The Centers for Medicare & Medicaid Services (CMS) recently released a final rule with changes to the Medicare Advantage (MA) and prescription drug program (MA-PD) for Contract Year 2025 (CY2025). CMS’ stated goal for the final rule is to strengthen…

Health plans are confronting significant pressure to their financial sustainability, including rising costs, new regulations, and increased competition. Rising medical costs remains an ongoing challenge, with medical expenses outpacing projections in 2023 driven by factors such as post-COVID demand, network…

In the past few years, the COVID-19 pandemic has dominated our attention, disrupting traditional healthcare delivery and access. During this time, member access to care was largely focused on adapting and responding to the pandemic. Now that the industry has largely reached stabilization…

Every January, we provide our perspective on areas of increasing importance and value for health plans for the upcoming year. Our prospective view of 2021 focused on the need for health plans to strike a balance between innovation and investment…

HealthScape Advisors is pleased to introduce this Executive Briefing focused on the importance of actively managing spend for intravitreal injections that treat serious eye conditions prevalent within Medicare Advantage (MA) plans’ membership populations. In this briefing, we will cover the…

Reflecting on the significant events of 2020, most notably, heightened racial unrest and the unequal impact of COVID-19, we have a unique and time-sensitive opportunity to address the reality that racial disparities exist in our country. Racial disparities permeate across…

2020 has redefined healthcare in a way no one could have predicted. The US healthcare system finds itself looking at an uncertain future in which healthcare, namely COVID-19, has manifested itself in nearly every aspect of life. The impact of…

YOUR PROVIDER DATA QUALITY PROBLEM MAY BE BIGGER THAN YOU THINK… AND IT COULD BE GETTING WORSE Under normal circumstances, inaccurate provider data presents significant operational and financial challenges for health plans. In 2020, these problems have been exacerbated across…

On December 3, 2020, the Centers for Medicare and Medicaid Services (CMS) Innovation Center released details on the much-anticipated Geographic Direct Contracting Model, or “Geo.” Geo is a new payment and care delivery model designed to assess whether Direct Contracting…

In June 2019, the Trump administration issued an Executive Order (EO) that directed the U.S. Department of Health and Human Services (HHS) to propose regulations that enhance the ability for patients to shop for healthcare services. As directed by the…