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Medicare

CMS Wants to Steer Accountable Care in a New Direction with ACO REACH

CMS Wants to Steer Accountable Care in a New Direction with ACO REACH

Mar 21, 2022 | Medicare

By Surabhi Dangi-Garimella, PhDd The Centers for Medicare and Medicaid Innovation—also known as the Innovation Center—wants to redesign the recently launched Global and Professional Direct Contracting (GPDC) Model to encourage care coordination and improve the quality...
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Letter Supported: Step Therapy for Part B Drugs in Medicare Advantage

Letter Supported: Step Therapy for Part B Drugs in Medicare Advantage

Nov 30, 2021 | Letters Supported, Medicare

The undersigned organizations, representing millions of Medicare beneficiaries with life-threatening, complex, chronic conditions and/or the physicians who care for them, are asking the Centers for Medicare and Medicaid Services (CMS) to ensure that beneficiaries...
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Comment Solicitation on Policy Modifications on Non-Opioid Pain Management Drugs

Comment Solicitation on Policy Modifications on Non-Opioid Pain Management Drugs

Sep 10, 2021 | Access, Actions, Federal Issues, Medicare

There is a constant drum beat around the rising cost of drug prices, with little discussion of the benefit design in plans whether they are government or employer sponsored. Medicare Part B requires patients without supplemental coverage to pay a 20% copay on all...
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CMS Wants to Steer Accountable Care in a New Direction with ACO REACH

Bundled Payment Model for End-Stage Renal Disease Introduces Step Therapy Complications

Sep 2, 2021 | Medicare

By Surabhi Dangi-Garimella, PhD Medicare’s Proposed Rule for the End-Stage Renal Disease (ESRD) Payment Model for Calendar Year 2022 was published on July 9, 2021. Established in 2011, this payment ‘bundle’ provides an adjusted payment to an ESRD facility for each...
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CMS Wants to Steer Accountable Care in a New Direction with ACO REACH

Diabetes Prevention for Medicare Beneficiaries Needs Sustaining Policies

Aug 12, 2021 | Medicare

By Surabhi Dangi-Garimella, Ph.D. With more than 25% of Medicare beneficiaries over 65 years suffering from diabetes, the Centers for Medicare & Medicaid Services (CMS) deployed a Medicare Diabetes Prevention Program (MDPP) in 2018, with interventions that...
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CMS Wants to Steer Accountable Care in a New Direction with ACO REACH

Inpatient or Outpatient Care? CMS Savings Will Burden Patient Pockets

Apr 8, 2021 | Medicare

By Surabhi Dangi-Garimella, Ph.D. Among the policies that previous Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma finalized before leaving office was to phase out Medicare’s Inpatient Only (IPO) list by 2024 so more procedures will be...
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