Reforming How Medicare Pays for Digital Health

Bill Of Health

Medicare could lead this charge. Congress has an opportunity to reform Medicare in 2024, when the Trust Fund will become insolvent. Reforms to Medicare’s traditional coverage and reimbursement approaches that harness the digital revolution can help the program secure additional value.

Hospital lobbying against Medicare cuts intensifies

Health Care Dive

Hospital interests are sending letters to top congressional leadership and even launching ad campaigns in a bid to stave off pending Medicare cuts

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Humana slashes Medicare Advantage outlook, shares tumble

Health Care Dive

Competition for members was "very aggressive" as Humana's competitors came in with lower-priced plans and spent more on marketing to attract customers away, CEO Bruce Broussard said

Centene's Medicare CFO promoted to segment CEO

Health Care Dive

Rich Fisher's promotion comes weeks after the insurer reported a $535 million quarterly loss but a 25% growth in its Medicare business

Medicare Advantage 2022 enrollment on the rise

Healthcare ECONOMIST

Fierce Healthcare reports that in 2022 Medicare Advantage enrollment is continuing to grow at the expense of traditional fee-for-service Medicare. They write that: Medicare Advantage plans signed up another 2.3 million people transitioning from traditional Medicare to MA.

Medicare telehealth visits increased 63-fold from 2019 to 2020, new government data shows

Health Care Dive

Virtual visits for Medicare beneficiaries went from hundreds of thousands pre-pandemic to tens of millions in 2020, with many beneficiaries using telehealth for the first time

Fixing the ‘Toxic’ Home Health-Medicare Advantage Relationship

Home Health Care

The home health industry’s battle with Medicare Advantage (MA) plans for fair rates has gone from a few stakeholders saying “the quiet part out loud” earlier this year to nearly every major provider in the country talking about the issue with regularity.

2021 Medicare Trustees Report

Healthcare ECONOMIST

The 2021 Medicare Trustees Report–formerly known as the “ Annual Report of the Boards of Trustees of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund “–had some grim news. Program overview Medicare covered 62.6

Preferred Pharmacies in Medicare Part D

Healthcare ECONOMIST

Medicare Part D plans have begun using preferred pharmacy networks in order to steer their beneficiaries to lower cost pharmacies. that compares Low Income Subsidy (LIS) Medicare beneficiaries and non-LIS beneficiaries. Health Insurance Managed Care Medicaid/Medicare Medicare Medicare Part D Pharmaceuticals PharmaciesA key question is, does this work? A paper by Xu et al. 2022) aims to answer this question using 2011-2016 data.

EasyHealth Secures $135M to Redesign Medicare Experience

HIT Consultant

What You Should Know: – Easyhealth raises $135M to redesign Medicare with its end-to-end Medicare experience to help 50 million Medicare members find the best plan and support them through their healthcare journey. Redesigning The Medicare Experience.

Hospital lobbying fails to stop looming Medicare cuts in year-end proposal

Health Care Dive

Hospital interests are sending letters to congressional leadership and even launching ad campaigns in a bid to stave off pending Medicare cuts

Home Care Providers Take Note As Medicare Advantage Grows, Creates Savings for Seniors

Home Health Care

Compared to fee-for-service Medicare, seniors save close to $2,000 on average in total annual health care spending with Medicare Advantage (MA). Between 2018 and 2019, health care spending went up 5% for MA beneficiaries and 9% for fee-for-service Medicare beneficiaries.

CMS rolls out changes to Medicare website aimed at usability

Fierce Healthcare

CMS rolls out changes to Medicare website aimed at usability. rking. Wed, 05/18/2022 - 14:21

Medicare insolvency still expected by 2026, unchanged by COVID-19, trustees say

Health Care Dive

The forecast is a bit of a bright spot for the otherwise grim financial prospects of the program, as experts worried COVID-19 would result in the fund that finances Medicare Part A running out of money faster than previously expected

In-Home Support Services Becoming Top Medicare Advantage Benefit

Home Health Care

In-home support services are the most popular — and arguably impactful — supplemental benefit offered by Medicare Advantage (MA) plans under the primarily health-related category. Medicare Advantage Better Medicare Alliance Milliman

Encompass Health Focused on Home Health Hiring, Medicare Advantage Relationships

Home Health Care

As was the case for much of 2021, the home health admissions growth we generated in Q1 came predominantly under our Medicare Advantage (MA) and managed care contracts,” Encompass Health President and CEO Mark Tarr said during a Thursday morning earnings call.

Medicare Advantage quality bonus program hasn't improved quality, study finds

Health Care Dive

The new findings published in Health Affairs suggest the quality bonus program doesn't move the needle on quality despite a significant federal investment — hinting the American people may not be getting enough bang for their buck

OIG flags potential $5B overpaid to Medicare Advantage plans

Health Care Dive

The watchdog calls out 20 private insurers, which it does not name, and urges CMS to conduct greater oversight

Better Medicare Alliance: MA adds $32.5B in value to Medicare

Fierce Healthcare

Better Medicare Alliance: MA adds $32.5B in value to Medicare. rking. Thu, 10/21/2021 - 16:23

Why Home Health Agencies Could See an Unfavorable Medicare Payment Landscape in 2023

Home Health Care

Home health operators should dig in even further ahead of the Medicare reimbursement battle coming later this year. Centers for Medicare & Medicaid Services (CMS) released its 2023 proposed payment rule for the nursing home industry earlier this month.

How CommonSpirit Reduced Medicare Spending by $136M

Home Health Care

CommonSpirit Health carved out $136 million in savings to Medicare for 2020, while also improving overall outcomes for hundreds of thousands of beneficiaries, the company recently announced. Centers for Medicare and Medicaid Services (CMS).

RecoveryOne, Cigna Offers Virtual Physical Therapy for Medicare Advantage Customers

HIT Consultant

We are proud to expand our partnership with Cigna to improve the overall quality of life, including pain reduction and a return to previous functionality for the Medicare Advantage population,” said Dustin Eggers, EVP and chief commercial officer of RecoveryOne. “We

Medicare proposes to limit coverage of Biogen Alzheimer's drug

Health Care Dive

The program will only cover Aduhelm, which the FDA controversially approved last June, for patients enrolled in clinical trials

Evaluating Home Care’s Progress in Medicare Advantage

Home Health Care

Many of the in-home supplemental benefits offered by Medicare Advantage (MA) plans are new. The post Evaluating Home Care’s Progress in Medicare Advantage appeared first on Home Health Care News. Featured HHCN+ Medicare Advantage Anthem ATI Advisory Centene Cigna healthAlign Humana In

CMS moves to scrap Medicare coverage of breakthrough devices due to clinical evidence concerns

Health Care Dive

AdvaMed said the repeal of the Medicare Coverage of Innovative Technology rule is the wrong decision for patients. Analysts noted the reimbursement pathway could be resurrected in Cures 2.0 legislation

Better Medicare Alliance: 99.9% of Medicare Advantage plans offering supplemental benefits

Fierce Healthcare

Better Medicare Alliance: 99.9% of Medicare Advantage plans offering supplemental benefits. rking. Tue, 03/01/2022 - 14:41

Medicare Modernization of Payment Software

Briggs Healthcare

CMS has provided MLN4761491 – Medicare Modernization of Payment Software Fact Sheet (5-pages in length) for providers submitting institutional claims to Medicare Administrative Contractors (MACs). Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare.

Biogen's pricey Alzheimer's drug contributes to major Medicare premium hikes

Health Care Dive

The 15% jump in Part B premiums for 2022 is a case study in how just one expensive medication can affect the spending of millions in the U.S.

Where the Director of the Center for Medicare Wants to See Care Go

Home Health Care

One of the most important Centers for Medicare & Medicaid Services (CMS) leaders – Dr. Meena Seshamani – is optimistic about the future of the home health care industry. Seshamani is the deputy administrator at CMS and the director of the Center for Medicare.

Health Care Paradox: Medicare Penalizes Dozens of Hospitals It Also Gives Five Stars

Kaiser Health News

The penalties — a 1% reduction in Medicare payments over 12 months — are based on the experiences of Medicare patients discharged from the hospital between July 2018 and the end of 2019, before the pandemic began in earnest.

OIG dings Medicare Advantage plans for use of prior authorization

Fierce Healthcare

OIG dings Medicare Advantage plans for use of prior authorization. pminemyer. Thu, 04/28/2022 - 13:17

Medicare Sequestration’s Return Puts Home Health Agencies in Financial Jeopardy

Home Health Care

Home health agencies and other Medicare-reimbursed health care providers are just a couple weeks away from the return of sequestration. The post Medicare Sequestration’s Return Puts Home Health Agencies in Financial Jeopardy appeared first on Home Health Care News.

RAND: Private plans paid hospitals 224% more than Medicare rates

Fierce Healthcare

RAND: Private plans paid hospitals 224% more than Medicare rates. rking. Fri, 05/13/2022 - 15:26

Can better physician practices reduce Medicare spending?

Healthcare ECONOMIST

To measure how these capabilities impacted Medicare spending, the authors linked the NSHOS responses with 2017 Medicare beneficiary fee-for-service claims data based on physicians’ Taxpayer Identification Numbers (TIN). Economics - General Medicare Physician CompensationAccording to a paper by Rodriguez et al.

Congress passes on delay to Medicare rate cuts for lab tests, for now

Health Care Dive

The American Clinical Laboratory Association wants lawmakers to stave off Jan. 1 cuts for nearly 600 lab tests. A stopgap bill late last week did not include a reprieve, but Cowen analysts are optimistic a legislative fix will be found