Medicare Advantage and Part D

From Medicare Advantage News - Medicare-Medicaid dual eligibles have worse outcomes than non-duals on many CMS star-rating measures not because of the plan’s quality of service but instead because of characteristics of the duals themselves, according to the final report of a large-scale, multivariate study by Inovalon, Inc. The conclusions in the report issued March 31 build on those in preliminary findings released last October by Inovalon (MAN 11/6/14, p. 1) — but apparently did not influence CMS’s decisions in the final 2016 Medicare Advantage pay notice sent out April 6 (see story, p. 1). Read more

From Medicare Advantage News - Providence Health Plan, which has a five-star Medicare Advantage plan with a long track record of success in its care management programs, will start in July an in-home multidisciplinary care program of both scheduled and unscheduled provider visits for frail and vulnerable members. The program will target about 2,200 of the MA plan’s approximately 46,000 members, selecting them based on algorithms that screen for such variables as multiple chronic conditions,… Read more

Medicare Advantage & Part D Blog

By James Gutman - April 28, 2015
If it’s true that “fool me once, shame on you; fool me twice, shame on me,” then Medicare Part D plans might be feeling a lot of shame right about now. This is because even though CMS has made it super-clear that one of its highest priorities is ensuring pharmaceutical access to Part D...
By James Gutman - April 17, 2015
There are legal and public-relations skirmishes between major corporations every day, but there is nothing quite like a UPMC-Highmark Inc. battle to move the level of the rhetoric to that of good, old-fashioned street fights. We got another taste of this within the past week and a half when the two...
By James Gutman - April 1, 2015
The findings certainly weren’t surprising, but the timing was at least interesting when Inovalon, Inc. on March 31 issued its long-awaited final report on the relationship between Medicare-Medicaid dual-eligible status and Medicare Advantage (MA) plans’ star ratings. The report thus came out six...

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