CMS proposes 0.25% increase in MA rates | Insurers need clarity, stability in exchanges, AHIP warns | Experts: Palliative care can play important role post-ACA
February 2, 2017
AHIP Solutions SmartBrief
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CMS proposes 0.25% increase in MA rates
Payments from the federal government to Medicare Advantage plan carriers would increase by 0.25% in 2018 under a CMS proposal announced Wednesday. The government did not proceed with plans to increase the use of encounter data in risk score calculations, something AHIP had said would base payments on faulty data and lead to rate cuts.
Reuters (2/1),  Modern Healthcare (tiered subscription model) (2/1) 
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Insurers need clarity, stability in exchanges, AHIP warns
Insurers need clarity, stability in exchanges, AHIP warns.
(Chip Somodevilla/Getty Images)
Health insurers are likely to leave Affordable Care Act exchanges or raise exchange plan premiums substantially if the administration does not take steps quickly to stabilize markets and provide clarity on the framework for 2018, AHIP President and CEO Marilyn Tavenner told the Senate Committee on Health, Education, Labor and Pensions. Tavenner stressed the importance of continued cost sharing reductions and premium subsidies, which she said could be restructured to incentivize enrollment by young adults.
The Washington Post (tiered subscription model) (2/1),  Bloomberg (2/1) 
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Position your plan to thrive through the next crisis
How can you be sure you're ready to serve your covered health plan members as COVID-19 subsides? Watch on-demand as panelists from eQHealth Solutions explain the significance of tailoring your risk-management strategy. Watch now.
Providers & Suppliers
Experts: Palliative care can play important role post-ACA
Repealing and replacing the Affordable Care Act could give states more power over health care access and payment, so they should consider ways to expand palliative care because data show it can improve quality of life and reduce costs, Stacie Sinclair and Diane Meier, both of the Center to Advance Palliative Care, write. States could consider policies that regulate facilities, clinicians and payments, and they can use their surveillance capabilities to assess the availability of palliative care, they write.
Health Affairs Blog (1/30) 
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Clinics improve care with focus on overlooked transitions
Montefiore Medical Group clinics in two New York counties improved patient care and clinical metrics by focusing on commonly overlooked care transitions. The group focused on improving the transition from a hospital emergency room or inpatient setting to outpatient care and from pediatric to adult care, along with transitions involving referrals between disciplines and when adding new patients.
Modern Healthcare (tiered subscription model) (1/28) 
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How to make shared risk work for everyone
Which strategies deliver real value? With goals for alternative payment established, what should health plans, providers, and purchasers do to ensure success? Eleven industry leaders evaluate the challenges, options, and priorities. Read the report from the Healthcare Financial Management Association.
Medical Update
Conn. monitors mothers, infants due to Zika, flavivirus
Connecticut's Department of Public Health is monitoring nine pregnant women who have tested positive for the Zika virus or flavivirus along with 30 infants whose mothers tested positive. Two of the infants have been confirmed as having Zika-related birth defects while nine were considered on the border of having them.
WVIT-TV (Hartford, Conn.) (1/30),  Connecticut Post (Fairfield County-Bridgeport) (1/30) 
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Emerging Trends
Study: Video decision aids may boost screening compliance
A study in the Annals of Family Medicine found the use of video decision aids might help get patients to follow evidence-based recommendations on prostate cancer and mammography screening. Researcher and family physician Barry Saver, M.D., said studies have shown traditional decision aids lead to just a modest increase in patient knowledge and little or no change in screening decisions.
AAFP News (1/30) 
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Health Insurance Plan Company News
Solutions Provider News
Pharma News
Takeda price increases in US to stay in single digits
Japanese drugmaker Takeda Pharmaceuticals affirmed its commitment to single-digit price increases in the US.
Reuters (2/1) 
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Policy Watch
GAO: CMS encounter data still not fully validated
The Government Accountability Office found the CMS has made inadequate progress on ensuring Medicare Advantage encounter data is accurate and complete and questioned the use of such data for risk adjustment. CMS officials said in the report they are working with MA carriers to refine their approach to encounter data, and they see the multiyear transition time frame as reasonable.
Health Data Management (1/31) 
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Senate Finance Committee moves to advance Price without Dems
In an effort to sidestep Democrats' boycott of votes on President Donald Trump's nominees for key Cabinet positions, the Senate Finance Committee suspended rules requiring at least one Democrat be present for a vote. The 14 Republican lawmakers present voted to send both Steve Mnuchin, the Treasury nominee, and Rep. Tom Price, R-Ga., the HHS nominee, forward for a vote by the full Senate.
CNN (2/1),  NBC News (2/1) 
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Speakers announced for Institute & Expo
Share ideas and learn from the most respected voices at AHIP's Institute & Expo, June 7-9 in Austin, Texas. Keynote speakers include Anthem's Joseph Swedish; GSD&M's Roy Spence; Zubin Damania, MD -- aka "ZDoggMD" -- from Turntable Health. Learn more and register.
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One powerful professional resource
AHIP offers a powerful professional resource for networking, career development, and news about the health insurance industry. Did you know an Individual Membership can be a smart investment? Health insurance agents and brokers, as well as health care industry consultants and attorneys, may be eligible to apply for membership. Preview the benefits, check your eligibility status, and join today.
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Video: The importance of the EPA National Environmental Leadership Award
Each year, the EPA distributes the National Environmental Leadership Award in Asthma Management, which recognizes health plans that deliver excellent environmental asthma management. Learn the value of the award and national recognition through the new video posted at
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