From Medicare Advantage News - It did not take long in 2015 for the first new Part D battle to erupt between a major insurer and a large trade group for independent retail pharmacies. The 23,000-member National Community Pharmacists Association (NCPA) on Jan. 7 rebuked Aetna Inc. for listing on the company’s websites and the CMS Medicare Plan Finder as in-network for 2015 numerous pharmacies that turned out not to be in most cases. Since Aetna did not admit or fix the problem until after the Annual Election Period (AEP) ended Dec. 7, Part D beneficiaries may have been victims of “bait and switch” tactics,… Read more
From Medicare Advantage News - Providers in Humana Inc.’s Accountable Care Continuum programs in Medicare Advantage got much higher HEDIS scores than did its providers outside of those settings in Medicare, and the scores improved as the degree of provider risk-bearing increased (see chart, this page), the company said this month. The comparisons also showed that Humana’s MA members in accountable care programs had 7% fewer emergency room (ER) visits per 1,000 patients and 4%… Read more
From Medicare Advantage News - If 2014 was the year for simply overcoming the problems involved in getting the three-year CMS-backed Financial Alignment Initiative (FAI) for Medicare- Medicaid dual eligibles started, 2015 may be the year to start finding solutions for the obstacles — some of them unexpected — encountered in furnishing the integrated care duals need. Read more
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