Reprinted with AIS Health permission from the Oct. 19 issue of Radar on Medicare Advantage Leading up to the Oct. 15 start of the Medicare Annual Election Period (AEP), news reports across the U.S. have depicted down-to-the-wire disputes between Medicare…

Introduction The recent publication of 2024 Medicare Advantage (MA) Star ratings confirmed that the regulatory and operating environment for this program will challenge health plans (especially compared to past years) as the Centers for Medicare and Medicaid Services (CMS) shifts…

Reprinted with AIS Health permission from the January 6, 2022, issue of RADAR on Medicare Advantage With continued emphasis on member experience, several new Part C measures and a directional shift to closing health care inequities, 2022 stands to be…

Reprinted with AIS Health permission from the January 6, 2022, issue of RADAR on Medicare Advantage For the Medicare Advantage industry, change wasn’t a major outcome of the Biden administration’s first year in office. But for 2022, MA organizations face…

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…

Reprinted with AIS Health permission from Oct. 21, 2021 issue of RADAR on Medicare Advantage. Thanks to numerous flexibilities granted to plan sponsors during the COVID-19 public health emergency, nearly 70% of Medicare Advantage Prescription Drug (MA-PD) plans earned an…

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…

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…

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…

YOUR PROVIDER DATA QUALITY PROBLEM MAY BE BIGGER THAN YOU THINK… AND IT COULD BE GETTING WORSE Under normal circumstances, inaccurate provider data presents significant operational and financial challenges for health plans. In 2020, these problems have been exacerbated across…