Wakely Wire
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Whitepapers, briefs, press releases and more
Summary of Provisions of HHS’ Proposed 2025 Notice of Benefit and Payment Parameters and Other Key Regulations
On November 15, 2023, the Department of Health and Human Services (HHS) released the proposed Notice of Benefit and Payment Parameters (Payment Notice) for 2025. The notice includes important proposed rules and parameters for the operation of the individual and small group health insurance markets in 2025 and beyond. This paper summarizes key provisions of ... Read more
Falling Stars: Wakely Dissects the Decline in Medicare Advantage Star Ratings
Updated October 31, 2024 On October 10th, CMS publicly released the 2025 Medicare Part C and D Star Ratings. Wakely has quantified the significant decline in 2025 Star Ratings on Quality Bonus Payments, or QBPs, for 2026. The result of our analysis: somewhere between $4 and $5 billion less in 2026 QBPs. This whitepaper dissects ... Read more
Week in Washington 10/24/24
A busy week of news – Medicaid Survey KFF released its annual survey of Medicaid Directors. Overall the survey found that Medicaid programs are expected to contend with serious revenue pressures. More than half of Medicaid directors surveyed said they saw at least a 50% chance of budget shortfall next year. They also noted that ... Read more
Events & More
Falling Stars: Who's Who in the 2025 Star Ratings
This webinar will cover the recently-released 2025 Star Ratings, including an analysis of the expected impact on 2025 Medicare payments. Attendees should expect to hear discussions of the latest performance and program changes, along with the resulting impact on the contract level star ratings. We’ll also dive into the dramatic increase in cutpoints and discuss what plans can expect over the next few years. Beyond cutpoints, we will cover other upcoming changes to the Star Rating program and discuss their potential impact on Medicare Advantage Organizations (MAO).
Mastering Star Performance: Analytics and Stratification for Success.
Wakely’s parent company, HMA, will also be hosting a webinar on November 13th at 12pm ET. This webinar will focus on how MA plans can optimize their Star Ratings using the HMA Stars Accelerator Playbook.
Newsworthy Findings
Centene Sues HHS Over Medicare Advantage Star Ratings Fall
Centene is following in the footsteps of other health insurers unhappy with how regulators handled their quality ratings for 2025.
State Medicaid Directors Concerned About Program’s Stability: KFF
The presidential election, loss of higher federal funding, inflationary pressures and other challenges are leaving state regulators uncertain about Medicaid’s “new normal.”
Enhancing Coverage of Preventive Services Under the Affordable Care Act Proposed Rules
These proposed rules would expand access to coverage of recommended preventive services without cost sharing in the commercial market, with a particular focus on reducing barriers to coverage of contraceptive services, including over the counter (OTC) contraceptives.
US Health System Ranks Lowest on Health Equity, Access and Outcomes, Commonwealth Fund Study Finds
The U.S. health system ranks last among 10 wealthy nations on key health equity, access to care and outcome measures, despite the fact it spends by far the most on healthcare, according to a study by the Commonwealth Fund.
Medicare Advantage Plans Received $4.2 Billion In Payments For Questionable Home Visits, Report Says
Medicare Advantage plans reaped $4.2 billion in extra payments last year by making home visits to senior citizens who may not have received treatment for serious health issues, a new government report has found.
Bonus Article
International Team Successfully Restarts Animal Brain, Offering Hope For Heart Attack Treatment, Better Transplants
Just for Fun
Math Joke:
Why should you never mention the number 288?
Prior Week
Q: Why don’t circles ever argue with triangles?
A: Because circles always know how to keep things “well-rounded”!
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