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
From Medicare Advantage News - On the surface, the changes in Medicare Advantage and Part D star quality ratings proposed by CMS in the 2016 draft Call Letter released Feb. 20 don’t seem large or surprising (MAN 2/26/15, p. 1). There is only a single new measure CMS intends to introduce for next year, and that one — regarding comprehensive medication reviews (CMRs) for plan members eligible for medication therapy management (MTM) programs — had… Read more
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