Investigating the Medicare Diabetes Prevention Program (MDPP)

Diabetes is a condition that affects more than 1 in 4 Americans age 65 and older.1 Centers for Medicare and Medicaid Services (CMS) estimated that Medicare spent $42 billion more on beneficiaries that have diabetes than it would have spent if those beneficiaries did not have diabetes. Let’s take a look at PMPY (Per Member Per Year) spend breakouts in 2018 [...]

2020-03-10T15:57:52-04:00

2018 MSSP ACO Results: Optimistic Savings Trends Encourage New CMS Risk Sharing Program

The Centers for Medicare and Medicaid Services (CMS) released the 2018 Financial Performance results on all Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). CMS shared this data for the last six years, contributing to a more transparent, open evaluation of the program, and demonstrating how ACOs are not only increasing overall savings, but striving towards value-based care. [...]

2020-03-10T16:01:55-04:00

Medicare Advantage 101

Medicare is the federal health insurance program started in 1965 that is provided for individuals who meet certain criteria. Those who are over the age of 65, younger people who have certain disabilities, or anyone who has End-Stage Renal Disease (ESRD) qualify for Medicare insurance. In 1997 Medicare Advantage (at that time called Medicare+Choice) was signed into law which gave Medicare eligible beneficiaries more [...]

2020-03-10T16:07:25-04:00

An Exploration of the Primary Care First (PCF) Payment Model

Earlier this year, the Center for Medicare and Medicaid (CMS) announced five new payment models designed to transform primary care by paying providers for outcomes rather than services. One of the payment models is the Primary Care First (PCF) Model which is a voluntary, five-year alternative payment model (APM) aimed at reducing Medicare spending via prevention of acute hospital utilization, improving doctor-patient [...]

2020-03-10T16:09:52-04:00

Opioid Epidemic, Part 1: The Prevalence of Opioid Use Disorder and Impact of Distressed Communities

The opioid epidemic is a serious public health crisis that is affecting the nation’s social and economic welfare. In 2017, opioids were responsible for about 130 deaths per day, more than 47,000 yearly. Opioid prescribing rates are three times higher than they were in 1999 while opioid overdoses are an astounding five times higher. How did this happen? [...]

2020-03-10T16:14:42-04:00

Rethinking Referrals to Post-Acute Care

In the wake of the Affordable Care Act (ACA), hospitals have drawn attention from policymakers as key partners in reducing the overall cost of care. Consequently, the effort has led to an enhanced focus on preventing readmissions and reducing unnecessary care. The ACA implemented several policy measures to hold hospitals accountable for what happens to patients post-discharge. [...]

2020-03-10T16:18:57-04:00

Those Who Switch, Part 1: Understanding Geographic Trends in Medicare Advantage Enrollment

CareJourney’s Network Advantage platform is largely built upon the full Medicare fee-for-service claims dataset, but it is used by members to draw insights about population health and quality of care for all Medicare enrollees. While fee-for-service and Medicare Advantage beneficiaries are sometimes considered as two distinct groups, these populations are fluid, as beneficiaries can switch enrollments in any given year. [...]

2020-03-17T11:07:21-04:00
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