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…

The Centers for Medicare & Medicaid Services (CMS) recently released data that highlights the benefit designs of 2024 Medicare Advantage (MA) plans, inclusive of each MA product’s dental offering. To help our clients understand the results, HealthScape has quickly ingested…

Introduction The recent publication of 2024 Medicare Advantage (MA) Star ratings confirmed that the regulatory and operating environment for this program will challenge health plans (especially compared to past years) as the Centers for Medicare and Medicaid Services (CMS) shifts…

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…

The Centers for Medicare and Medicaid Services (CMS) recently released data that highlights the benefit designs of 2023 Medicare Advantage (MA) plans, inclusive of each MA product’s dental offering. To help our clients understand the results, HealthScape Advisors has quickly ingested the…

The Centers for Medicare and Medicaid Services (CMS) Innovation Center recently introduced the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model as a redesign of the Global Professional Direct Contracting Model (GPDC). The move represents the…

Medicare Advantage (MA)—the alternative to traditional Medicare which allows seniors to receive Part A and B benefits through private insurance—continues to rise in popularity. As of April 2022, almost half (46%)¹ of all Medicare beneficiaries are enrolled in an MA plan.…

The Centers for Medicare and Medicaid Services (CMS) Innovation Center recently provided long- awaited clarification on the status of the Direct Contracting program. CMS has formally canceled the Geographic Direct Contracting Model (Geo) and is phasing out the Global and…

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…

Reprinted with AIS Health permission from the December 16, 2021, issue of RADAR on Medicare Advantage Although it may have gone largely unnoticed by Medicare Advantage plans this year, a clarification regarding rewards and incentives (R&I) programs embedded in an…