Medicare Advantage and Part D

From Medicare Advantage News - When it comes to managing risk and closing gaps in care, the solution isn’t always as simple as targeting the costliest members. Read more

From Medicare Advantage News - Nineteen of the 23 program audits conducted in 2015 of Medicare Advantage plans that were reviewed by CMS since the beginning of 2016 have resulted in the plan involved being directed to hire an independent auditor (IA) to verify that the problems found have been corrected, a CMS official said at a conference session June 16. This figure and other comments made by Doreen Gagliano, technical advisor in the Division… Read more

Medicare Advantage & Part D Blog

By Lauren Flynn Kelly - July 14, 2016
At sessions of the 12th Annual Government Health Care Congress held July 12 and 13 in Tysons Corner, Va., two central themes rang out: integration and value. Whether it comes to coordinating post-acute care for seniors enrolled in Medicare or meeting the more complex needs of the dual-eligible...
By Lauren Flynn Kelly - June 16, 2016
When Medicare accountable care organizations and the Medicare Shared Savings Program (MSSP) were established in 2011 as a result of the Affordable Care Act, some industry observers predicted a large-scale movement of ACOs building their own risk-bearing entities and forming their own Medicare...
By Lauren Flynn Kelly - May 23, 2016
A year-and-a-half ago, CMS backed off a proposal pertaining to direct and indirect remuneration and pharmacy price concessions in an effort to further clarify the types of DIR fees charged to pharmacies participating in Part D networks that should be included in the negotiated price of a drug...

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