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Flexible MA plans account for half of new growth
Washington, D.C.-More seniors are enrolling in Medicare Advantage plans, particularly in the expanding number of more flexible "private fee-for-service" (PFFS) plans.
WASHINGTON, D.C.-More seniors are enrolling in Medicare Advantage plans, particularly in the expanding number of more flexible "private fee-for-service" (PFFS) plans. The Centers for Medicare and Medicaid Services (CMS) reported a 20% rise in MA plan members for 2006; about half of the growth is in PFFS plans, and the other half in HMOs and PPOs; local HMOs continue to dominate the MA program, with 5.4 million of nearly 7.5 million total MA enrollees.
PFFS plans are attractive to seniors because they don't limit beneficiaries to providers in a certain network. This also has made them more expensive than HMOs or PPOs, but now they can receive more attractive rates, particularly for serving Medicare patients in rural areas. PFFS plans thus are growing most noticeably in rural and other areas that previously did not attract MA plans because of difficulties contracting with the smaller number of physicians in these markets who often are reluctant to join MCO networks.
PFFS plans now serve more than 800,000 seniors, more than half of them in plans sponsored by Humana, according to an analysis by Avalere Health. This represents a jump from about 220,000 PFFS enrollees last December and just 20,000 three years ago. While Humana PFFS covers Medicare Part D drug benefits, seniors in such plans sponsored by UHC-Pacificare and WellPoint obtain drug benefits from separate Part D plans.
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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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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FDA Site Inspections Decreased During Pandemic. Questions Continue about Drug Quality.
December 4th 2023A recent study has found that FDA inspections of drug manufacturing facilities have increased since the COVID-19 health emergency but have not yet returned to pre-pandemic numbers.
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