Babyscripts’ Post

Not sure what Medicaid disenrollment means for non Medicaid payers? J2 investigated and put together our new article that outlines: How much Medicaid disenrollment is left How many of those ineligible for Medicaid will look at Marketplace plans What demographics are most impacted Why narrow networks should pay close attention How payers can use this information to prep for a challenging PY2024 for adequacy Read it here: https://lnkd.in/gUwfSqnH

Leveraging Negotiations with Medicare Advantage Plans: Insights for Post-Acute Care Providers By [Your Name/Your Company] 🔹 Demographics as Leverage: The increasing need for home-based care highlights a significant opportunity for providers to demonstrate their value. #HomeCare #DemographicShift 🔹 Strategic Partnerships: Pure Healthcare’s approach of partnering with nonprofits and diverse provider types exemplifies how to create a critical mass for engaging payers. #StrategicPartnerships #HealthcareCollaboration 🔹 Clinical Alignment & Value Preparation: Preparing for value by aligning clinical services with the growing demand for alternative care sites. #ClinicalAlignment #ValueBasedCare 🔹 Effective Utilization of Medicare Advantage (MA): Clear communication of the value offered is essential. The goal is to encourage payers to reinvest their dollars more efficiently, not to increase their spending. #MedicareAdvantage #HealthcareEconomics 🔹 Data-Driven Negotiations: Providers must be adept at using data and value propositions to fit into existing payer structures, focusing on avoidable spends. #DataDrivenHealthcare #CostEfficiency 🔹 Innovative Conversations for Value-based Arrangements: Successful negotiations require innovative approaches, as exemplified by a Georgia provider’s dealings with Humana Inc. Providers should seek collaborative terms that pave the way to value-based arrangements. #InnovativeNegotiation #ValueBasedContracts Link to full article 🔗 from Patrick Filbin with Home Health Care News https://lnkd.in/gyuE5qeT

Interesting study analyzing demographics of #MedicareAdvantage enrollees including #PPO (broader access, higher base premiums) vs #HMO (narrower networks, lower base premiums) and comparison of the socioeconomic status of regular #Medicare members with those choosing MA, now the majority of Medicare recipients. Study showed 29% lower utilization (“consumption”) of #healthcare services for those members enrolled in HMO products vs PPO. #Healthcarecosts #populationhealth #healthequity #TripleAim #QuadrupleAim #PrimaryCare #DSNP #Medicaid #PublicPrivatePartnerships #PublicPrivatePartnership #CMS #HHS #Harvard #SDoH

Why Is Understanding HHS-HCC Important? Broader Population Coverage: The HHS-HCC model, with its inclusion of various conditions and demographics, plays a pivotal role in ensuring comprehensive coverage for the general population, including non-Medicare beneficiaries. This underscores the importance of your role in healthcare management and decision-making. It accounts for various conditions and situations, such as maternity and pediatric care, less emphasized in the CMS-HCC model. ACA Compliance: Health plans in the individual and small group markets must adhere to ACA regulations, which utilize the HHS-HCC model for risk adjustment. By understanding the HHS-HCC model, healthcare systems and insurance providers can accurately predict costs and allocate resources effectively within these markets. Resource Allocation: Both models aim to allocate resources efficiently, but they do so based on different population needs. Incorporating both models allows healthcare systems to tailor their resource distribution strategies better. This dual approach ensures that all patient populations receive appropriate care and funding, whether in Medicare Advantage or ACA markets. Financial Stability: The HHS-HCC model plays a pivotal role in maintaining health plans' financial stability. By comprehending both HHS-HCC and CMS-HCC models, healthcare systems can more accurately anticipate costs and set premiums that align with their enrollees' risk profiles. This dual understanding mitigates the risk of underfunding or overcharging, promoting financial sustainability. Quality of Care: Proper risk adjustment leads to more equitable payment systems, ensuring high-risk patients receive necessary care without financially overburdening health plans. Healthcare systems implementing both models can significantly improve the quality of care by ensuring that resources are distributed based on patients' accurate risk profiles.

How Does Use of Medicaid Wraparound Services by Dual-Eligible Individuals Vary by Service, State, and Enrollees’ Demographics?: This issue brief describes the share of dual-eligible individuals with full Medicaid benefits who use wraparound services, including institutional LTSS, home- and community-based services (HCBS), vision services, dental care, and non-emergency medical transportation (NEMT); and how use of these services varies by state and select demographic characteristics of enrollees. #medicaid #mdrp #financial

This is just one study but 29% more utilization of healthcare services for #MedicareAdvantage #PPO members compared to #HMO is a big difference.  This probably explains some of the Q4 uptick in utilization experienced by the national payers with significant PPO memberships.  

A new Health Affairs study examines the source of Medicare Advantage’s rapid growth over the last 18 years, looking at both new enrollment as well as switching patterns between MA and traditional Medicare. The study found that switching from traditional Medicare to MA more than tripled between 2006-2022 while the transition rate from MA to Medicare decreased. The study also noted the demographics of MA are incredibly diverse – attracting enrollees across all walks of life: Black, Hispanic, dual-eligible, disabled, rural and urban as well as younger and healthier individuals. This deep dive is important information for those in health care, like Alignment Health, as we continue innovating more customized products and services that better meet the needs of today’s seniors. #MedicareAdvantage #seniorcare #healthcare https://lnkd.in/g2t4xi9z

Key Facts about the Uninsured Population: This issue brief describes trends in health coverage in 2022, examines the characteristics of the nonelderly uninsured population, and summarizes the access and financial implications of not having coverage. #medicaid #mdrp #cms

What Do Medicaid Unwinding Data by Race and Ethnicity Show?: As of September 2023, nine states are reporting data that allow for analysis of disenrollment patterns by race and ethnicity. Five states (Arizona, California, Indiana, Minnesota, and Oregon) provide data on disenrollment rates by race and ethnicity. Four states (Nevada, Oklahoma, Virginia, and Washington) report the distribution of disenrollments by race and ethnicity that can be compared to the distribution of overall Medicaid enrollment in each state by race and ethnicity. #medicaid #mdrp #cms

Interesting study out of #Harvard: #MedicareAdvantage beneficiaries have more than 50% fewer inpatient #hospital stays and 22% fewer #emergencydepartment visits than traditional #Medicare enrollees. In addition, there is comparable access to high quality #preventivecare and routine care use. Global cost of care 12% lower for MA. Study adjusted for health status, demographics & social determinants variation. #TripleAim #QuadrupleAim #PrimaryCare #SDOH #publicprivatepartnership #publicprivatepartnerships #patientcenteredcare #valuebasedcare #valuebasedhealthcare