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Byline: Caroline Hudson Insurers were furious about a recently proposed rate cut for Medicare Advantage, a reaction met with a collective eye roll from providers accustomed to slashed reimbursement rates. [...]

Byline: Nona Tepper Stricter rules governing Medicare Advantage marketing may offer smaller health insurance companies an opportunity to snatch market share from dominant players such as Humana and UnitedHealthcare. Large [...]

Byline: Diane Eastabrook Older adults shifting from fee-for-service Medicare to Medicare Advantage is costing the home health industry millions of dollars in revenue, prompting some providers to demand higher reimbursements [...]

Byline: Diane Eastabrook And Nona Tepper Medicare Advantage insurers are laying off thousands of workers and tinkering with benefits in response to unfavorable Centers for Medicare and Medicaid Services policies. [...]

The article explores the reasons why UnitedHealth Group, Humana and Centene have each sued the U.S. federal government over quality scores for the Medicare Advantage Star Ratings program for the 2025 plan year. Cited are their claim that the Centers for Medicare & Medicaid Services (CMS) have instituted changes that made high scores more difficult to achieve, the common theme shared by the lawsuits, and what insurers want to achieve in filing lawsuits.

The article presents an interview with Warner Thomas, chief executive officer (CEO) of Sutter Health. Among the issues he discussed include the ways on how providers can manage the growing Medicare and Medicare Advantage populations, how his company is expanding its outpatient network, and examples of the partnerships that he is developing with Medicare Advantage plans.

The articles explores the impact of the decision of more health care providers to opt out from contracts with Medicare Advantage (MA) plans. Cited are the decline in the earnings per member of insurance companies caused by the slowing down of the growth of MA enrollment, the strategies employed by insurers to improve their finances including cutting MA plans, and the increase in public contract disputes between insurers and providers involving MA plans.

The article features SCAN Group, a company based in Long Beach, California that includes SCAN Health plans, along with medical groups and a community service department aimed at serving seniors.

The article discusses the unexpected rise in costs and utilization of medicare Advantage plans. Topics include situations that make it challenging for the Medicare Advantage business, remarks from Matthew Fiedler, senior fellow at the Brookings Institution Center on Health Policy, about Medicare Advantage, and factors that could be driving utilization and cost trends in Medicare Advantage including regulatory changes, effects of COVID-19, and payer-provider relationships.

The article explores the policies that could be affected by the U.S. Sureme Court ruling in Loper Bright Enterprises v. Raimondo which weakened the executive branch's authority to interpret laws and enhanced the judiciary's power to resolve disputes about congressional intent. It includes the Medicare Advantage audits and the risk-adjustment program, the eligibility policy to critical access hospital program, and at-home care reimbursement and wages.

The article explains the potential effect of the midnight rule on Medicare Advantage finances. It cautions increased scrutiny of Medicare Advantage companies' coverage policies and decision-making tools and raises concerns about increase in utilization costs, or expenses associated with doctor's visits and increase in out-of-pocket costs. Data indicate higher billing for Medicate Advantage patients, increased inpatient revenue of hospital over outpatient revenue, and higher medication costs.

The article reports on the ideas being considered by the U.S. Centers for Medicare and Medicaid Services (CMS) on the use of Medicare to improve maternal health by adding baseline safety and quality standards for obstetrical services. Data shows the maternal care services covered by Medicare. It discusses maternal health issues that the CMS is trying to address including racial disparities, lack of access to quality maternal care, and gaps in maternal care quality and pay.

An interview with Dr. Harlan Levine, president of health innovation and policy at City of Hope and former chief medical officer at UnitedHealth Group's Optum, is presented. Dr. Levine discusses how the City of Hope is using the funding round for AccessHope, how the City of Hope is trying to meet the growing demand for cancer care, and policies that could improve access to cancer care for those with Medicare Advantage.

The article reports on a legal fight between four Pennsylvania health systems and Aetna which could upend how Medicare Advantage insurers manage costs for supplemental benefits. Topics discussed include a lawsuit filed by Bridges Health Partners against CVS Health subsidiary Aetna, costs assumed by Bridges Health Partners related to Aetna supplemental benefits in 2023, and higher medical costs faced by Medicare Advantage insurers.

The article announces the recognition earned by Arcadia Stepro chief product and technology officer Nick Stepro in the 2024 Innovators Awards program of "Modern Healthcare" journal.

The article reports on the changes in the Medicare Advantage Star Ratings program of the U.S. Centers for Medicare and Medicaid Services (CMS). Topics discussed include the reward to be given to health insurance companies that focus on addressing health disparities, the termination of the bonus policy which concerns insurers that maintained high overall quality ratings, and the possible response of insurers to the changes according to Jeff Schoenborn of Baltimore Health Analytics.

The article reports on the declining participation of health insurers in the Accountable Care Organization (ACO) Realizing Equity, Access and Community Health (REACH) pilot program of the U.S. Centers for Medicare & Medicaid Services (CMS). Topics discussed include the withdrawal of Cityblock Health and Clover Health from the program, the concerns raised by health insurers over medical cost inflation and the provider-focused design of ACO REACH, and the outlook offered by the CMS for ACO REACH.

The article announces the recognition earned by Camille Harrison, executive vice president of Medicare and chief innovation and experience officer at Florida Blue and GuideWell, in the 2024 Innovators Awards program of "Modern Healthcare" journal.

The article reports on the reaction of insurers to a proposed rate cut for Medicare Advantage in the U.S. Topics discussed include the growth in enrollment for the 2024 plan year by the Centers for Medicare and Medicaid Services (CMS), rate cut faced by physicians under the 2024 Medicare fee schedule, and the move by the CMS to control Medicare Advantage spending.

The article features Karen Schulte, president of Medicare Division at SCAN Group who has led SCAN Health Plan's expansion into Arizona, Nevada, New Mexico and Texas.

Byline: Michael Brady During his confirmation hearings, Becerra hit on a number of issues that could impact insurers, providers and drugmakers: 1. Medicare Advantage Becerra expressed support for Medicare Advantage, [...]

Byline: Shelby LIvingston Monthly premiums for Medicare Advantage plans are expected to decrease again in 2021, with average premiums estimated to fall about 11% to $21 from $23.63 this year. [...]

Byline: Tara Bannow Hackensack Meridian Health is launching a Medicare Advantage plan with Horizon Blue Cross and Blue Shield of New Jersey. The partners hope to get RWJBarnabas Health on [...]

Byline: Tara Bannow In its third investigation into how much private insurers pay for inpatient and outpatient hospital services, not-for-profit think tank RAND Corp. found hospitals were paid on average [...]

Byline: Tara Bannow Starting this week, CMS is requiring hospitals to have positive COVID-19 laboratory tests in patients' records to qualify for Medicare's 20% add-on payment. The new rule, which [...]

Byline: Rachel Cohrs Two months after Congress created a $100 billion fund to aid providers struggling due to the COVID-19 pandemic, some organizations serving women, children and vulnerable populations still [...]

Byline: Michael Brady CMS May 22 made it easier for Medicare Advantage plans to meet network adequacy standards. The agency finalized a rule allowing Advantage plans to contract with telehealth [...]

CARES Act provider relief grants Available to any healthcare provider that treated any patient after Jan. 31, 2020, and billed Medicare fee-for-service in 2019, or qualified for targeted funding allocations. [...]

Byline: Shelby Livingston Earnings for health insurers for the first three months of 2020. Percentage changes are relative to the same period in 2019. Anthem; Indianapolis THE NUMBERS $29.6 billion [...]

Byline: Michael Brady CMS last week finalized a wide range of temporary Medicare and Medicaid changes in response to the COVID-10 pandemic, including some big wins for accountable care organizations. [...]

Byline: Maria Castellucci The CMS issued guidance last week allowing independently owned free-standing emergency departments to temporarily participate in Medicare and Medicaid. The guidance is a way to expand capacity [...]

-- Hospitals Without Walls: The CMS initiative allows hospitals to triage patients by sending them to an appropriate care site based on patient acuity. Ambulatory surgery centers and other facilities [...]

Byline: Maria Castellucci Dr. Craig Burrows, a rural provider for 17-bed Mammoth Hospital, has to make a decision: Should Mammoth participate in a downside-risk track in the Medicare Shared Savings [...]

Byline: Rachel Cohrs and Michael Brady Here's a rundown of actions Congress and the Trump administration took last week to aid the healthcare industry. President Donald Trump signed a second [...]

Byline: Harris Meyer Medicare's decision to reimburse ambulatory surgery centers for certain cardiovascular procedures has invited a flurry of deals and partnerships. To take advantage of Medicare's new payment rule, [...]

Byline: Michael Brady Congress created the Center for Medicare & Medicaid Innovation under the Affordable Care Act to design, test and expand new payment and care delivery models that cut [...]

Byline: Rachel Cohrs President Donald Trump on March 13 urged hospitals to activate their emergency preparedness plans and declared the COVID-19 outbreak a national emergency, allowing HHS to give providers [...]

Byline: Rachel Cohrs The bid for the Democratic presidential nomination is essentially a two-man race--former Vice President Joe Biden and Sen. Bernie Sanders (I-Vt.). While Rep. Tulsi Gabbard (D-Hawaii) hasn't [...]

Byline: Michael Brady While specialists have argued that they don't have enough opportunities to participate in value-based payment models, new federal research suggests that isn't the case. Specialists have significant [...]

Byline: Michael Brady In many ways, the problems of complexity that plague the Medicare program reflect the disjointed nature of the U.S. healthcare system. There are steps that policymakers could [...]