Medicare Advantage and Part D

From Medicare Advantage News - In the midst of earnings releases and conference calls held by publicly traded Medicare and Medicaid insurers in late April and early May, the Pennsylvania Dept. of Human Services disclosed earlier than anticipated that eight plans total, including three large insurers, had won contracts to serve the state’s mandatory Medicaid managed care program for up to five years. The big winners were incumbent UnitedHealth Group, which won across all five regions, and Centene Corp., which was new to the state and selected to serve in three regions. Read more

From Medicare Advantage News - There are significant health care disparities, both in terms of access and results, between minority groups and whites in Medicare Advantage plans, according to the first-ever CMS release of data stratified by contract for race and ethnicity in MA. The data, which were released April 19 and are slated to be issued annually, show “we have a number of measures that we need to do a better job” on, Cara… Read more

Medicare Advantage & Part D Blog

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...
By Lauren Flynn Kelly - May 6, 2016
We at AIS recently said a bittersweet farewell to managing editor James Gutman, who retired from his full-time post writing Medicare Advantage News but will continue to contribute to our slate of webinars. Jim hired me out of AIS’s database section in the early 2000s and taught me nearly everything...

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