Wakely Wire

New Insights

Whitepapers, briefs, press releases and more

Oops, Let’s Do It Again: CMS Announces Sweeping Changes to 2025 Quality Bonus Payments

On June 14, 2024, the Center for Medicare and Medicaid Services (CMS) announced that they will recalculate the 2024 Star Ratings for the purpose of determining 2025 Quality Bonus Payments (QBPs), following recent court rulings in favor of SCAN Health Plan and Elevance Health, Inc. As a consequence of this decision, many Medicare Advantage (MA) ... Read more

Read more

Week in Washington 06/27/24

Campaign KFF created a good comparison of the two Presidential Health Care records and positions. You can find it here. There is a stark contrast between the candidates on a number of issues and KFF has a good summary of them. Congress Politico reports that several health care bills are potentially getting committee votes in ... Read more

Read more

Events & More

Unlocking Solutions in Medicaid, Medicare, and Marketplace

HMA Fall Conference • October 7–9
Pre-Conference: October 7 • Marriott Marquis Chicago

Recent decisions by CMS regarding Medicare Advantage (MA) plan Star Ratings will profoundly influence the MA market now and in the coming years. At HMA’s Fall Conference, expert-led sessions will delve into the evolving issues shaping MA as well as traditional Medicare landscapes.

As CMS intensifies its data collection efforts and puts downward pressure on MA rates, attendees will hear from health plan executives about impacts on plan bids and strategic directions. Discussions will also focus on:

  • Refining incentives to supplemental benefits to improved competitive positioning
  • Critical decision points driven by Medicare’s regulatory frameworks
  • Opportunities to drive improvements in integrated services and supports
  • Innovative approaches to reduce cost and improve quality outcomes
  • How health equity affects quality ratings

Read more

Newsworthy Findings

Appeals Court Upholds ACA’s Preventive Services Mandate, but Opens Door to Future Challenges

The Fifth Circuit Court of Appeals’ decision Friday is a win for the upwards of 150 million people that receive health insurance through their employers.

Read full article
Editor's Note
While the preventive services mandate was upheld, the judges stated that the USPSTF, a group of expert volunteers, didn’t have constitutional authority to issue recommendations of the benefits to be included in the mandate.

HHS Finalizes Info Blocking Penalties for Providers

Providers pushed back against the disincentives, with the Medical Group Management Association calling them “unnecessarily punitive.”

Read full article
Editor's Note
The penalties include the potential to miss out on annual payment increases, earn lower quality scores and be suspended from a major value-based payment program in Medicare.

Wyden blasts Express Scripts' pricing tactics, asks CMS to intervene

Senate Finance Committee Chair Ron Wyden urges CMS to enforce Medicare Part D requirements for PBMs to protect small pharmacies and ensure fair reimbursements.

Read full article
Editor's Note
Stricter enforcement may require PBMs to adjust reimbursement practices, impacting their financial interactions with pharmacies.

Where UnitedHealthcare is seeing cost savings in its Surest plan

UnitedHealthcare's Surest health plan, previously known as Bind, has demonstrated significant cost savings and improved utilization, with an Aon study showing over $400 in claims cost savings per member per year by eliminating deductibles and providing upfront pricing information.

Read full article
Editor's Note
The success of Surest's innovative approach to benefit design suggests potential for wider adoption of deductible-free plans with transparent pricing, potentially reshaping cost management and member satisfaction strategies for payers.

PatchRx to integrate medication adherence data with virtual care platforms

Remote therapeutic monitoring company PatchRx can now integrate its medication adherence insights into existing care management platforms through PatchRx Connect.

Read full article
Editor's Note
PatchRx derives medication adherence insights from a device that attaches to the cap of a prescription. The device transfers data to Patch’s web app, where clinicians can view a daily adherence score, consistency trends and the amount of medication taken per day.

Bonus Article

Boy Who Got Free Life-Changing Leg Surgery Returns to Same Hospital Ship a Decade on–Wanting to Be a Doctor

Romino developed bowed legs in early childhood which prevented him from walking properly. In 2015, his mother brought her three-year-old to a charity hospital ship called Africa Mercy, while it was docked nearby, and successful surgery was performed. This year, Africa Mercy returned to Madagascar, and Romino told the staff that he wants to become a doctor himself, inspired by the Mercy Ships surgeons that saved his legs nine years ago.
Read Full Article

Just for Fun

Math Riddle:

How are a dollar and the moon similar?

Prior Week

Q: What number has the same number of letters as its value?
A: Four