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Medicare Quality Big Focus for CMS

In lieu of its usual analysis, MedHOK is updating you on developments from past Strategic Insights.

Quality Focus in Medicare Advantage and Part D

CMS announced that many Medicare Part D plan ratings fell from 2011 to 2012. Ratings fell in part due to a greater focus on quality and compliance. CMS said 28% of Part D plans received poor ratings and just 24% were rated 4 and above. With very limited exceptions, 40% or more of residents in each state are in plans with fewer than 3 Stars.

The Part D news dovetails generally with statistics available from the Medicare Advantage program. In 2011, only a quarter of all enrollees were in plans with 4 or 5 Stars.

While quality bonuses do not come to standalone Part D plans, PPACA calls for quality bonuses for MA plans with 4 or better ratings. Because so few plans would receive bonuses for the next few years, CMS loosened the requirement to temporarily allow bonuses to 3 Star plans as well. CMS also has proposed a new regulation that will allow it to terminate plans that score below three stars for three consecutive years.

Governors still pushing Medicaid managed care expansion

Recently the National Association of Medicaid Directors endorsed greater flexibility to move dual eligibles into managed care in an effort to reduce costs and rein in high trends on this medically fragile population. While most costs for these individuals are in the Medicare world, the Medicaid efforts (which could include integration of the two programs) could help reform Medicare as well.

Mississippi Gov. Haley Barbor (R) recently endorsed the notion of allowing states to share in savings in both programs. The concept has been endorsed by any number of governors on both sides of the aisle. Democratic governors endorsed the concept in a letter to the Super Committee tasked with ongoing deficit reduction.

Health law support falling

The Kaiser Family Foundation released a poll recently that showed a significant drop in support of the national health reform act. Much of the loss can be attributed to declining support among Democrats. Support now stands at its lowest since the law passed in March 2010: only 34 percent of Americans view national health reform favorably.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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