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July 5, 2017

Hot Topic

Health insurers pushing to participate in the Medicare Access and CHIP Reauthorization Act’s (MACRA) Advanced Payment Models got more details about what the “all-payer” option for APMs might look like. Here’s a look at the evolution of MACRA’s quality payment program:

Despite Protests, MA Plans Must Wait for MACRA Payment Status
The health insurance industry remains upset that CMS excluded Medicare Advantage plans from possibly qualifying for the program’s Quality Payment Program until 2021...

MACRA Poses Questions for Health Plans As Providers Gauge Networks, Payments
Health insurers are not quite looking over the shoulder of physicians and provider groups when it comes to MACRA, but they certainly are attuned to how this possibly game-changing legislation will be implemented...

MA Plans Consider Contracting, Quality As MACRA Lays Value-Based Framework
CMS's final rule implementing the provider payment portion of MACRA unveiled a “pick-your-own-pace” approach for Medicare fee-for-service providers that will be subject to new reporting requirements and performance measurement...

Today's AIS Health Datapoint

349,455 ... is the number of members as of June 2017 enrolled in Kaiser Permanente Senior Advantage, a California-based Medicare Advantage (MA) plan and the top MA plan in the U.S. California's Kaiser Foundation Health Plan, Inc. also holds the second spot in MA enrollment; its Kaiser Permanente Senior Advantage LA, Orange Co. has 192,310 members.


AIS’s Medicare and Medicaid Market Data: Enrollment, Premium Rates, Benefit Designs and Strategies of Medicare and Medicaid Plans

Quote of the Day

“Adding specialty pharmacies to an LD [i.e., limited-distribution] network is not surprising, but DROPPING a pharmacy from a network is very rare.”

— Bill Sullivan, principal consultant for Specialty Pharmacy Solutions LLC, in a recent client alert reacting to Vertex Pharmaceuticals Inc.’s decision to remove CVS Specialty from its limited-distribution specialty pharmacy network.

Click here to read the SPECIALTY PHARMACY NEWS article in which this quote appeared — "Dropping Pharmacies From Networks Is Rare, but Companies Will Do It" (Free for SPN subscribers; $17 for non-subscribers.)


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