Provider/Plan Contracting

The healthcare giant cut its guidance for 2024 yet again

The Final Rule gives CMS additional grounds on which to deny PACE organizations’ initial and service area expansion applications, imposes immunization requirements on staff who have direct contact with PACE participants, establishes deadlines for reviewing recommendations and scheduling services for PACE participants, and alters the grievance resolution process.

It is CVS Health's only ACO REACH partnership in the state, helping advance health equity issues and address social determinants of health

Collaboration across CMS centers and with ACO participants is key.

Few surprises or material changes from the advanced notice. Plans may see wildly different impacts based on their population and programs.

This new guidance has implications for Medicare Advantage stakeholders as a whole and for MAOs that seek to participate in the VBID program in the future.

Health plans and providers alike are disgruntled with a new report to Congress released by the Medicare Payment Advisory Commission (MedPAC).

A provision in the Inflation Reduction Act will implement a $2000 out-of-pocket cap on Medicare beneficiaries’ prescription drug spending, which could save money for more than one million enrollees when it takes effect next year.

Though a spike in utilization among seniors slammed payers last year, particularly in the fourth quarter, each of the six major national firms turned a profit in 2023.

The rule implements changes to the Medicare Advantage RADV program, which CMS uses to recover improper risk adjustment payments made to Medicare Advantage plans.

Payers up against slight decline in 2025 Medicare Advantage payments

Humana's stock dipped following the earnings report, prompting the organization to cut its earnings guidance for this year and next.

Shares of US managed care carriers generally underperformed other types of insurers and the wider market in 2023

If finalized, these proposals will generally take effect on January 1, 2025, unless otherwise noted.

Changes would increase incentives to engage the American Indian and Alaska Native population, whose communities have been underserved.

Physician pay in final rule is untenable, providers say, as they laud the delay of MIPS policy and extension of telehealth flexibilities.

Prosecutors said that, in order to carry out their scheme, Valle and unnamed co-conspirators obtained physicians' login credentials to add fake diagnoses to patients' electronic medical records.

The Global and Professional Direct Contracting Model is now ACO REACH.

Specifically, across EPHRB, SSBCI and VBID authorities in 2024, 867 plans will offer in-home support services (IHSS) as a supplemental benefit, according to ATI. This is a decrease from the 1,308 plans offering this benefit in 2023.

The impact on individual palliative care providers will largely be determined by the terms of their current agreements with MA plans and how they apportion risk between the payer and provider entities.