Medicare Policy
Expert articles and analysis related to medicare policy.
AI Summary â Last 30 Days
Over the past 30 days, the Centers for Medicare & Medicaid Services (CMS) has been laying the groundwork for a significant shift in value-based care through the advancement of the Long-term Enhanced ACO Design (LEAD) model, which aims to enhance financial incentives tied directly to quality performance and patient outcomes. The impending launch of the ACCESS Model is also set to expand Medicareâs reach in managing chronic care, indicating a strategic move towards a more outcome-oriented payment approach in Original Medicare. Additionally, recent successes in the Medicare Shared Savings Program (MSSP), as exemplified by the Community Care Cooperative's $10.2 million savings achievement, underscore the continued significance of ACOs in navigating these evolving payment landscapes and their role in promoting population health management [here](https://news.google.com/rss/articles/CBMivwJBVV95cUxOcDZudEsxYk44TTZXNndKMEoxZEV1Q3Nrc0E4N0hENE1fSHJpallvV2t5YzdQRnROZDgzU0djS0FBNFozaXVncndpRl9nZklQWkpyMUdIOFkwbTZxVE9oUUg0SW5nOFQxNVRoX1ZuMjgzQzN0SzdaWFBqU1hFU0dfT09nOVp0dGJSYTdyZzgxbTExZ
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CMS receives record comments on controversial Medicare Advantage payment proposal
The Trump administration wants to keep MA rates flat next year and change how risk adjustment is calculated. Insurers had a lot to say about this, CMS officials shared Tuesday during an event in D.C.
CMS threatens Elevance with Medicare Advantage sanctions
Federal regulators are planning to suspend enrollment in Elevance's MA plans at the end of March, in a rare and serious threat to the companyâs finances.
Considerations for implementing Medicare Advantage encounter data in risk adjustment - MedPAC (.gov)
Considerations for implementing Medicare Advantage encounter data in risk adjustment  MedPAC (.gov)
Considerations for implementing Medicare Advantage encounter data in risk adjustment - MedPAC (.gov)
Considerations for implementing Medicare Advantage encounter data in risk adjustment  MedPAC (.gov)
The Value Shift â How Medicare Advantage Benefits Are Evolving for 2026
This updated paper builds on Wakelyâs prior analysis of Medicare Advantage benefit design, incorporating newly released 2026 enrollment data to provide a clearer picture of how market dynamics are evo...
Which types of health insurers make the most money?
It turns out the answer is Medicare Advantage plans according to a KFF analysis released today. However the reason why Medicare Advantage is more profitable may not be obvious: At the end of 2024, gro...
Medicare Advantage Policies, ABNs, and QIO
Letâs start with what seems to be a never-ending topic of conversation: the new policies by Medicare Advantage (MA) plans to deny or reduce payments for inpatient admissions. Last week Independence Bl...
HIMSSCast: 2026 could be the most challenging year yet for Medicare Advantage payers
This is a difficult time for the Medicare Advantage insurers.MA plans are facing rising medical costs due to increased utilization across a population that is continuing to age and experience chronic ...
Clover Health Moves from Pledge to Production, Becomes The First Payer Live on a CMS Aligned Network
Clover Health Moves from Pledge to Production, Becomes The First Payer Live on a CMS Aligned Network  Clover Health
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About 280,000 older adults experience the âMedicare Cliffâ each year, becoming eligible for Medicare and losing Medicaid coverage when they turn age 65 years due to discontinuities in financial eligib...