The asthma treatment landscape is continually evolving, bringing new options to the millions of individuals affected by this chronic condition. As novel treatments, such as new triple-therapy inhalers, prepare to enter the market, payers are faced with critical evaluation challenges.
CMS is adding four new or updated measures for the 2027 Star Ratings. The Colorectal Cancer Screening measure is being replaced by a respecified version and will be treated as a new measure.
CMS updated the Medicare Adjustment (MA) risk adjustment model using more recent underlying Fee-For-Service (FFS) data (2023 diagnoses to predict 2024 costs, vs. 2018 diagnoses predicting 2019 costs), leading to significant changes in some coefficients and other model parameters.
The headline number in the Advance Notice is the Effective Growth Rate and resulting Expected Average Change in MA plan payment.
Compared to the Part C rate discussion, the “new” Part D content in the CY 2027 Advance Notice is mostly (1) annual parameter updates and (2) CMS reiterating IRA-driven benefit rules that remain in force.
The Advance Notice of Methodological Changes for Calendar Year (CY) 2027 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (Advance Notice) was recently released.
President Trump introduced the concept of a copper plan as a solution to healthcare affordability. But is it a solution? Yes, copper premiums will be lower than what is currently offered...
Designing health benefits as if they were one-size-fits-all is a bit like issuing steel-toed boots to accountants or medical scrubs to long-haul truckers—it sounds equitable until you look at the bill.
The U.S. healthcare system, marked by extraordinary technological capability and deeply rooted inequities, has reached a critical inflection point.
How Employers Should Evaluate the Shift from Fully Insured Health Plans. Self-funding is an alternative approach where employers directly manage and fund healthcare claims, allowing greater transparency, flexibility, and control over healthcare costs...
