Kristin Begley

Going into 2025, CMS’ proposed changes to Medicare Advantage and Part D could reshape the industry. From GLP-1 coverage to stricter prior authorization rules, here are 10 must-know updates: https://hubs.li/Q0315LWL0

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A Don’t Miss Reveleer Webinar: Patient-centered Prospective Risk Adjustment Join CareOne Consulting's Donna Page and Reveleer's Roxanna Cross & Anthony Polizzi as they share their unique perspectives on the benefits – and challenges – of implementing a more holistic, patient-centric view to risk adjustment. Gain valuable insights into: • How a more holistic approach can improve care delivery and outcomes • Importance of clinical documentation • Value of securing data outside a patient's EMR • The role of HIEs • Challenges that will need to be overcome • Best practices to integrate holistic patient data into risk adjustment models When Date: August 21, 2024 Time: 10:30 a.m. PST / 1:30 p.m. EST Learn more and register here: https://bit.ly/3WQv5d4 #RiskManagement #QualityImprovement #ValueBasedCare #Integration #RISEwebinars #Reveleer

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The era of splashing the market with flashy supplemental benefits is in the rearview as CMS, MA plans, and downstream risk-bearing providers are collectively challenged to "do more with less."   CMS' heightened data collection requirements will slowly but surely drive an emphasis on cost-saving, impact-driving supplemental benefits rather than those that simply attract members.   This shift could serve risk-bearing providers well, as overly generous and unmanageable supplemental benefit allowances have often driven MLR headwinds in recent years.

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New year, new model! CMS has announced updates to the 2024 Medicare Advantage risk adjustment model, including more Hierarchical Condition Categories (HCCs) than the previous system. Read our latest blog to learn more about the new updates: https://hubs.li/Q02wgNS10 #riskadjustment #medicareadvantage #medicare #hcc #cms

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New CMS report: The Medicare Shared Savings Program (MSSP) continues to demonstrate its effectiveness in delivering high-quality care while generating significant cost savings. Key highlights from the report: - MSSP generated $1.8B in savings for Medicare in 2022 - 483 ACOs participated, serving 11 million Medicare beneficiaries - 99% of ACOs successfully reported quality measures - 54% of ACOs earned shared savings payments These outcomes reinforce that VBC can drive care quality while improving financial outcomes for the ACOs who participate. Check it out here: https://lnkd.in/dJDNU6-c #Valuebasedcare #healthcareinnovation #ACOs #Medicare

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The growth of the health insurance marketplace is picking up steam, fuelled by Medicaid disenrollment. https://ow.ly/N1vW50Tafsq MMIT’s Erin Trompeter explains what these large-scale changes mean for providers, manufacturers, payers and health IT vendors. Get the insights by clicking the link in this post. #HealthInsuranceMarketplace #HealthInsurance #Medicaid

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Medicare Advantage plans require an increased commitment to improving risk adjustment coding practices while optimizing medical record retrieval and interoperability. But health plans don’t have to handle these challenges alone! Watch our on-demand RISE webinar, where Cotiviti’s risk adjustment experts unravel trends shaping 2024 and beyond. https://bit.ly/49HsK7m #RiskAdjustment #HealthPlans

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CMS will sunset the Medicare Advantage (MA) Value-Based Insurance Design model at the end of 2025 because of cost. https://lnkd.in/gJ3wQeiQ

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CMS’s 2025 Medicare Advantage star ratings are down—only 62% of enrollees are in 4-star+ plans vs. 90% in 2022. Are plans getting worse—or is CMS stricter? Joe Albanese explains the new CMS rules and their impact in this week's #ParagonPIC. READ: https://t.co/1c6vwrlEiB MA star ratings peaked in 2022 but have fallen since. #MedicareAdvantage’s average star rating fell to 3.92 for 2025, with just 7 plans earning 5 stars. Avoiding "grade inflation" for stars may be one goal, but the ratings have other well-known flaws. Plans want to get more stars and earn bonuses, but this encourages a focus on government metrics rather than accountability to enrollees. And the cost of bonuses has risen over the past decade. #MedicareAdvantage #StarRatings Technical changes to CMS calculations are likely a bigger factor in declining stars than worsening plan quality. But fixes to the star ratings and quality bonuses are needed.

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With over 2 million members displaced by major healthcare players exiting underperforming Medicare Advantage markets, regional insurers face both a challenge and an opportunity. This influx of high-cost members demands innovative solutions to manage chronic conditions like diabetes and heart failure effectively. At Circadian Health, we’re helping regional insurers navigate this disruption with virtual-first specialty care, reducing costs and improving outcomes for the most complex members. This market shake-up isn’t just a challenge—it’s a chance to redefine care delivery. Discover how regional insurers can transform disruption into opportunity—read more on our blog. #MedicareAdvantage #HealthcareInnovation #VirtualCare #CircadianHealth #ValueBasedCare #HealthEquity

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📌 The Battle For Medicare Advantage Star Ratings: SCAN and Elevance Victories Provide a Roadmap for Plans to Challenge CMS Methodologies 📌 ❇ In the world of Medicare Advantage, the calculation of Star Ratings is more than a measure of quality – it’s a pivotal marker that can significantly sway federal funding and market competitiveness. ✳ Against the backdrop of high financial stakes and rigorous scrutiny, recent legal victories for SCAN Health Plan and Elevance Health have charted a path in challenging Star Ratings methodology. ▶ Read more from Charles Baker, MHA, MSW about how these cases underscore the impact that Star Ratings have on the financial and operational aspects of Medicare Advantage plans. https://rb.gy/5zc924

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Despite recent challenges, Medicare Advantage, or MA, now accounts for more than half of all Medicare beneficiaries—a patient population that every healthcare organization must engage. In a new article Joyjit Saha Choudhury, John Poziemski and Webster Macomber explore possible scenarios for the future of MA—and the potential impact on providers and payers—amid rising uncertainty. #payerproviders #medicare #healthcaremanagement https://lnkd.in/gB_GTZU4

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Insurance Discovery finds active primary, secondary, and tertiary patient coverage – as well as their Medicare Beneficiary Identifier (MBI) and demographic details – all in one quick inquiry. Get enhanced clarity on patient coverage, increased efficiency and accuracy in patient access, and improved back-end revenue cycle management (RCM) results, made possible by front-end success. Explore Insurance Discovery: https://ow.ly/OS9Y50RlHv7 #HealthcareSoftware #PatientAccess #InsuranceDiscovery #FrontEndRCM

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