2027 Advance Notice – Stars Deep Dive
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.
2027 Advance Notice – Risk Adjustment Deep Dive
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.
2027 Advance Notice – Rate Setting Deep Dive
The headline number in the Advance Notice is the Effective Growth Rate and resulting Expected Average Change in MA plan payment.
2027 Medicare Advantage and Part D Advance Notice – Deep Dive
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.
2027 Medicare Advantage and Part D Advance Notice
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.
One Size Doesn’t Fit All: Industry-Based Utilization Patterns in Health Insurance
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.
An Unexpected Lesson from the Emergency Room
As actuaries, we are constantly scrutinizing unit costs, utilization patterns, reimbursements, and more in an attempt to blunt the impact of distressing healthcare...
Maximize Practice Value with Enhanced Contracting Strategies
Practices trying to improve their viability or considering or pursuing an equity transaction should look at ‘low hanging fruit’ opportunities for commercial payment increases.
Actuaries to the Rescue: Recovery from Bankruptcy
Bankruptcies are on the rise for healthcare companies backed by private equity and venture capital[1]. A recent study discovered that PE-backed bankruptcies in 2023 were more than double compared...
Understanding Provider Financial Losses in Value-Based Contracts
The shift from fee-for-service (FFS) healthcare models to value-based care (VBC) has been a monumental transformation in the healthcare industry. However, as this transition unfolds, it has added significant complexity to the healthcare system...