Medicare Advantage and Part D

From Medicare Advantage News - While Medicare Advantage products generally have performed strongly recently, that has not been the case in at least some aspects for two of the industry’s former stalwarts, Humana Inc. and Universal American Corp. In both cases the culprit may be related to aggressiveness that has led to high medical loss ratios (MLRs) in some markets, and the setbacks come despite relatively strong star-ratings performance. Read more

From Medicare Advantage News - If there was one factor that enabled Essence Healthcare to become a five-star-rated Medicare Advantage plan for the first time in 2016, it probably was the insurer’s model of physician engagement, Essence’s chief medical officer told an AIS star-ratings virtual conference session Feb. 4. Deborah Zimmerman, M.D., traced how the structure and incentives used in working closely with 12 physician groups have translated into having just a 2.9% medical cost… Read more

Medicare Advantage & Part D Blog

By James Gutman - April 27, 2016
What a long strange trip it’s been! When I came to AIS nearly 15 years ago as executive editor, I didn’t even know what a Medicare + Choice plan, as it then was called, meant. I got educated quickly, courtesy of a fantastic reporter and writer, Judy Packer-Tursman, who was the editor of AIS’s...
By James Gutman - April 22, 2016
The findings are certainly striking, even if they aren’t surprising. There are big differences in the care and access to care among Medicare Advantage (MA) beneficiaries when racial and ethnic minorities are compared with whites, based on new research done by the CMS Office of Minority Health and...
By James Gutman - April 6, 2016
Medicare Advantage (MA) plans in recent years have gotten accustomed to big changes in provisions affecting their pay between CMS’s preliminary rate notice in February and the final one in April 45 days later. But there was somewhat less of that last year for 2016, and now there are even fewer...

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