Medicare

• Changes to 2020 Medicare Plan Finder

  By Michelle Klein, Matt Kranovich | 15 October 2019

  This paper highlights several key changes to Medicare Plan Finder— and potential unintended consequences— and offers suggestions as to how those changes could potentially affect Medicare Advantage Organizations.

• Bonus or penalty? Medicare provider payments are now adjusted based on quality metrics

  By Christopher Kunkel, Mike Hamachek | 16 September 2019

  What happened in the first year of Merit-Based Incentive Payment System reporting?

• Early thoughts on the Primary Care First model

  By Raheel Sohail, Cory Gusland, Daniel Henry | 22 August 2019

  This paper explores key model features of the Center for Medicare and Medicaid Innovation’s Primary Care First, a new voluntary payment model focused on primary care.

• A new Part D benefit design? Prescription Drug Pricing Reduction Act proposes major changes to Part D

  By Joanna Amend, Samantha J. D’Anna, Dustin J. Grzeskowiak, Justin Harris, Matthew Hayes | 15 August 2019

  This article provides an overview of the provisions in the Prescription Drug Pricing Reduction Act of 2019 and the effects on Medicare Part D stakeholders.

• The real-world Medicare costs of Alzheimer disease: Considerations for policy and care

  By Bruce S. Pyenson, Charles Steffens | 28 June 2019

  This article compares total Medicare-covered (allowed) costs of patients with Alzheimer disease with the risk-adjusted costs of beneficiaries without dementia over their last years of life, using claims data.

• Medicare Advantage enrollment: Growth expectations for new organizations

  By Kelly S. Backes, Julia M. Friedman | 26 June 2019

  This paper analyzes historical enrollment experience for parent organizations new to the Medicare Advantage market from 2007 to 2018.

• Model change impact on the Medicare Advantage 2020 RxHCC risk scores

  By Adrian L. Clark, David Koenig | 23 May 2019

  This paper summarizes the changes in member risk scores resulting from the revised Medicare Part D risk score model for payment year 2020.

• Removal of safe harbor affects EGWPs

  By Stephen Kaczmarek | 02 May 2019

  A proposed rule from the Department of Health and Human Services would revise the safe harbor protection in Medicare Part D that currently allows pharmaceutical manufacturer rebates to be paid after the point-of-sale and start requiring such rebates to be credited against the drug’s point-of-sale price.

• Taking on Medicare Part D risk: Provider perspective

  By Matthew J. Kramer, Simon Moody, Michael T. Hunter | 12 April 2019

  This article summarizes the key issues providers need to consider before taking on Part D risk, an increasingly common ask from Medicare Advantage organizations, and highlights some of the complexities and common barriers observed when advising provider clients on their strategies for Part D risk.

• Hang on tight! Why maintaining a zero-dollar MA-PD premium plan is worth the effort

  By Bradley J. Piper, Mary L. Gabe | 08 April 2019

  What happens to membership in Medicare Advantage-Prescription Drug plans with a zero-dollar premium when a premium is added?

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