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medicare mostly final updates
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evanbrociner committed May 7, 2024
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Expand Up @@ -93,6 +93,10 @@ <h3 style="margin-top: 20px;">Outline</h3>
<a href="#challenges">Challenges in Medicare</a>
</li>

<li>
<a href="#people">People/Newsletters to Follow</a>
</li>

</ul>
<section id="101">
<h3 id="101" style="margin-top: 40px;">Medicare 101</h3>
Expand Down Expand Up @@ -770,32 +774,169 @@ <h3 id="challenges" style="margin-top: 40px;">Challenges in Medicare</h3>

<tr>
<td>
<a href="https://medium.com/wharton-pulse-podcast/farzad-mostashari-aledade-on-the-power-of-primary-care-889b950603ed" rel="noopener noreferrer" target="_blank">
Farzad Mostashari, Aledade, on the power of primary care</a>
<a href="https://kffhealthnews.org/news/article/health-202-hospitals-doctors-medicare-advantage/" rel="noopener noreferrer" target="_blank">
Hospitals and Doctors Are Fed up With Medicare Advantage</a>
</td>
<td>
<p>
<b>
KFF writes how Medicare Advantage plans are facing growing criticism from hospitals and doctors due to claim denials, preapproval hassles, and low reimbursement rates, leading to new regulations and potentially impacting patient choice.
</b>

</p>
<h5>Key Points</h5>
<ul>
<li>Hospitals and doctors are voicing frustrations with
<strong>Medicare Advantage plans</strong>. They cite
<strong>claim denials</strong>, burdensome preapproval processes, and inadequate reimbursement rates. This frustration is leading some providers to stop accepting certain Medicare Advantage plans.</li>
<li>The Biden administration is
<strong>taking action</strong>
to address these concerns. New regulations aim to
<strong>restrict prior authorization</strong>
requirements and improve access to
<strong>necessary care</strong>
for patients.</li>
<li>Increased scrutiny surrounds
<strong>Medicare Advantage plans</strong>, coming from both healthcare providers and lawmakers. This scrutiny is expected to persist as the federal government
<strong>implements new regulations</strong>.</li>
</ul>

</td>
</tr>

<tr>
<td>
<a href="https://www.youtube.com/watch?v=V0kJ1k2Vpv0" rel="noopener noreferrer" target="_blank">
March 21 Web Event: Unpacking the Controversy Over Medicare Advantage</a>
</td>
<td>
<p>
<b>
Alex Wess, published in The Pulse by Wharton Digital Health, chats with Dr. Farzad Mostashari about how Aledade believes independent primary care physicians are best positioned to benefit from value-based care.
On Thursday, March 16, 2023, KFF hosted an hour-long web briefing focused on how state Medicaid programs are approaching this unwinding of the continuous enrollment provision. States’ existing enrollment and renewal procedures and their differing approaches to the unwinding will have major impacts on Medicaid enrollees, state spending, and broader health coverage trends.
</b>

</p>
<h5>Key Points</h5>
<ul>
<li>
<b>Focus on Independent Primary Care:
</b>
Aledade partners with existing independent primary care practices to help them transition to value-based care. They believe independent practices have the most to gain from value-based care because they influence a large portion of healthcare costs while accounting for a small percentage themselves.</li>
<b>Debate over how much Medicare pays Medicare Advantage plans:</b>
The federal government pays Medicare Advantage plans a fixed amount per beneficiary each month. There is disagreement about whether these payments are too high, with some arguing that Medicare Advantage plans are getting paid more than they should for the people they cover.</li>
<li>
<b>Technology and Evidence-Based Approach:
</b>
Aledade uses a technology platform and data analysis to guide practice workflows and implement interventions to reduce healthcare costs and improve outcomes. They heavily rely on evidence-based practices and constantly test new interventions before large-scale implementation.
</li>
<b>Risk adjustment and coding:</b>
A key factor in how much Medicare Advantage plans are paid is a system called risk adjustment. This system takes into account the health status of enrollees, so that plans are paid more for sicker patients and less for healthier patients. Some argue that Medicare Advantage plans are reporting more diagnoses for their enrollees than traditional Medicare, which inflates their risk scores and leads to higher payments.</li>
<li>
<b>Potential impact of proposed changes to payment system:</b>
The Biden Administration has proposed changes to the way Medicare Advantage plans are paid. These changes could reduce payments to plans by 3%. However, the impact on beneficiaries is uncertain. Some argue that plans will reduce benefits or increase premiums, while others argue that they will absorb the changes.</li>
</ul>

</td>
</tr>

<tr>
<td>
<a href="https://www.npr.org/sections/health-shots/2024/04/17/1244879040/medicare-chronic-care-management-seniors" rel="noopener noreferrer" target="_blank">
Medicare's push to improve chronic care attracts businesses, but not many doctors</a>
</td>
<td>
<p>
<b>
This article Phil Galewitz and Holly K. Hacker discusses the debate surrounding how much Medicare pays Medicare Advantage plans, including the risk adjustment system and potential effects of proposed payment changes.
</b>

</p>
<h5>Key Points</h5>
<ul>
<li>
<strong>CCM Benefits:</strong>
The Chronic Care Management program provides personalized care, regular touchpoints with healthcare providers, and coordinated care to Medicare enrollees with chronic conditions. This program helps keep patients out of the hospital and reduces unnecessary visits, potentially improving health outcomes.</li>
<li>
<b>Profitability and Growth:
</b>Aledade is one of the rare profitable healthcare tech companies. They recently raised $123 million to invest in new interventions and expand their platform. They prioritize long-term success and mission over an IPO and are in a good position to choose when and if to go public.
</li>
<strong>Sluggish Participation:</strong>
Despite clear benefits, enrollment in the CCM program remains low. This is due to a variety of factors including the opt-in requirement for both patients and doctors, capacity limits for some medical practices, and the bureaucratic burdens of documentation and billing.</li>
<li>
<strong>Outsourcing Solutions & Financial Incentives:</strong>
Some medical practices outsource CCM services to companies, while others manage it in-house. The program offers additional income for providers, with Medicare paying an average of $62 per patient, per month, for the service. However, concerns exist about potentially unnecessary CCM enrollment for patients who don't fully need the service.</li>
</ul>

</td>
</tr>

</tbody>
</table>
</section>

<section id="people">
<h3 id="people" style="margin-top: 40px;">People/Newsletters to Follow</h3>
<table class="table mx-auto">
<thead>
<tr>
<th scope="col">Resource</th>
<th scope="col">Description</th>
</tr>
</thead>
<tbody>

<tr>
<td>
<a href="https://www.linkedin.com/in/zachmdavis/" rel="noopener noreferrer" target="_blank">
Zach Davis</a>
</td>
<td>
<p>
Zach's goal is to help ACOs in the MSSP, ACO REACH, Medicare Advantage and Commercial markets tap into the actuarial expertise that the health insurance industry has relied on for decades.
</p>

</td>
</tr>

<tr>
<td>
<a href="https://www.linkedin.com/in/yubin-park-phd/" rel="noopener noreferrer" target="_blank">
Yubin Park, PhD</a>
</td>
<td>
<p>
Yubin consistently posts great data analysis in the Medicare space.
</p>

</td>
</tr>

<tr>
<td>
<a href="https://www.linkedin.com/in/bryce-platt/" rel="noopener noreferrer" target="_blank">
Bryce Platt, PharmD</a>
</td>
<td>
<p>
Every day Bryce posts highly insightful content in the Medicare space. He is somebody everyone should follow if they are interested in the space.
</p>

</td>
</tr>

<tr>
<td>
<a href="https://thegerontechnologist.com" rel="noopener noreferrer" target="_blank">
TheGerontechnologist</a>
</td>
<td>
<p>
TheGerontechnologist compiles great content on AgeTech.
</p>

</td>
</tr>

<tr>
<td>
<a href="https://www.linkedin.com/in/ben-schwartz-md/" rel="noopener noreferrer" target="_blank">
Benjamin Schwartz, MD, MBA</a>
</td>
<td>
<p>
Ben is one of the insightful people in healthcare.
</p>

</td>
</tr>

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