Blog Post | May 2, 2018

The Pulse: Industry News & Knowledge

The Pulse: Industry News & Knowledge

Data vulnerabilities, federal exchanges and value-based care programs are in the news this month. Read how Medicare Advantage plans have been cleared to go beyond medical coverage.

This blog takes a birds-eye view of the most relevant industry news, opinion and research to help you keep up to date with the latest coverage related to regulatory/government, ACOs/accountable care and Medicare Advantage (MA). Links and URLs are provided below. In some cases, you may be directed to a log-in page or asked to register to access the article.

Regulatory and Government

GAO Finds Several Medicare Beneficiary Data Vulnerabilities
April 9, 2018 – CMS may have significant Medicare beneficiary data vulnerabilities because of security standards gaps within organizations that review and audit Medicare performance, a new GAO report found. Continue reading.


CMS wants to ‘wind down’ federal exchanges by 2020
April 5, 2018 — CMS outlined its strategy to cut federal exchange funding by $400 million, but first, it needs Congress to pass an ACA repeal. Continue reading.


11.8M Members Bought Health Plans Via Affordable Care Act Exchanges
April 4, 2018 — CMS found that a total of 11.8 million beneficiaries enrolled or re-enrolled in health plans through Affordable Care Act exchanges. Continue reading.

ACOS & Accountable Care

Analysis: MSSP ACOs Have Performed Below CBO Estimates

April 3, 2018 — ACOs participating in the federal Medicare Shared Savings Program (MSSP) have performed considerably below the financial estimates from the Congressional Budget Office (CBO) made in 2010 when the MSSP was enacted as part of the Affordable Care Act (ACA). Continue reading.


Study: UnitedHealthcare Report Details Value-Based Care Successes

March 12, 2018 — Accountable care organizations (ACOs) serving employer-sponsored plan participants perform better than non-ACOs on 87 percent of quality metrics that were tracked in UnitedHealthcare’s second annual value-based care report. Continue reading.

Medicare Advantage

Medicare Advantage Plans Cleared to Go Beyond Medical Coverage — Even Groceries

April 3, 2018 — Air conditioners for people with asthma, healthy groceries, rides to medical appointments and home-delivered meals may be among the new benefits added to Medicare Advantage coverage when new federal rules take effect next year. Continue reading.


U.S. Government Sets 3.40 Percent Hike in 2019 Payments to Medicare Insurers

April 2, 2018 — The U.S. government on Monday said it would increase by 3.40 percent on average 2019 payments to the health insurers that manage Medicare Advantage insurance plans for more than 20 million people aged 65 and older or who are disabled. The rate, which affects how much insurers charge for monthly healthcare premiums, plan benefits and, ultimately, how much they profit, represents an increase over the 1.84 percent increase proposed by the Centers for Medicare & Medicaid Services (CMS) in February. Continue reading.

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