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Bonus payments for Medicare Advantage plans extended
The Obama administration has decided to extend bonus payments meant to reward top-quality Medicare Advantage plans to those performing at average quality levels, and provide larger bonuses to top performers.
The Obama administration has decided to extend bonus payments meant to reward top-quality Medicare Advantage plans to those performing at average quality levels, and provide larger bonuses to top performers. The move is intended to motivate low-performing plans to improve more quickly.
The Patient Protection and Affordable Care Act builds in an average 17% rate cut over the next several years for Medicare Advantage plans, which shrinks the total payments by more than $132 billion over 10 years. It also increases operational costs as a result of compliance and reporting requirements.
The healthcare reform law calls for rewarding plans that receive at least four out of five stars on quality measurements with bonuses of 1.5%, 3% and 5% in 2012, 2013 and 2014, respectively. However, the administration has extended the bonuses to plans that score at least three out of five stars, which include 62% of insurers. The bonuses begin in 2012. It will also reward five-star plans with an immediate 5% bonus in 2012, and four-star plans with a 4% bonus in 2012, instead of using the annual stepped bonus percentages.
The change was made by Medicare officials without congressional approval via a demonstration project.
For more on the changes to the Medicare Advantage plans, read Tidal Shift.
Bridging the Diversity Gap in Rare Disease Clinical Trials with Harsha Rajasimha of IndoUSrare
November 8th 2023Briana Contreras, an editor with Managed Healthcare Executive, spoke with Harsha Rajasimha, MD, founder and executive chairman of IndoUSrare, in this month's episode of Tuning in to the C-Suite podcast. The conversation was about how the disparity in diversity and ethnicity in rare disease clinical trials in the U.S. has led to gaps in understanding diseases and conditions, jeopardizing universal health, and increasing the economic burden of healthcare.
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35th World AIDS Day Marks 20 Years of PEPFAR: Challenges and Strategies to Combat HIV/AIDS
November 29th 2023PEPFAR, having invested $100 billion and saved 25 million lives in the global fight against HIV/AIDS, faces Congressional hurdles in its reauthorization due to abortion debates. Despite widespread support and no evidence of abortion-related activities, the legislative process is at a standstill. Members of PEPFAR and authors of a recent editorial stress the significance of PEPFAR and advocate for integrating behavioral and social science into healthcare programs to achieve UNAIDS targets and address barriers in HIV/AIDS testing and treatment.
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Managing Editor of Managed Healthcare Executive, Peter Wehrwein, had a discussion with William Shrank, M.D., a venture partner with Andreessen Horowitz, a venture capital firm in Menlo Park, California, about how artificial intelligence's role is improving healthcare, where we are today with value-based care and the ongoing efforts of reducing waste in the healthcare space for this episode of the "What's on Your Mind" podcast series.
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Study Raises Concerns Over Insurance Barriers to HIV Prevention Medications
November 29th 2023Despite its efficacy, PrEP remains underutilized compared to the need for it. High costs are among the barriers to PrEP use, along with limited knowledge among clinicians, lack of health insurance, stigma, and underestimation of personal HIV risk.
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