Unbiased Analysis of Today's Healthcare Issues
A KFF article provides some highlights of changes to Medicare Advantage for 2015: Near universal access to an MA plan. 99% of Medicare beneficiaries will have access to a Medicare Advantage plan as an alternative to traditional Medicare in 2015. The only individuals without access to an MA plan are concentrated in a few rural areas. Lots of…
Austin Frakt says although Medicare Advantage plans used to be considered high cost, low-quality options, in recent years, these Medicare Advantage plans have vastly increased quality of care and have become less focused on cream-skimming healthier patients. Medicare Advantage plans — private plans that serve as alternatives to the traditional, public program for those…
In 1995, Newt Gingrich claimed that Medicare would end. He stated that “going to wither on the vine because we think people are voluntarily going to leave it — voluntarily.” Was he right? In the one hand, Medicare total enrollment and spending is rising and the program still has widespread political support. On the other…
Medicare beneficiaries have the option to enroll in private plans to have them operate their benefits rather than use the tradiational Medicare Fee-for-services (FFS) program. Medicare pays these private plans, known as Medicare Advantage (MA) plans, premiums based on the health status of their enrollees. Medicare uses a risk score to measure beneficiary health status.…
How does Medicare measure patient case mix? For the most part, Medicare uses the Hierarchical Condition Category (HCC) model. A recent CMS presentation describes the HCC model in more detail. Today I review where CMS applies the HCC model, provide an overview of the HCC methodology, briefly describe its performance, and give some background on…
Medicare is a government-run insurance program. Can policy changes be made to add competition to Medicare, maintain quality and reduce cost? A book titled Bring Market Prices to Medicare argues that it can through a competitive bidding process. This book makes a number of sensible arguments which I review today. The main proposal of the…
In short, yes. California is the land of managed care. Kaiser-Permanente–the managed care poster child–owns one third of the market. Love for managed care is not just in the private market; in 2010, over half of all Medi-Cal and more than one-third of Medicare beneficiaries were enrolled in managed care plans. Further, California managed care…
Medicare beneficiaries have a choice: pick the standard Medicare fee-for-service (FFS) benefit or rely on managed care plans to supply their healthcare through the Medicare Advantage (MA) program. Many Medicare beneficiaries prefer MA because it offers them lower out-of-pocket costs and provide benefits not available in the traditional FFS Medicare program. Other beneficiaries prefer the…
Do you support Accountable Care Organizations? Many policymakers think they are a great idea. Why? If ACOs better integrate care coordination between a variety of physician specialists and other providers, ACOs can increase the efficiency of the health care system. Improving quality and reducing cost sounds like a great idea. To implement these integrated care settings in…
The CMS-HCC risk adjustment model is used to adjust payments for Part C benefits offered by MA plans and Program of All-Inclusive Care for the Elderly (PACE) organizations to aged/disabled beneficiaries. The CMS-HCC model includes both diseases and demographic factors. There are separate sets of coefficients for beneficiaries in the community, beneficiaries in long term care…