@HMRLab

Helping Build a Better Health Care System

 Boston, MA
hmrlab.hcp.med.harvard.edu
Joined November 2014
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What Does the Recent Literature Say About Medicaid Expansion?: Economic Impacts on Providers - Issue Brief kff.org/2982950/
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For more detail see: ajmc.com/view/the-merits-of-… w/ a shout out to @JHeath_. Key is, if ACOs are to succeed, they need stable benchmark policy that does not penalize success. Hopefully getting there.

The Merits of Administrative Benchmarks for Population-Based Payment Programs | AJMC

The different approaches to setting benchmarks for population-based payment models (empirical, bidding based, and administratively set) have unique advantages and challenges.

ajmc.com
Farzad Mostashari@Farzad_MD1 Nov 2022
Replying to @Farzad_MD
8/ Incorporating a Prospective, External Factor in Growth Rates Used to Update the Historical Benchmark this deserves more than one tweet, cause it's a big departure. Instead of benchmark updates being set by observing actual trends, let's begin to set it administratively 👇
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CMS releases Shared Savings Program results for 2021 modernhealthcare.com/account… via @modrnhealthcr

CMS releases Shared Savings Program results for 2021

Participating ACOs earned a combined $1.96 billion in shared savings last year, compared to $2.3 billion in 2020.

modernhealthcare.com
Medicare Advantage in 2022: Enrollment Update and Key Trends kff.org/d175b72/
Insurers, providers exposed as clock winds down for enhanced ACA subsidies modernhealthcare.com/politic… via @modrnhealthcr

Insurers, providers exposed as clock winds down for enhanced ACA subsidies

Insurers could lose young, healthy customers and providers could suffer greater uncompensated care costs if exchange enrollment drops.

modernhealthcare.com
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Claims Denials and Appeals in ACA Marketplace Plans in 2020 kff.org/09f3c95/
Insurer-provider wrangling limits bundled maternity growth modernhealthcare.com/payment… via @modrnhealthcr

Insurer-provider wrangling limits bundled maternity growth

Providers and insurers agree bundled payments for prenatal care, delivery and postpartum care lower costs and boost quality, but squaring away payment terms has proven more tricky.

modernhealthcare.com
Here's why hospitals want more time to repay their Medicare loans modernhealthcare.com/finance… via @modrnhealthcr

Here’s why hospitals want more time to repay their Medicare loans

CMS recouped most of the $107 billion in advance reimbursements already, but some hospitals facing cash crunches could be subject to interest penalties without an extension.

modernhealthcare.com
See who dominates Medicare Advantage market this year modernhealthcare.com/insuran… via @modrnhealthcr

See who dominates Medicare Advantage market this year

Seven insurers cover nearly 70% of Medicare Advantage enrollees as new entrants struggle to gain ground.

modernhealthcare.com
How fee-for-service stymies promising, cost-saving dementia care programs modernhealthcare.com/payment… via @modrnhealthcr
How ACA Marketplace Premiums Are Changing by County in 2022 - Issue Brief kff.org/cea7226/
In their new blog, @MedicareMeddler, @AnilMakam, + @DavidCGrabowski from @MarquetteU, @UCSF, + @harvardmed discuss how Medicare #COVID19 payment + coverage waivers alleviated the patient burden for short-term care, but should not be extended indefinitely. bit.ly/3G9VUOh
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Outside investors pay up for Medicare brokers modernhealthcare.com/medicar… via @modrnhealthcr

Outside investors pay up for Medicare brokers

Private equity and venture capitalists are increasingly investing in brokers that help older adults enroll in the crowded Medicare space.

modernhealthcare.com
Consolidation, prior authorization drive improper Medicare payments to historic low modernhealthcare.com/payment… via @modrnhealthcr

Consolidation, prior authorization drive improper Medicare payments to historic low

Medicare Advantage insurers accounted for $23.1 billion in improper payments in fiscal 2021.

modernhealthcare.com
CMS leaders outline vision for Medicaid, CHIP modernhealthcare.com/medicai… via @modrnhealthcr

CMS leaders outline vision for Medicaid, CHIP

Under President Joe Biden, CMS emphasizes equity, access to care and communication with states, top agency leaders wrote in Health Affairs.

modernhealthcare.com
How do you get employees to shop around for care? Offer Rewards! Both the employer and employee win! @CM_Whaley @Michael_Chernew @Ateevm tinyurl.com/sdsh958
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MedPAC wades back into outpatient site-neutral payments modernhealthcare.com/payment… via @modrnhealthcr

MedPAC wades back into outpatient site-neutral payments

MedPAC wants to revisit aligning pay for ambulatory care settings, which it says could help tackle healthcare consolidation.

modernhealthcare.com
Medicare issues ESRD rule with equity in mind modernhealthcare.com/payment… via @modrnhealthcr
Seven in Ten Medicare Beneficiaries Did Not Compare Plans During Past Open Enrollment Period - Issue Brief kff.org/5d142f1/
Medicare Advantage star ratings increase as consumer options grow modernhealthcare.com/safety-… via @modrnhealthcr

Pandemic helps quadruple portion of Medicare Advantage plans with five stars

More Medicare Advantage plans scored high quality ratings for their 2022 plans than the year before.

modernhealthcare.com
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