020 and costs $50 per person. Coordinator Bridgette Bostic says the program has been successful despite COVID-19. Cleveland Rocks: University Hospitals, based in Cleveland, formed a joint venture with digital health company, ValueHealth, to create a high-value network of ASCs. The centers will focus...
Oct 27, 2020 | Commercial Insurance, Payers
KFF’s annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. This brief highlights key findings. Click to read more.
Oct 26, 2020 | Medicare, Physicians
As of January 2020, CMS reports that there are 517 Medicare Shared Savings Program (MSSP) ACOs present in 49 states and DC. These ACOs serve approximately 11.2M beneficiaries nationwide. ACOs are an increasingly important element of the healthcare market and a recent report by CMS Administrator Seema Verma discusses the $1.2B in savings to Medicare generated by ACOs. Click to read more.
Oct 23, 2020 | Managed Care Friday
1.1B: The amount of money Highmark's True Performance value-based reimbursement program saved in healthcare costs. The savings were related to ED visits and hospitalizations and were generated from 2017-19. About 2M Highmark members see a primary care doctor through the True Performance program. Payer results in value-based care vary - one Blue plan told us they lowered cost of care by about 3%, Aetna and Cigna somewhat less, while United has saved more (7-9%). In one example the plan saved $1.5M via value-based design (which they describe as not a lot of money), keeping about $1M of that....
Oct 22, 2020 | Legislation/ Budgets/ Macro
BRG collaborated with Health Care Cost Institute (HCCI) to estimate the impact of COVID-19. A new report, published by HCCI, found that between April and August, 1.9 million excess years of life have been lost. Despite lower COVID-19 mortality rates, working age adults 20-64 account for 47% of excess years of life lost. Click to read more.
Oct 19, 2020 | Ambulance, Ground, Medicare
Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization(RSNAT) Model: CMS announced the expansion of this model nationwide. The RSNAT model has saved CMS $650 million over the past four years, with analysts suggesting the improper payment rate for non-emergent ambulance transport declined 4% from 2017 to 2018. CMS did not find any evidence of the RSNAT model impacting the quality of care in a negative way. Click to read more.
Oct 19, 2020 | ESRD, Medicare
ETC Model Begins in 2021, Encourages Home Dialysis and Transplant Use CMS has released the final rule for the ESRD Treatment Choices (ETC) Model, which will begin on January 1, 2021 and run through June 30, 2027. The model aims to expand the use of home dialysis and kidney transplants by providing additional financial incentives for providers in select geographies. Model participation is mandatory to limit adverse selection for financial gain. Click to read more.
