Healthcare Dive

FEBRUARY 20, 2024

The big question coming out of the health insurance earnings season is how much elevated utilization among seniors will carry over into 2024.

Medicare 317

Medicare Medicare Health Insurance 317

Healthcare Dive

JANUARY 30, 2024

However, growth in Medicare's flagship shared savings model has plateaued over the past five years, according to government data.

Medicare 189

Medicare Medicare Governance 189

Healthcare Dive

JANUARY 8, 2024

The payer is taking issue with how regulators calculated quality scores for 2024, after seeing a stars decline that could cause its bonus revenue to fall by $500 million.

Medicare 299

Medicare Medicare 299

Healthcare Dive

OCTOBER 30, 2024

Despite the stronger membership, Humana doesn’t expect earnings growth next year due to significant investments the insurer plans to make to boost MA stars.

Medicare 264

Medicare Medicare 264

Healthcare Dive

JUNE 14, 2024

The redo comes after regulators lost two court cases over the methodology used to determine 2024’s quality ratings, and should result in hundreds of millions of dollars in additional bonuses to plans that see their ratings improve.

Medicare 278

Medicare Medicare 278

Healthcare Dive

NOVEMBER 2, 2022

Beginning in January 2024, ACOs that don’t have experience with performance-based risk will be able to stay in a one-sided risk arrangement for up to seven years before transitioning to two-sided risk.

Medicare 299

Medicare Medicare 299

Healthcare Dive

DECEMBER 22, 2023

A shift in funding sources, new regulatory policies in Medicare and technology advances may influence M&A in the sector next year, according to Samantha Prokop from law firm Gunster, Yoakley & Stewart.

Medicare 274

Medicare Medicare 274

Fierce Healthcare

OCTOBER 13, 2023

Approximately 42% of Medicare Advantage plans that offer prescription drug coverage will have a star rating of four or more in 2024, marking yet another substantial decrease from

Medicare 126

Medicare Medicare 126

Healthcare Dive

MARCH 16, 2023

Updating base physician payment rates by 1.45% in 2024 as proposed by the group that advises Congress on Medicare policy is “grossly insufficient,” the Medical Group Management Association said in a statement.

Medicare 306

Medicare Medicare 306

Fierce Healthcare

SEPTEMBER 26, 2023

Expect premiums, benefits and plan choices for Medicare Advantage (MA) and the Medicare Part D prescription drug program to look similar in 2024, the Centers for Medicare & Medicaid Services (C | CMS announced that nearly three-quarters of MA plan beneficiaries will not see their premiums rise.

Medicare 119

Medicare Medicare Medicaid Medicaid 119

Fierce Healthcare

MARCH 31, 2023

CMS to raise Medicare Advantage pay rates by 3.3% in 2024; phase in risk adjustment changes rking Fri, 03/31/2023 - 16:02

Medicare 135

Medicare Medicare 135

Fierce Healthcare

AUGUST 13, 2024

Fifty-four percent of Medicare beneficiaries are enrolled in a private Medicare Advantage plan, and in seven states that figure tops 60%, according to a new report from KFF.

Medicare 131

Medicare Medicare 131

HealthIT Answers

AUGUST 29, 2023

By Chris Emper - On July 13, the Centers for Medicare & Medicaid Services released a 1,920-page proposed rule that would update payment policies and programs regarding Medicare payments to physicians and other providers under the Physician Fee Schedule on or after January 1, 2024.

Medicare 111

Medicare Medicare Medicaid Medicaid 111

Fierce Healthcare

MARCH 4, 2024

Medicare Advantage (MA) growth has broadly slowed, but the biggest players in this space continue to claim the lion's share of this expansion, according to a new report from healthcare consultant C | Medicare Advantage growth has broadly slowed, but the biggest players in this space continue to claim the lion's share of this expansion, according (..)

Medicare 122

Medicare Medicare 122

Fierce Healthcare

JUNE 17, 2024

LAS VEGAS—The eyes of many regulators and lawmakers are on Medicare Advantage (MA), and, amid rising criticism of the program, one industry leader is making the case that "nostalgia" for traditiona | LAS VEGAS—The eyes of many regulators and lawmakers are on Medicare Advantage, and amid rising criticism of the program, one industry leader (..)

Medicare 111

Medicare Medicare 111

Fierce Healthcare

SEPTEMBER 16, 2024

billion in Medicare Advantage quality bonus payments, according to a new analysis from KFF. Health plans are set to rake in $11.8

Medicare 132

Medicare Medicare 132

Fierce Healthcare

FEBRUARY 1, 2023

CMS proposes small hike to Medicare Advantage, Part D plan payments in 2024 amid risk adjustment changes rking Wed, 02/01/2023 - 17:35

Medicare 111

Medicare Medicare 111

Fierce Healthcare

JUNE 3, 2024

Blue Cross and Blue Shield of Kansas City is leaving the Medicare Advantage (MA) market at the end of 2024, the insurer announced recently. Blue Cross and Blue Shield of Kansas City is opting out of the Medicare Advantage market.

Medicare 124

Medicare Medicare 124

Fierce Healthcare

NOVEMBER 4, 2024

Days before the 2024 presidential election, the Centers for Medicare & Medicaid Services (CMS) released an unpublished version of the final calendar year 2025 physician fee schedule final rule | Digital therapeutics, telehealth, rural heath clinics and opioid treatment programs all got updates in the final 2025 Medicare physician fee schedule rule, (..)

Medicare 127

Medicare Medicare Medicaid Medicaid 127

Fierce Healthcare

JUNE 4, 2024

SCAN Health Plan secured a court victory Monday when a federal judge agreed that the Centers for Medicare & Medicaid Services (CMS) inappropriately calculated its star ratings for the 2024 plan | SCAN Health Plan secured a court victory Monday when a federal judge agreed that the Centers for Medicare & Medicaid Services inappropriately calculated (..)

Medicare 119

Medicare Medicare Medicaid Medicaid 119

Fierce Healthcare

JANUARY 12, 2023

MedPAC calls for slight pay update to 2024 Medicare rates for hospitals, physicians. Thu, 01/12/2023 - 14:33.

Medicare 98

Medicare Medicare Hospitals 98

Fierce Healthcare

SEPTEMBER 29, 2023

The industry is just two weeks away from the beginning of Medicare's annual enrollment period, a critical window for the hottest market in insurance. | The industry is just two weeks away from the beginning of Medicare's annual enrollment period, a critical window for the hottest market in insurance.

Medicare 122

Medicare Medicare 122

Healthcare Dive

JANUARY 31, 2024

The payer is leveraging CenterWell’s growing network of primary care centers for seniors to boost margins in its hard-pressed Medicare Advantage business.

Medicare 147

Medicare Medicare 147

Fierce Healthcare

OCTOBER 2, 2023

Independence Blue Cross unveiled Medicare Advantage (MA) packages that the company said will greatly enhance benefits for its MA members, including a bigger allowance for vision, dental, hearing an | The MA enhancements touted by Independence Blue Cross include reducing premiums for its Personal Choice 65 PPO while including a Part B giveback and a (..)

Medicare 111

Medicare Medicare 111

Healthcare IT Today

OCTOBER 26, 2024

Read more… It’s Time to Combat “Instafraud” in Medicare Advantage. Read more… This Week’s Health IT Jobs for October 23, 2024: Multiple organizations with systems analyst roles to fill. In the wrong hands, LLMs can generate false or exaggerated medical documentation in an instant.

Ransomware 95

Ransomware Fraud Licensing Nurses 95

Fierce Healthcare

JANUARY 8, 2024

For the 2023 plan year, Aetna's performance in the annual Medicare Advantage star ratings took a massive hit, with just 21% of its members enrolled in plans that earned a score of four stars or mor | After a rough showing a year ago, Aetna bounced back for 2024, and was one of the stronger performers in the latest star ratings.

Medicare 115

Medicare Medicare 115

Healthcare Dive

APRIL 18, 2024

The findings suggest it would be challenging to restrict telehealth payment in Medicare, researchers said. Some pandemic flexibilities are set to expire at the end of 2024.

Medicare 182

Medicare Medicare 182

Healthcare IT Today

NOVEMBER 30, 2024

Five million Americans need to find new Medicare plans in 2025. Read more… This Week’s Health IT Jobs for November 27, 2024: Multiple roles in informatics and information management, plus California’s Clinicas del Camino Real seeks a Chief Medical Officer.

Medicare 92

Medicare Medicare 92

Fierce Healthcare

DECEMBER 18, 2023

Payers need to properly adapt to changes made to the Medicare Advantage star ratings program or risk financial repercussions, industry experts told Fierce Healthcare. Payers are being urged to prioritize health equity considerations more than ever before to improve their Medicare Advantage star ratings scores.

Medicare 119

Medicare Medicare 119

Healthcare Dive

JANUARY 5, 2024

CVS on Friday solidified what had been a temporary role for Cowhey, while sharing it expects enrollment in Medicare Advantage plans to exceed previous targets for 2024.

Medicare 173

Medicare Medicare 173

Healthcare IT Today

JANUARY 5, 2024

As we kick off 2024, we wanted to start the new year with a series of 2024 Health IT predictions. With legislation currently being drafted for nurses to receive the same reimbursement doctors and physicians do, this will likely become a top-of-mind topic in 2024.

Nurses 105

Nurses Medicare Medicare Medicaid 105

HIT Consultant

APRIL 19, 2024

Medicare providers in hospitals and skilled nursing facilities (SNFs) are adjusting to new split/shared services documentation and billing regulations rolled out by the Centers for Medicare and Medicaid Services (CMS) as part of the 2024 Medicare Physician Fee Schedule (MPFS) final rule.

Nurses 102

Nurses Medicare Medicare Medicaid 102

Healthcare IT Today

OCTOBER 19, 2024

John summarized a study in the American Journal of Managed Care highlighting how real-time interventional analytics reduced 30-day readmissions and Medicare spending per beneficiary for Penn Medicine affiliates. Read more… Healthcare IT Today Podcast : HLTH 2024 Conference Preview.

Health Insurance 94

Health Insurance Medicare Medicare Hospitals 94

Healthcare IT News - Telehealth

MAY 21, 2024

In its latest 2024-2025 Budget, for example, the Ministry of Health and Aged Care announced a funding of A$588 million over eight years to establish a new national digital service to provide support for people in temporary distress. It will be implemented initially over the next two years starting in November.

Hospitals 154

Hospitals Governance Health Insurance COVID-19 154

Healthcare IT Today

JANUARY 4, 2024

As we kick off 2024, we wanted to start the new year with a series of 2024 Health IT predictions. We believe that trend will accelerate further in 2024 as obesity medication options and supply grow. In 2024, nurse leaders will drive the paradigm shift toward AI-enabled virtual nursing.

Nurses 96

Nurses Medicaid Medicaid Medicare 96

Healthcare Dive

SEPTEMBER 12, 2023

The partnership, which Walgreens plans to launch in ACO REACH in 2024 and Medicare Advantage in 2025, is the retail giant’s first significant move in the healthcare space since CEO Roz Brewer departed earlier this month.

Doctors 182

Doctors Medicare Medicare 182

Fierce Healthcare

JUNE 8, 2023

Phase 1 enrollment in the Medicare Shared Savings Program (MSSP) for 2024 is currently underway, and recent reforms hold promise in attracting new providers into accountable care.

Medicare 105

Medicare Medicare 105