All Articles In 'Medicare Advantage'

Integrating Care for Medicare-Medicaid Dual Eligibles: A Primer for States

Integrating Care for Medicare-Medicaid Dual Eligibles: A Primer for States

Improving care integration for Medicare-Medicaid dual eligible beneficiaries is one of the many initiatives embedded in the Affordable Care Act (ACA). The health reform law created the Medicare-Medicaid Coordination Office at the Centers for Medicare and [...]

Future of Health Insurance Industry: Public Programs, Consolidation, New Products, Opportunities

Future of Health Insurance Industry: Public Programs, Consolidation, New Products, Opportunities

Health insurance in America has changed dramatically in the past few years, changes that will speed up once the Affordable Care Act (ACA) major provisions take effect in 2014. It’s easy to be sucked into the [...]

Risk Adjustment for Health Plans Under ACA: Evaluating, Improving Risk Adjustment Models

Risk Adjustment for Health Plans Under ACA: Evaluating, Improving Risk Adjustment Models

Risk adjustment is a key mechanism to ensuring appropriate payments for Medicare Advantage plans, Medicare Part D drug plans, and Medicaid health plans.  Since health plans vary in their mix of healthy and sick enrollees, risk adjustment [...]

Medicare Spending, Beneficiaries, Providers, Health Plans, and Drug Plans: MedPAC Data Book for 2013

Medicare Spending, Beneficiaries, Providers, Health Plans, and Drug Plans: MedPAC Data Book for 2013

Medicare will spend $598.4 billion on health care services for seniors and the disabled in 2013 and about $635 billion in 2014.  Medicare expenditures will top $1 trillion in 2021, according to CMS actuarial projections. Medicare [...]

Geographic Variation in Health Care Spending and Medicare Payment Reform

Geographic Variation in Health Care Spending and Medicare Payment Reform

In the ongoing struggle over wasteful health care spending, geographic cost variation is a veteran hot topic. The fact that public programs and private health plans spend more for providers in some regions, even after accounting [...]

Shared Savings: Most Popular Model, Best Practices for Accountable Care Organizations

Shared Savings: Most Popular Model, Best Practices for Accountable Care Organizations

Even as Accountable Care Organizations and other payment reform models become more common, there is still not much comprehensive information about which models providers participate in most often, and what exactly to do to make those [...]

Medicare Special Needs Plans: MedPAC Recommendations on Future of Special Needs Plans

Medicare Special Needs Plans: MedPAC Recommendations on Future of Special Needs Plans

Special Needs Plans (SNP) are part of the Medicare Advantage program and were created by the Medicare Modernization Act of 2003 (MMA). There are three types of SNPs, each intended to provide coordinated care for Medicare [...]

Health Care Spending and Hypertension: The Cost of High Blood Pressure

Health Care Spending and Hypertension: The Cost of High Blood Pressure

Hypertension, or high blood pressure, is related to several major chronic diseases. Obesity and diabetes raise your chance of developing high blood pressure, which in turn makes you more likely to suffer from heart disease and [...]

Medicare Physician Sustainable Growth Rate: Repealing SGR

Medicare Physician Sustainable Growth Rate: Repealing SGR

For over a decade, the sustainable growth rate (SGR) has been a source of financial worry for physicians who serve Medicare patients. Medicare’s physician payment rate is based on a composite measure of the cost of [...]

Chronic Care Management: CMS Multiple Chronic Conditions Dashboard

Chronic Care Management: CMS Multiple Chronic Conditions Dashboard

Many new care models in both the public and private sector focus on people with chronic diseases, particularly conditions like diabetes, congestive heart failure, and hypertension. The Veterans Health Administration (VHA) Care Coordination/Home Telehealth (CCHT) pilot program [...]