October 27, 2022
© 2022 – Don Gerdts. All rights reserved.
The tech-enabled health plan that was a darling of Wall Street less than a year ago during its IPO is shedding all individual and family-based plans and focusing on Medicare Advantage business in California and Florida where it has an integrated model through its Neuehealth subsidiary:
CMS has created and maintains a new tool for mapping Medicare health disparities by population (MMD).
The MMD interactive tool contains health outcome measures for disease prevalence, costs, hospitalization for 60 specific chronic conditions, emergency department utilization, readmission rates, mortality, preventable hospitalizations, and preventive services.
The Families First Coronavirus Response Act specifies that Medicaid beneficiaries must re-determine their eligibility once the federal public health emergency is declared to have ended.
While all people who lose their Medicaid coverage qualify to enroll in the federal ACA marketplace for 2023 coverage, HHS estimates that five to ten million people will lose eligibility or choose to forego coverage.
CVS Health and Centene have reported projected 2024 earnings reductions of 5% due to year-over-year declines quality bonus payments from the Medicare Advantage Star Rating program. The declines were caused primarily by the expiry of the one-time changes to the rating system due to the COVID pandemic, which results in a sharp reduction in Centene and CVS members in plans with a 4+ Star-rating for 2023.
The downward shift in MA Star Ratings will present revenue headwinds and operational hurdles for Medicare Advantage health plans in 2024, as additional changes in the Medicare Advantage Star Ratings are implemented.
Alliance of Community Health Plans (ACHP) member companies offering Medicare Advantage plans score better than other MA plans in CMS Star Ratings, both on critical health measures and overall satisfaction. More than 33% of all beneficiaries nationwide in 5-Star plans are enrolled with an ACHP member plan while ACHP members represent approximately 10% of total Medicare Advantage enrollees. Why? When payers and providers work together, they’re able to focus on consumers’ needs—ensuring better health outcomes and an overall better care experience.
Social determinants of health can contribute to health disparities and inequities when there are challenges with regard to the accessibility and availability of nutritious food, safe housing, reliable transportation, and quality health care. AmeriHealth Caritas is referring to SDoH as the Social Determinants of Life® (SDOL) and developing an entire strategy around addressing SDOL. AmeriHealth Caritas are implementing their SDOL strategy through screening for key social determinants of health and be creating a new company focused on addressing those needs.
The 14 updates to HEDIS Quality Measures for MY 2023 include new measures that target access, prevention, utilization, and disease management. Other changes target improving health equity through screening, intervention, expanded race and ethnicity data segmentation, and more inclusive measure language. The 2023 update to the HEDIS Quality Measures also advances digital measure transformation.