Unbiased Analysis of Today's Healthcare Issues
About two-thirds of Medicare beneficiaires are enrolled in tradiational Medicare FFS, but the remaining thrid is now enrollingin Medicare Advantage plans. Which plans are dominant? The following figure from Avalere provides a breakdown. Note that this figure obscures significant regional variation in plan market share. For instance, Kaiser Permanente has almost half (48%) of the…
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 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…
In 2010, one quarter of Medicare beneficiaries chose capitated plans through the Medicare Advantage (MA) program. According to MedPAC, “[MA] coverage must include all Medicare Part A and Part B benefits except hospice. All plans, except PFFS [private fee-for-service] plans, must also offer an option that includes the Part D drug benefit.” How do private health plans set premiums…
From the Commonwealth Fund: “The analysis says people have many plans to choose from but that enrollment is concentrated in a handful. It notes, for example, that the average Medicare beneficiary in 2010 has 33 plans from which to choose. But in 14 states and the District of Columbia, a single company (not the same…