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From Medicare Advantage News - CMS this year began implementing portions of its landmark Medicaid managed care rule — the first major update to the program since 2002 — including a key provision that states include requirements for managed care plans to calculate and report a medical loss ratio (MLR). Read more

From Health Plan Week - CMS’s decision to cancel two planned mandatory value-based programs and to scale back a third is unlikely to have significant ripple effects on commercial insurers’ value-based contracting (VBC) arrangements. Insurers say they’re moving ahead as quickly as possible to shift providers into accountable care organizations and bundled payment arrangements. However, the move by CMS does come amid a slowdown in the move to VBC, some stakeholders say. Read more

From Health Plan Week - Congress has set the stage for a September return to debate on stabilizing the individual health insurance market, with major changes to Medicaid funding or expansion taking a back seat. Read more

From Medicare Advantage News - CMS will soon begin soliciting applications from plan sponsor participants that wish to test innovative benefit designs in the third year of the Medicare Advantage Value-Based Insurance Design (VBID) model and may be providing greater flexibility to participating plans, as indicated in a September request for information (MAN 9/21/17, p. 1). As MA organizations weigh the potential risks and rewards of offering a VBID program, officials from CMS and UPMC… Read more

From Drug Benefit News - For payers, value-based contracts (VBCs) can provide some sense of security that patient outcomes will be linked to the price paid for a drug. But VBCs are just beginning to take off, and a number of barriers must first be addressed, according to a panel gathered by the Academy of Managed Care Pharmacy (AMCP). The findings are summed up in an article titled, “AMCP Partnership Forum: Advancing Value-Based Contracting,” and… Read more

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