Our jobs in healthcare are never boring and 2018 proved the point. There are just so many moving parts in the healthcare world and it is often hard to sit back and take it all in.
Well, here goes our quick recap of 2018 for what it’s worth.
- Medicare Advantage (MA) and Part D continue to be the place to be in healthcare. Growth continued at high levels for MA overall with the PPO product continuing to be a super growth area.
- CMS continued its strong Medicare compliance regime. Program audit scores improved but compliance actions remained high. Indeed, CMS is further honing its audit regime. It is also merging Chapters 13 and 18.
- CMS focused on IRE auto-forward rates and the OIG published a study on the high-rate of overturns at various appeals’ levels.
- Medicare provider network accuracy was a major focus.
- A major focus, too, was MA Special Needs Plans, with various announced changes for C-SNPs and D-SNPs coming in the future.
- CMS entered the digital age by saying that plans may fulfill various member materials, including regulatory letters, via email and portals if enrollees opt in.
- 2019 MA and PDP Star measures tuned out to be relatively flat in terms of the number of plans hitting 4 Star and above and the percentage of members in such plans. But the Centers for Medicare and Medicaid Services (CMS) have to proud of all they have accomplished in this decade.
- The MA and PDP Star road map continues to focus on new and more complex measures that will take all health plan departments coordinating to succeed.
- Major changes were announced for the Medicare Opioid program and the CARA drug lock-in program guidance was issued.
- 2018 also saw two major policy changes by CMS in Medicare that will drive growth and help improve outcomes and eventually save money.
- Plans are now able to vary benefits to certain members within a plan if these cost-sharing reductions or added benefits or services help get chronic conditions under control.
- Similarly, plans can now offer non-traditional Medicare benefits, such as home supports, to reduce long-term care costs and keep people in the community.
- CMS continued refining the Medicare rate methodology for plans and reintroduced the phaseout of the current risk adjustment submission process.
- CMS announced it would abandon its Medicare provider enrollment process in favor of plans monitoring for precluded providers. This change will occur in early 2019.
- Major pharmacy changes in Medicare drug coverage were announced to save money, including Step therapy in Part B, Part D indication-based UM, and lower costs in the Part D Coverage Gap for seniors and the disabled.
- CMS announced that for 2019 it would liberalize enrollment in the early year enrollment period to allow for MA plan enrollment, as well as curb the ability of duals to jump plans too often.
- The so-called death panel (the Independent Payment Advisory Board) met its demise through repeal.
- CMS also signaled that waste, fraud and abuse will have a renewed focus in government programs, including new Medicaid managed care plan financial audits.
- CMS announced it is tweaking the Medicaid mega rule, but the Obama-era regulation remain substantially intact and will drive compliance and quality in the program.
- 1115 waivers began taking hold largely in more conservative states. These included experiments with work requirements to access the program.
- The Children’s Health Insurance Program received a long reauthorization, saving it from petty politics over the next several years.
- The Trump administration floated a number of drug policy ideas, including a price control measure, that could galvanize bipartisan action in 2019.
- The assault on Obamacare continued in 2018, including with the recent federal court decision that the law may be unconstitutional after the zeroing out of the individual mandate in the Republican tax bill.
- The Trump administration announced it wants to tackle social determinants and long-term care, opening up another bipartisan policy opportunity.
- Amazon got into the drug game with the purchase of PillPack, an online pharmacy.
- CVS closed its acquisition of Aetna, with Cigna closing its purchase of Express Scripts. Anthem rolled out its PBM. Humana and Walgreens announced they will take stakes in each other and forge a strong relationship. WellCare acquired Aetna’s PDP business (2 million lives) and closed on its buying of Meridian Health Plan.
- The Three Wisemen (Warren Buffett of Berkshire Hathaway, Jeff Bezos of Amazon, and Jamie Dimon of JP Morgan Chase) announced they were forming a new insurance entity that will rationalize cost and quality in the commercial world. They will start with their companies.
Well that’s it. Did you make it through this list and 2018?