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.

Latest Resources

• WelbeHealth Announces Opening Of Two New PACE Centers, In Sacramento County & San Bernardino County, California
• MedBetter Health Selects Alzheimer’s Community Care As Key Partner In Delivering Medicare GUIDE Dementia Model
• SCAN Health Plan Expands Its Footprint Into Washington State And Broadens Its Presence In California And Texas
• Medicare Advantage Organization SCAN Health Plan Launches ‘Health Insurance Is Broken’ Campaign
• Dually Eligible Individuals Received 91% Of Outpatient Care From Clinical Settings Other Than FQHCs & RHCs
• Medicare Spending On Remote Patient Monitoring Up 31% From 2023, To $536 Million
• Skilled Nursing Care Provider Organizations Report Frequent Medicare Advantage Plan Denials
• Real Physician Revenue Down 33.6% Since 2016 Due To Medicare & Medicare Advantage Reimbursement Trends & Inflation
• Medicaid MLTSS Programs Covered 71% Of Dual Eligibles In 2022, Up From 39% In 2012
• More Than 80% Of Home Health Agency Markets Were Highly Concentrated In 2022
• California Lessons
• 3.25% Of Medicare Beneficiaries Aged 45 To 64 In 2022 Had Young-Onset Dementia
• Author Health® Launches In CMS’s New Innovative Dementia Care Model
• CMS To Test Prior Authorizations To Reduce Wasteful Or Inappropriate Services In Fee-For-Service Medicare
• Most Medicare Advantage Beneficiaries Live In Highly Concentrated Markets With Few Plan Choices

See All

Telehealth Flexibilities Did Not Increase Outpatient Medicare FFS Visit Volume, But Did Result In Lower Post-Visit Costs

After Medicare eased telehealth restrictions during the COVID-19 public health emergency, telehealth visits among fee-for-service (FFS) beneficiaries rose during 2020, but then stabilized in 2021 and beyond. The increased volume of telehealth visits was not associated with an increase in the volume of outpatient evaluation and management (E&M) visits. Telehealth-initiated episodes of care were associated with lower use of lab tests and imaging compared to in-person visits. Telehealth visits were associated with lower 30-day Medicare… Read

• CMS Proposes New Behavioral Health Integration Add-On Codes For Advanced Primary Care Management Services
• Estimated Average Spending On Health Care During Retirement Rose 4% Between 2024 & 2025
• Nevada Medicaid To Launch PACE For Medicare, Medicaid Beneficiaries
• Physician Exit Rates From Traditional Medicare Accelerated From 2010 To 2023
• DOL Proposes Rolling Back Minimum Wage, Overtime Rules For Hospice, Home Health Aides

To sign-up for monthly Medicare alerts, you must be signed in to your account.