Medicare
Accelerating Primary Care Redesign: CMS’ Innovation Center Announces Five New Transformative Models
By Billy Wynne, Katie Pahner, and Josh LaRosa
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April 24, 2019
On April 22, 2019, the Centers for Medicare and Medicaid Services (CMS) announced the Primary Cares Initiative (PCI), a suite of five voluntary payment models aimed at overhauling primary care. Marking the Trump Administration’s latest investment in Medicare value-based reform, PCI focuses on the role of primary care providers as the central coordinators of patient health, with the goal of enhancing patient care while lowering overall Medicare fee-for-service (FFS) costs. Once implemented, CMS estimates that more than a quarter of all Medicare FFS beneficiaries – nearly 11 million individuals – will be included in these transformative primary care delivery models....
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A Tell-All on Telehealth: Where Is Congress Heading Next?
By Billy Wynne and Josh LaRosa
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May 16, 2019
The Centers for Medicare and Medicaid Services (CMS) recently enacted modest but important expansions in Medicare’s telehealth policy.
Telehealth, which uses telecommunications to support virtual health care delivery to improve access to and quality of health care, is moving from promise to reality. The benefits are appealing: Patients can interact with their providers remotely, which improves access to care and can help providers manage chronic conditions from afar....
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The Drug Pricing Debate Part II: The Many Acts of Congress
By Billy Wynne, Josh Larossa, and Alyssa Llamas
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July 30, 2019
As we outlined earlier this spring, congressional action on drug pricing continues to intensify. Key committees have advanced an array of reforms, demonstrating Congress’ intent to finalize legislation this year. We aim to clarify what that might include....
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The Drug Pricing Debate: Sizing Up Recent Actions and What May Come Next
By Billy Wynne and Josh LaRosa
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March 7, 2019
What goes up must — or rather, should — come down.
Such is the thinking of the Trump administration when it comes to prescription drug pricing, at least. Over the past five years, 12 of the 20 most commonly prescribed brand-name drugs have seen price increases of more than 50 percent.
To date, most of what we’ve seen from the federal government is messaging and some initial proposals, with the majority coming from the administration. Congress, for its part, has initiated a series of drug pricing hearings and begun introducing meaningful legislation. The result is a wide array of policy alternatives, some of which stand a chance of being enacted....
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Medicare’s Hospital Outpatient Prospective Payment System Proposed Rule: Big Changes For 2019
By Billy Wynne
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July 27, 2018
CEO Billy Wynne's breakdown of the key policy changes described in the CY19 Medicare Hospital Outpatient Prospective Payment System proposed rule....
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With Great Power Comes Great Responsibility: Medicare Advantage’s Newfound Supplemental Benefit Flexibility
By Billy Wynne & Max Horowitz
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June 7, 2018
The Centers for Medicare and Medicaid Services (CMS) recently made a series of interrelated policy changes to give Medicare Advantage (MA) plans more flexibility than ever to offer additional services outside of traditional Medicare. Known as supplemental benefits, these services have historically included items like dental, vision, and hearing. By allowing plans to offer an even wider and more tailored array of services, CMS expects that plans will be better positioned to attract members and meet beneficiary needs.
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The Consumerization Of Health Care To Improve Value: Secretary Alex Azar’s “Radical” Vision
By Billy Wynne & Max Horowitz
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April 23, 2018
HHS Secretary Alex Azar recently laid out a four-part strategy to achieve a "radical" vision of reforming health care: giving consumers greater control over health information, encouraging price transparency, using experimental models in Medicare and Medicaid to drive value, and removing government burdens. While certain elements of the secretary’s strategy reflect important reforms, his recommendations raise questions about the desirability of a shift toward consumerization of health care and whether these changes are actually in the best interest of consumers....
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What Does Alex Azar’s Plan for Value-Based Care Really Mean?
By Billy Wynne, Taylor Cowey
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April 9, 2018
New HHS Secretary Azar has articulated a four-point plan for value-based transformation of our health care system, but so far concrete details regarding the initiatives he will pursue are scarce. In this post, we break down the components of his plan and their potential implications for various health care stakeholders....
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The CHRONIC Care Act Passes Senate, Obstacles Remain
By Billy Wynne
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October 5, 2017
his post outlines the key components of the now adopted Chronic Care Act, assessed its outlook in the House, and considered what its progress may tell us about the prospect for more bipartisan action on health care in the future. ...
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Breaking Down The MACRA Final Rule
By Billy Wynne
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November 9, 2017
On November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) released a final rule making changes to the 2018 Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The QPP includes both the Merit-Based Incentive Program (MIPS) and Advanced Payment Models (APMs). This post explains the key policies implemented in the final rule....
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