Blog
A Pulse on Healthcare Insights, Trends, and Hot Topics
Measuring the Success of Medicare Advantage Open Enrollment 2019
While much of the healthcare market hypes Open Enrollment (OE), for CareJourney, the months to follow are an equally exciting time. During OE, the Centers for Medicare and Medicaid (CMS) and health plans are able to recruit new (and retain existing) Medicare Advantage (MA) insurance plan beneficiaries as individuals select their choices for the year. [...]
Understanding the Direct Contracting (DC) 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. Direct Contracting and Primary Care First are two of these models announced by CMS to help encourage providers […]
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 [...]
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. [...]
Exploring Variation in Healthcare Services in the Medicare Diabetic Population
As of February 2018, about 30 million people (or 9.4% of the U.S. population) suffered from diabetes; another 84 million people aged 18 or above had prediabetic symptoms.1 Diabetes is a chronic condition; proper and timely diabetes care management is critical to ensure that people with diabetes can avoid long-term sequelae and maintain their quality of life. [...]
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 [...]
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 [...]
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? [...]
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. [...]
Those Who Switch, Part 2: Investigating Characteristics of Medicare Advantage “Switchers”
In the last post, we highlighted trends in the migration of beneficiaries between Medicare fee-for-service and Medicare Advantage in the United States. In doing so, we can understand why this is such a hot topic for so many of our members across various markets. We are regularly asked: What can we learn about Medicare Advantage populations [...]
Want a walk through of our product?
Request a full demo presentation of CareJourney’s features and capabilities. We can integrate complex open healthcare data to help drive your population health strategy into action using customized analytics.
