Wakely Wire
December 19, 2024
New Insights
Whitepapers, briefs, press releases and more
High Cost Members in Medicare Advantage Plans Strategies for Success
The management of high cost or complex condition members is a vital component of a successful Care Management program. These members make up a disproportionate level of costs, and losses, to Medicare Advantage Organizations (MAOs). On average, the costs associated with high-cost members are more than three times greater than the risk-adjusted revenue received from the Centers for ... Read more
Week in Washington 12/19/24
Budget Bill A little bit of chaos this week for the end of year package. Congress has until the end of day December 20th to pass a spending bill to avert a government shutdown. The initial bill that many had expected to pass failed at the last minute to pass the House. The result is ... Read more
Newsworthy Findings
MedPAC Supports Add-On Payments for Low-Income Medicare Patient Care
Commissioners on the Medicare Payment Advisory Commission largely supported recommendations to increase pay for physicians and other health professionals by slightly less than inflation, and establish add-on payments for services delivered to low-income enrollees.
Breaking News: CMS Will Terminate MA Value-Based Insurance Design Model at End of 2025
The Centers for Medicare & Medicaid Services (CMS) announced Monday it will stop the Medicare Advantage (MA) Value-Based Insurance Design (VBID) model at the end of 2025 due to the model’s “substantial and unmitigable costs” to the Medicare Trust Funds.
Stopgap Funding Bill Includes Sweeping PBM Reform, Preserves Telehealth Flexibilities
Lawmakers Tuesday night released the full text of a bipartisan agreement to fund the government through March.
CMS Says Private Medicare Plans Can’t Automatically Deny Biogen’s ALS Drug
In a rare move, the U.S. agency behind Medicare is warning Medicare Advantage providers they can’t have blanket policies that deny coverage of Qalsody because it’s “experimental and investigational.”
CMS: Health Spending Grew by 7.5% in 2023 Amid Increase in Insurance Coverage, Care Utilization
Healthcare spending in the U.S. reached nearly $5 trillion in 2023, driven by increased insurance enrollment, higher utilization of services, and rising costs in hospital care, prescription drugs, and private insurance, according to a CMS report.
Bonus Article
Tiny Implantable Sensors Helped Broken Bones Heal in Weeks Rather Than Months
Just for Fun
Math Joke:
Why was the equal sign so humble?
Prior Week
Q: Why couldn’t the angle get a loan?
A: Its parents wouldn’t cosine.
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