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April 4, 2017

Hot Topic

Here’s a look at efforts by Medicare Advantage Special Needs Plans for dual eligible beneficiaries to reform the star ratings program:

SNPs Hope for Permanency, Stars Fixes, Enhanced Dual Integration
A major change in risk-adjustment methodology that went into effect for 2017 alleviated a deep concern of many Medicare Advantage plans with large percentages of dual eligibles....

ASPE Report Supports Case for Long-Term Stars Changes for Duals
A recent report from the HHS Assistant Secretary for Planning and Evaluation (ASPE) found that social risk factors and indicators such as disability status, low income and lack of social supports were strong signals of poor health outcomes...

Minimal Impact of SES Adjustment on 2017 Stars May Prompt Further Research
As expected, an interim adjustment used to address socio-economic status (SES) in CMS’s star quality ratings aided a small portion of Medicare Advantage plans serving dual eligible and low-income subsidy (LIS) members...

Today's AIS Health Datapoint

$27.07 ... is the average copay for an in-network primary care physician visit for silver plans in all individual markets , while in-network specialist visit copays average $53.78. Emergency room copays for these plans average $356.92, and inpatient visit copays average $551.76


            Check out a demo of AIS Health's Rx benefit database

Quote of the Day

“After what was almost a massive decapitation of the Medicaid program, I see reform being much more incremental.”

— Jerry Vitti, founder and CEO of Healthcare Financial, Inc., tells Medicare Advantage News

Click here to read the MEDICARE ADVANTAGE NEWS article in which this quote appeared — "After Death of AHCA, Should States Prep For Medicaid Expansion or Lower Funding?" (Free for MAN subscribers; $17 for non-subscribers.)


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