PREMIUM CONTENT Building home care capacity will give plans more flexibility to meet patients on their own terms and could improve outcomes. Learn what is changing models of care in the home.
PREMIUM CONTENT States are developing plans to increase Medicaid provider participation in and adoption of value-based care models. How will these new payment models work?
PREMIUM CONTENT Medicare Advantage Plans are expanding supplemental benefits in 2021. Learn what services are expanding and how this expands your partnerships.
PREMIUM CONTENT States are expanding value-based payments (VBP) in Medicaid and leveraging their Medicaid managed care programs to advance their payment reform goals. We discuss the details.
PREMIUM CONTENT CMS' innovation center (CMMI) is about to roll out a new model allowing insurance plans to take on financial risk for patients enrolled in both Medicare and Medicaid. How will this affect payers? What other new models can you expect in the future?
PREMIUM CONTENT Insurers' strategies to provide greater services in the home are moving rapidly. Changing models have insurers partnering-up with primary care physicians, telehealth, and pharmacies to deliver care in the home. We provide insights to insurers' reactions post COVID-19 and beyond.
PREMIUM CONTENT Payers are interested in talking about the data. In particular, they are interested in understanding how home care providers are able to reduce their penalties and increase their rewards in a value-based payment system. Learn how one organization is advancing conversations.
Strategy Insight: How To Align Financial and Clinical Incentives with Payers and the Most Costliest Medical Conditions
In this article, we take a look at data reflecting the costliest medical conditions by payers. This becomes an important strategy as payers begin to move more value-based care contracting into the home care space and look to treating higher acuity patients in the home.
PREMIUM CONTENT CMS has provided blanket waivers with a retroactive effective date of March 1, 2020 through the end of the emergency declaration to help providers during COVID-19. We gathered the waivers for discharge planning, in-home care providers, and other post-acute care settings.
PREMIUM CONTENT Amid COVID-19 pandemic, 91% of Medicare Advantage beneficiaries using telehealth report favorable experiences while a record-setting 99% express satisfaction with their MA plan. 78% are willing to use it again.
In 2020, Medicare Advantage (MA) plans have doubled the number of condition-specific supplemental benefits from approximately 820 to 1,850. However, the new Special Supplemental Benefits for the Chronically Ill (SBBCI) for 2020 didn’t fare as well.
In its March 2020 report to the Congress, MedPAC makes payment policy recommendations for provider sectors in fee-for-service (FFS).
The Bipartisan Act (BBA) of 2018 Act updated the hospital transfer policy for early discharges to hospice care. The law required that, beginning in FY 2019, discharges to hospice care would qualify as a post-acute care transfer and be subject to payment adjustments.
Aggressive moves by payers teaming up with big players such as CVS are advancing their healthcare programs into the home. How does this impact healthcare organizations?
Landmark estimates about 20 percent of chronically ill patients currently experience a gap in the care they are receiving, which can be addressed through medical care, support and education provided in the home.
The Center for Medicare and Medicaid Innovation’s Emergency Triage, Treat, and Transport (ET3) Model is designed to test expanded care destination alternatives to the ED for Medicare beneficiaries who call 911.
How can providers offer support for caregivers? A key way for providers to assist may be to collaborate with charitable organizations in the community.
Medicare Advantage and Part D programs for contract years 2021 and 2022 has provisions changing care management requirements for special needs plans.
In a proposed rule issued on February 5, CMS announced that beneficiaries with ESRD will be able to enroll in Medicare Advantage Plans starting in 2021.
CMS issued a proposed rule and the Advance Notice Part II to further strengthen and modernize the Medicare Advantage and Part D prescription drug programs.
2020 Senior Living Communities Are Aligning with Medicare Advantage Plans to Address High-Cost, High-Need Patients
An integrated program of services can contribute to reducing the cost of care and services to Medicare beneficiaries residing in seniors housing.
The tides are shifting the expectations of home care. Pressure from reimbursement, shifting payment models, and value-based care are driving the change.
Starting November 1, UnitedHealthcare will not pay for unplanned surgeries in an outpatient setting unless it determines the site is medically necessary.
Private Medicare plans will soon include expanded plan options for seniors, more telehealth, and innovative plan designs and payment models.
Medicare Advantage (MA) Plans are adding two new dementia codes in their risk adjustment payment system and expanding flexibility in the MA benefit design.
A unified value-based incentive program for SNFs, home health services, inpatient rehabilitation facilities, and long-term care hospitals is recommended.
A GAO report explored the efforts to manage high-expenditure beneficiaries, which are 5% of all Medicaid beneficiaries but nearly half of all expenditures.
Payers and providers are redefining and rethinking how new models of care can move the needle toward value-based care.
Managed Care Organization and Visiting Nurse Association’s Elderly Heart Failure Program – A Pilot Study
PREMIUM CONTENT Kaiser Permanente Colorado and VNA-Denver jointly offer intense, consistent education to elderly heart failure patients discharged from the hospital.
PREMIUM CONTENT Fragmentation of the care delivery system is widely recognized as a cause of missed opportunities to treat both acute and chronic conditions.
People who are continuously enrolled in Medicare Advantage are less likely to die in a hospital than those continuously enrolled in Medicare fee-for-service.
PREMIUM CONTENT A recent filing by Humana indicates the insurer is instituting a new bonus plan that is not just tied to financial performance, but also to health outcomes.
CMS recently proposed a new payment model that would bundle payment to acute care hospitals for heart attack and cardiac bypass surgery services.
Payers and Alternative Payment Models (APMs) are turning to palliative care programs as a way to offer value-based end-of-life care.
Medicaid’s reform will lead to greater care coordination, a focus on reducing costs and more possibilities of risk and preferred provider networks.
PREMIUM CONTENT Aetna’s Compassionate Care Program is designed to improve the quality of patient care for individuals with life-threatening illnesses.
Early evidence suggests that, under episode-based incentives, clinicians and organizations can improve the value of care for certain episodes.
Greater use of Medicare Advantage over traditional fee-for-service Medicare has been associated with fewer overall hospitalizations.
Telehealth policy develops much more slowly than the rapidly advancing technology, but incremental changes are taking place.
In 2014, 14% of inpatient stays were readmitted within 30 days. More than one-third of these readmissions occurred within seven days.
This issue of FutureFocus highlights the innovation of an in-home, physician-led model working collaboratively with a payer to manage complex care.