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December 7, 2017

Recent Stories

From Medicare Advantage News - After more than a month of speculation, CVS Health Corp. on Dec. 3 confirmed its agreement to acquire Aetna Inc. for about $69 billion, or $207 per share. Although both companies operate multiple lines of business, executives during their first conference call on the deal highlighted the potential to use CVS retail pharmacies to create a more seamless health care experience for members, including Medicare Advantage and Part D enrollees. Read more

Increased plan flexibility and reduced burden were two key themes in a… Read more

In her first major speech on the Medicaid program, CMS Administrator Seema… Read more

In a sweeping final rule containing changes for the second year of… Read more

From the Editor

Welcome to your Medicare Advantage News subscriber-only Web page

Be sure to visit often, for PDFs of issues, archives of articles, links to government documents and more!

Please e-mail me with your comments on the last issue of Medicare Advantage News, story ideas for future issues, or any other suggestions you have that can make the newsletter more useful for you.

November 2, 2017
New Look, Same Great Content

Good afternoon from the editor of Medicare Advantage News! You may notice a few changes when you open this week's issue: brighter colors, new graphics, and a more readable flow of copy, to name a few. Rest assured, the content we deliver to you twice a month will feature the same in-depth coverage of issues that are critical to Medicare and Medicaid plan sponsors and their partners. But if you feel something is missing from that content, do let me know by using the link in the box above. I'm always interested in hearing from readers on what's important to them.

October 11, 2017
2018 Star Ratings Show Boost in Average Overall Score for MA-PDs, PDPs

CMS this morning posted 2018 star quality ratings data for Medicare Advantage and Part D plan sponsors, indicating a slight drop in the number of MA Prescription Drug contracts earning 4 stars or higher but a greater percentage of beneficiaries enrolled in high-performing plans and an improved average star rating for MA-PDs. Specifically, approximately 44% of MA-PDs (170 contracts) that will be offered in 2018 achieved overall ratings of 4 or above, down from 49% of plans (178 contracts) offered in 2017. Weighted by enrollment, nearly 73% of MA-PD enrollees are currently in contracts that will have 4 or more stars in 2018, compared with approximately 69% based on 2017 star ratings, CMS said. And the average star rating for MA-PDs improved from 4.02 in 2017 to 4.06 this year.

Meanwhile, the percent of PDPs receiving an overall star rating of 4 or higher rose from 49% (27 contracts) last year to 52% (28 contracts) for their 2018 Part D rating. And the average star rating for PDPs rose from 3.55 last year to 3.62 for the 2018 star ratings. Weighted by enrollment, nearly 47% of PDP enrollees are in contracts with 4 or more stars, up from 41% in the 2017 star ratings. Similar to last year, a total of 23 contracts are highlighted on the Medicare Plan Finder with a high performing (gold star) icon for achieving 5 stars; 15 of these are MA-PDs, seven are PDPs and one is an MA-only contract.

View the new data here.

September 22, 2017
CMS Considers 'New Direction' for Innovation Center

Since the arrival of the new administration and the appointment of HHS Secretary Tom Price, M.D., rumors have been swirling about the future of CMS's Innovation Center, which Republicans have criticized for operating too many demonstrations that are "experimenting" on seniors and are putting too much of a burden on physicians. So it should come as no surprise that CMS this week released an informal Request for Information (RFI) to collect stakeholder input on "a new direction to promote patient-centered care and test market-driven reforms that empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes."

In the document, CMS said it is interested in testing models in eight focus areas, including Medicare Advantage. In addition to potential modifications to the MA Value-Based Insurance Design model to provide plans more flexibility to innovate, CMS said it is considering a demonstration that incentivizes MA plans to compete for beneficiaries, including those beneficiaries currently in Medicare fee-for-service (FFS), "based on quality and cost in a transparent manner." CMS would look at what flexibilities around supplemental benefits could be included to increase choice, improve care quality, and reduce cost, and is seeking comments on what options might exist beyond FFS and MA for paying for care delivery that "incorporate price sensitivity and a consumer driven or directed focus and might be tested as alternatives to FFS and MA."

The deadline for comments to be submitted online is Nov. 20.

View the RFI here.

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