Medicare Advantage and Part D

From Medicare Advantage News - In what may be a preview of issues other states also will face as they expand Medicaid managed care extensively and quickly, the California state auditor (CSA) on June 16 severely criticized what both managed Medicaid plans and state agencies have done to ensure adequate provider-network access for beneficiaries. But the major state agency involved said only some of the criticisms are warranted. Read more

From Medicare Advantage News - A highly rated Medicare Advantage plan operator in Michigan has used an unusual partnership with five local nonprofit skilled nursing facilities (SNFs) and a local ambulance company to achieve large reductions in cost of care for about 300 of its complex chronically ill MA members. And based on the results and the need, Grand Rapids, Mich.-based Priority Health wants to boost the number of MA members in the program to… Read more

Medicare Advantage & Part D Blog

By James Gutman - July 21, 2015
Provider directories, not long ago an annual hard-copy document customarily banished shortly after receipt to either the “circular file” or the nethermost reaches of beneficiaries’ storage areas, are now one of the hottest areas for regulations in Medicare Advantage (MA). If there had been any...
By James Gutman - July 8, 2015
Just when things showed signs of settling down in the Medicare Advantage (MA) industry after years of payment-rate cuts — or maybe partly because things were settling down — there is a new wave of insurer consolidations to shake things up. And the impact of that shakeup will not be confined just to...
By James Gutman - June 24, 2015
Massachusetts had probably the toughest assignment in making a CMS-backed demonstration for Medicare-Medicaid dual eligibles work — and it’s about to get even harder. Fallon Total Care, one of three chosen plans that actually started the demo (three others dropped out before the demo started in...

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