Every year the Centers for Medicare & Medicaid Services (CMS) releases the Star Ratings for Medicare Advantage plans. The Medicare Star Rating System was developed to help Medicare consumers compare Medicare Advantage plans based on quality and performance. Star ratings are determined from a set of quality performance ratings developed by the National Committee for...
As of May 2022, nearly 89,000,000 people were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), according to government data. To effectively manage care for these populations, payers and providers must do the following: Streamline delivery of preventive, holistic care Broaden access to resources for enrollees Boost patient/member engagement Improve coordination of care...
Over the past few decades, health programs such as Medicare and Medicaid have increasingly turned their attention to solving the social and economic inequalities that contribute to health disparities. As they continue to strategize on the best ways to address health disparities, many plans and states are gradually shifting to managed care models in response....
Improving health outcomes and reducing costs of care for Medicare populations may seem like an overwhelming challenge with chronic conditions costing billions each year. After all, these populations are typically older, and with age comes the onset of some of the most common (and expensive to manage) chronic conditions, such as cardiovascular disease, heart failure, hypertension,...
Improve Health Outcomes, Drive Member Engagement, and Reduce Costs Complex and chronic conditions are commonplace among Medicare populations, and one of the most expensive drivers of healthcare spending. In 2017, an estimated 66 percent of all non-dual-eligible Medicare beneficiaries were living with two or more chronic conditions. In 2020, data from the Chronic Conditions Data...
Medicare Advantage (MA) plans have fully embraced whole-person, integrated care and are designed to provide members with much more than traditional clinical healthcare. Many provide additional value-added benefits and services such as dental, vision and hearing coverage, wellness rewards, and transportation to medical appointments. From traditional Medicare Advantage plans to Medicare Advantage plans with prescription...
Track 1: Building the Infrastructure for Better Value-Based Primary Care CMS recently announced its new Making Care Primary (MCP) model, a voluntary initiative set to launch in July 2024 among selected participants in eight states. As of September 2023: “CMS is working with State Medicaid Agencies in eight states – Colorado, North Carolina, New Jersey,...
For healthcare organizations, CMS-0057-F outlines the modern healthcare system and offers opportunities to improve care and utilization management In the last couple of years, the Centers for Medicare & Medicaid Services (CMS) have been making strides to increase health data exchange, as well as improve and expand access to care. On January 17, CMS finalized...
