Health plans are focused on capturing membership in the expanding Medicare market—and open enrollment is right around the corner. Right now there are 11 major benefit categories covered under Part A and Part B. Of that, 76% of Medicare beneficiaries are in managed care plans, or are assigned to accountable care organizations (ACOs). Specifically, 53% are in Medicare managed care, 18% are in a Medicare Shared Savings Program (MSSP), and 5% are in other ACOs or ACO-like models. That leaves 24% of beneficiaries with both Part A and Part B coverage in traditional fee-for-service (FFS) Medicare . . .

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Medicare

The Medicare program is a health insurance program funded by the federal government for older adults, aged 65 and above, as well as younger individuals who have disabilities or end-stage renal disease. There are both strategic opportunities and challenges for health and human service provider organizations serving Medicare beneficiaries, who often have complex health and social support needs. As a result, Medicare plans are looking for innovative services and initiatives that demonstrate a return-on-investment in spending and consumer outcomes.


Medicare mental health specialists with high uptake of telemedicine mental health services between 2018 and 2023 had a 0.88 percentage point higher share of services provided to fee-for-service (FFS) beneficiaries in rural areas, compared to mental health specialists in the lowest telemedicine uptake quartile, according to a recent study. Much of the increase in rural service use was due to existing patients moving farther away from their specialists, rather than new rural beneficiaries seeking out… Read