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Article | August 2022

ACO REACH Model Program Updates – ‘Do Nothing’ is Not a Strategy

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The Centers for Medicare and Medicaid Services (CMS) Innovation Center recently introduced the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model as a redesign of the Global Professional Direct Contracting Model (GPDC). The move represents the…

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Executive Briefing | May 6, 2022

2022 Medicare Advantage Dental Benefits in Review

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Medicare Advantage (MA)—the alternative to traditional Medicare which allows seniors to receive Part A and B benefits through private insurance—continues to rise in popularity. As of April 2022, almost half (46%)¹ of all Medicare beneficiaries are enrolled in an MA plan.…

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Article | March 7, 2022

ACO REACH Model: Implications for Providers and Plans

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The Centers for Medicare and Medicaid Services (CMS) Innovation Center recently provided long- awaited clarification on the status of the Direct Contracting program. CMS has formally canceled the Geographic Direct Contracting Model (Geo) and is phasing out the Global and…

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Executive Briefing | January 13, 2022

Health Plan Success Drivers in 2022 (A Renewed Focus on Performance and Execution)

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Every January, we provide our perspective on areas of increasing importance and value for health plans for the upcoming year. Our prospective view of 2021 focused on the need for health plans to strike a balance between innovation and investment…

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Article | December 16, 2021

Rewards and Incentives Rule Has Compliance, Stars Implications

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Reprinted with AIS Health permission from the December 16, 2021, issue of RADAR on Medicare Advantage Although it may have gone largely unnoticed by Medicare Advantage plans this year, a clarification regarding rewards and incentives (R&I) programs embedded in an…

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Article | October 8, 2021

Will New Release of 4+ Star Plans Hasten the Depletion of the Medicare Hospital Insurance Trust Fund? Key Takeaways & Implications for Plans Coming Out of Recently Published 2022 Star Ratings

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Star Year 2022 Ratings have officially posted, allowing Medicare Advantage beneficiaries to compare plan options based on quality. This year, more beneficiaries will select from above-average plans, with 68% of MA-PDs (322 contracts) earning 4 stars or higher for Star…

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Article | September 16, 2021

With More Online Enrollment, MAOs Must Add ‘Personal Touch’

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Reprinted with AIS Health permission from the Sept. 16, 2021, issue of RADAR on Medicare Advantage. As Medicare Advantage organizations prepare to promote their plans for the 2022 Medicare Annual Election Period (AEP), marketing experts say they see a continued…

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Article | September 8, 2021

Star Year 2022 Second Plan Preview: Everything You Need to Know

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Several changes have been made between the 2021 Star Ratings and the 2022 Star Ratings; below is a summary of key measure and methodological changes, as well as the impact they may have on your plan. Key Changes for Star…

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Article | August 6, 2021

What You Need to Know About CMS’​ Recent Flurry of MA Star Ratings Reports, Data and Notifications

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Yesterday evening CMS released a number of key documents for Star Year 2022 and 2023 including a last-minute announcement that the two, triple weighted HOS outcomes measures will be moved to the display page effective Star Year 2022 and 2023…

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Executive Briefing | February 9, 2021

Racial Disparities in Healthcare: A Call to Action

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Reflecting on the significant events of 2020, most notably, heightened racial unrest and the unequal impact of COVID-19, we have a unique and time-sensitive opportunity to address the reality that racial disparities exist in our country. Racial disparities permeate across…

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