For most of the 2016 election cycle, the future of the Affordable Care Act (ACA) looked secure. But President-elect Donald Trump’s surprise victory, coupled with Republicans retaining their majority in both the House and Senate, has thrown the healthcare industry for a loop, with payers, providers, and participants alike all anxiously awaiting what may happen next. Could all the work that has happened to implement the ACA be reversed? One thing is for certain—everything is uncertain!... Read More
Health plans across the country expend significant energy on annual HEDIS® quality reporting requirements. With quality metrics increasingly tied to financial success, the importance of both a successful submission process and continued performance improvement has only grown.... Read More
In its Summer 2016 newsletter, the Resource Initiative and Society for Education (RISE) features an interview with Verscend experts on the hot topic of the Centers for Medicare & Medicaid Services’ (CMS’) shift in how the risk adjustment factor scores for Medicare Advantage (MA) will be determined going forward. The interview sheds light on the implications of the transition from the Risk Adjustment Processing System (RAPS) to the Encounter Data System (EDS).... Read More
There is one healthcare acronym that is currently impacting provider organizations across the country more than any other—MACRA. While MACRA, or the Medicare Access & CHIP Reauthorization Act of 2015 is not a new subject, a notice by the Centers for Medicare & Medicaid Services (CMS) in late April has elevated the urgency for providers to know and understand the proposed legislation and its repercussions.... Read More
Following the release of the Centers for Medicare & Medicaid Services’ (CMS’) proposed changes for 2017 Medicare Advantage (MA) growth rates and adjustments to the HCC risk adjustment model, the industry is abuzz with questions and thoughts on what to prepare for. With less than a month until the final 2017 Rate Announcement and Call Letter, we have highlighted three proposed changes to the risk adjustment model and methodology that will likely impact plan revenue.
Tackling the first year of risk adjustment since the ICD-10 transition took effect last fall, we’ve kept our ears to the ground for updates on how plans have been affected by the change. While the jury is still out on longer-term impact, we caught up with a few of our experts to get their take on what to expect across risk adjustment this year.
One of the attributes of a sustainable value-based healthcare delivery system is payment based on the value of services delivered, instead of the volume-based fee-for-service model. Bundled payments have been explored for several years as an alternative to value-based payment models and there have been some notable recent successes. A great example is Horizon Blue Cross Blue Shield of New Jersey’s episode of care program.... Read More
Recently, the Center for Medicare and Medicaid Services (CMS) announced the addition of 141 new Medicare Accountable Care Organizations (ACOs), bringing the total number of Medicare ACOs in the United States to nearly 500. In addition, hundreds of provider groups are also participating in accountable care arrangements with commercial insurance plans, and some have even formed ACOs with state Medicaid agencies. These changes are part of a larger initiative being led by CMS to move reimbursement away from fee-for-service and towards alternative payment models that emphasize value over volume.... Read More