Posts Tagged ‘Medicare Advantage’

Infographic: Value-Based Models’ Impact on Humana’s Medicare Members

November 25th, 2015 by Melanie Matthews

Members treated under the care of providers in value-based reimbursement models with Humana experienced greater quality than those treated by providers in standard Medicare Advantage settings, according to a new infographic by Humana.

This infographic examines key performance indicators for these Medicare members, including inpatient admissions per thousand, emergency room visits per thousand, assessment rates for vulnerable populations, as well as the impact of these models on HEDIS measures, CMS Star Scores and healthcare costs.

Healthcare’s inevitable shift from volume to value-based reimbursement is reflected not only in Medicare’s alternative payment timeline but also in the waves of commercial payors now evaluating and rewarding providers on the basis of quality of care delivered rather than number of services provided. Adding to its roster of quality-centered payment models, CMS announced in 2015 plans to explore value-based reimbursement for Medicare Advantage and home health.

2015 Healthcare Benchmarks: Value-Based Reimbursement captures the healthcare industry’s reaction to payment formulas for value-added care, and how this shift away from fee-for-service is transforming care delivery and quality.

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Infographic: Medicare Advantage Patient Satisfaction, Quality of Care

February 27th, 2015 by Melanie Matthews

Medicare Advantage beneficiaries are overwhelmingly satisfied with the coverage the plans provide, according to a new AHIP infographic.

The infographic breaks down satisfaction scores by beneficiaries among six key measures and looks at the impact of Medicare Advantage plans on readmission rates and clinical quality measures.

Physician Reimbursement for Chronic Care Management: Identifying New Practice Revenue OpportunitiesStarting this year, Medicare is reimbursing physician practices for select Chronic Care Management (CCM) services not previously eligible for reimbursement, underscoring the vital role of care management in primary care.

Physician Reimbursement for Chronic Care Management: Identifying New Practice Revenue Opportunities offers practical guidance to prepare physician practices to maximize CCM reimbursement in the year ahead.

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Which CMS 5-Star Quality Domains Are Best Candidates for Improvement?

March 5th, 2014 by Jessica Fornarotto

CMS Five-Star Rating

With an additional star in CMS Five-Star Quality Ratings System worth about $50 per member per month (PMPM), according to L.E.K. Consulting (when moving from a three- to four-star Medicare Advantage plan), health plans are anxious to fine-tune operational processes and improve their rankings. Joseph Johnson, vice president of L.E.K. Consulting, shares which of CMS’ Five-Star Rating categories could be improved.

There is some data that indicates that certain CMS Five-Star Ratings domains or categories are better candidates for improvement than others. All Medicare Advantage (MA) plans score similarly to the top 10 MA contracts, and perform better on measures directly under their control — particularly member experiences with health plans, member complaints and appeals, and customer service.

Given the relative underperformance of measures in managing chronic conditions, we believe this is an area ripe for innovation and improvement from prioritization initiatives. CMS has recognized the opportunity to further improve the measures under ‘managing chronic conditions’ and has increased its emphasis by weighting these measures more heavily relative to other domain areas.

Now I’d like to discuss how to best identify CMS Five-Star Quality Rating improvement initiatives in a rigorous and systematic manner, by looking at sample data from the performance of an HMO MA product, with thresholds for the three-, four- and five-star scores. Within a given CMS Five-Star Quality Rating measure, individual members or provider segments are seen within a given MA contract.

When looking at which providers do well, which ones see a large base of membership, and also more importantly, the measures where skew may exist across the member-provider segments or cohorts, the end goal is to drive overall performance to the next threshold. Diabetes/cholesterol control and diabetes eye exams are seen as potential good member and provider cohorts to focus on for targeted improvement opportunities. This approach lays the foundation for how to prioritize targeted star improvement efforts.

Excerpted from: A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings, a 45-minute webinar

Pioneer ACO Repurposes Care Management for Accountable Care

February 4th, 2014 by Jessica Fornarotto

As a top performer in Year 1 of the CMS Pioneer ACO program, Monarch HealthCare is paving the way to accountable care with a foundation of patient- and provider-centered strategies that support Triple Aim goals, which is to improve quality, improve health outcomes and reduce cost. Here, Colin LeClair, executive director of ACO for Monarch HealthCare, recounts how Monarch recast its Medicare Advantage (MA) care management program to target about 1,200 high-risk patients who have a similar constellation of issues.

Monarch repurposed our Medicare Advantage (MA) care management program for the ACO. Monarch’s ACO care management team was designed to anticipate and prevent acute events and then to facilitate transitions of care for patients post-discharge.

This interdisciplinary team is comprised of a primary care physician who quarterbacks the team, and a care navigator, also known as a care coordinator, who performs most of the patient onboarding into the care management program and performs an initial triage of the patient’s needs. The care manager is often a non-complex patient’s primary point of contact. The complex care manager is responsible for most of the complex cases.

Then as needed, we also deploy a behavioral health clinician, a community services coordinator, a clinic dietician and a palliative care nurse. The other resources may include a pharmacist or Pharm D to perform post-discharge medication reconciliation. Then we have a team of medical directors, employed and contracted hospitalists, and employed and contracted skilled nursing facilitators (SNFs) to support us as well.

The idea is that the team is tailored for the patient’s need at enrollment, and it can then be augmented as the patient’s health status changes. This model scales best when you can target large patient populations with a fairly common list of conditions, which allows you to hire and assign clinicians with the appropriate expertise to each patient. For example, we can afford to hire and assign a registered nurse (RN) or a nurse practitioner (NP) who has experience in a dialysis clinic or a nephrologist office if we have enough renal disease patients to fill their case load.

Excerpted from: Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care

HINfographic: Secrets from a Medicare Advantage ‘Star Czar’

October 2nd, 2013 by Jackie Lyons

Kaiser Permanente is known as a ‘star czar’ in Medicare Advantage (MA) circles. Ninety percent of Americans in a five-star health plan belong to a Kaiser Permanente plan, according to a new infographic from the Healthcare Intelligence Network.

This infographic goes behind the CMS Star Quality Rating System for MA plans and shares key population health management strategies behind Kaiser Permanente’s high-tech, high touch five-star success.

Secrets from a Medicare Advantage 'Star Czar'

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Information presented in this infographic was excerpted from: Formula for CMS Five-Star Quality Population Health Management. If you would like to learn more about star quality improvement strategies, this resource includes even more information, including an in-depth case study in Kaiser Permanente’s total panel ownership approach, advice from L.E.K. Consulting on stratifying and prioritizing strategies to improve quality ratings, tactics to engage providers and members in improvement efforts, and insight into CMS’s future direction for this quality improvement effort.

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Infographic: Medicare Advantage Cuts — Higher Costs and Reduced Benefits

April 2nd, 2013 by Melanie Matthews

Medicare Advantage plan members will face higher premiums, reduced benefits, and loss of coverage options if new Medicare Advantage cuts proposed by the Centers for Medicare & Medicaid Services (CMS) take effect next year. CMS recently proposed a 2.3 percent reduction in Medicare Advantage payments for 2014 at a time when medical costs are projected to increase by three percent. The new proposed payment cuts are in addition to the Medicare Advantage cuts and the new health insurance tax included in the Affordable Care Act (ACA).

An AHIP infographic highlights the proposed changes and impact.

Medicare Advantage Cuts: Higher Costs and Reduced Benefits

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You may also be interested in this related resource: Healthcare Trends & Forecasts in 2013: Performance Expectations for the Healthcare Industry.

Infographic: Medicare Advantage Enrollment Growth

October 10th, 2012 by Melanie Matthews

Since 2005, the number of Medicare beneficiaries choosing Medicare Advantage has grown steadily, according to a new infographic by GoHealth, a health insurance technology platform.

The infographic highlights the number of Medicare beneficiaries enrolled in Medicare Advantage, along with average monthly premiums.

Medicare Advantage Enrollment Growth

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