From Medicare Advantage News - Pharmacies participating in the first phase of a joint SCAN Health Plan-Express Scripts Holding Co. incentive-based program to improve outcomes for SCAN’s Medicare Advantage beneficiaries had dramatically higher performance scores in several measures than did a national sample of retail pharmacies, the two organizations said last month. The differences in performance related to some measures that also are examined in CMS star quality ratings, the two organizations said, include 60% higher scores for reducing use of high-risk medications among SCAN members and 23% higher scores for improving compliance with diabetes treatment guidelines. The scores also were 34% higher on high-risk… Read more
From Medicare Advantage News - The issue of whether Medicare Advantage plans are being overpaid because of inflated risk-adjustment scores is starting to play out in the courts as well as via regulatory scrutiny. At least “a half dozen whistleblower lawsuits” alleging such overcharges have been filed since 2010, the Center for Public Integrity (CPI) news organization reported last month, and one of those pending cases shows the kinds of allegations MA organizations increasingly may… Read more
From Medicare Advantage News - Now that almost all of the CMS-backed initiatives for Medicare-Medicaid dual eligibles are up and running, it has become clear that reaching many of the ambitious goals in these programs will be nearly impossible over the short term. There have been and will continue to be improvements in integrated care for duals as a result of the demo, plan executives tell MAN, but such aspects as cost savings, good outcomes… Read more
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