Wakely Wire

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Whitepapers, briefs, press releases and more

Falling Stars: Wakely Dissects the Decline in Medicare Advantage Star Ratings

Updated October 31, 2024 On October 10th, CMS publicly released the 2025 Medicare Part C and D Star Ratings. Wakely has quantified the significant decline in 2025 Star Ratings on Quality Bonus Payments, or QBPs, for 2026. The result of our analysis: somewhere between $4 and $5 billion less in 2026 QBPs. This whitepaper dissects ... Read more

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Week in Washington 10/31/24

Medicare Negotiation Lawsuit The multiple lawsuits challenging implementation of the Inflation Reduction Act drug negotiations continue to wind their way through the court system. Oral arguments were heard yesterday at the Third Circuit Court. To date the government hasn’t lost a major hearing but the cases are ongoing. On the Campaign Trail Speaker Mike Johnson ... Read more

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Events & More

Falling Stars: Who's Who in the 2025 Star Ratings

This webinar will cover the recently-released 2025 Star Ratings, including an analysis of the expected impact on 2025 Medicare payments. Attendees should expect to hear discussions of the latest performance and program changes, along with the resulting impact on the contract level star ratings. We’ll also dive into the dramatic increase in cutpoints and discuss what plans can expect over the next few years. Beyond cutpoints, we will cover other upcoming changes to the Star Rating program and discuss their potential impact on Medicare Advantage Organizations (MAO).

Learn more and register

Mastering Star Performance: Analytics and Stratification for Success.

Wakely’s parent company, HMA, will also be hosting a webinar on November 13th at 12pm ET. This webinar will focus on how MA plans can optimize their Star Ratings using the HMA Stars Accelerator Playbook.

Learn more and register

Newsworthy Findings

For People With Opioid Addiction, Medicaid ‘Unwinding’ Raises the Stakes

As of September, more than 25 million Americans — including 1.9 million Floridians — had lost Medicaid coverage since the expiration of federal covid-19 pandemic protections in March 2023 that had kept people continually enrolled.

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Editor's Note
It is unclear how many people with opioid addiction have lost coverage in the Medicaid disenrollment, known as the “unwinding.” But research estimates that more than 1 million low-income Americans depend on the federal-state Medicaid program for lifesaving addiction care.

‘Dreamers’ Can Enroll in ACA Plans This Year — But a Court Challenge Could Get in the Way

When open enrollment for the Affordable Care Act starts nationwide this week, children brought to the United States without immigration paperwork who have since qualified for the Deferred Action for Childhood Arrivals program will be eligible for the first time.

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Editor's Note
States challenging the ACA rule say it will cause administrative and resource burdens as more people enroll, and that it will encourage additional people to remain in the U.S. when they don’t have permanent legal authorization.

Humana Boosts 2024 Earnings Guidance Thanks to Medicare Advantage Member Retention

Despite the stronger membership, Humana doesn’t expect earnings growth next year due to significant investments the insurer plans to make to boost MA stars.

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Editor's Note
The earnings are linked to retained membership, as well as higher risk scores that result in higher reimbursements.

Change Healthcare Cyberattack Affected PHI of 100 Million

This represents a third of the population and makes the data breach the largest one known at a HIPAA-regulated entity.

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Editor's Note
This cyberattack cost the company $22 million in ransom, and they are still in the restoration process since the attack in February.

Palliative Care in the ED Reduces Costs, Improves Patient Outcomes

The presence of an embedded palliative care practitioner in the emergency department can significantly improve patient outcomes and reduce costs.

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Editor's Note
A 2023 study found that including palliative care clinicians in an ED setting can produce over a 6% return on investment in health systems.

Bonus Article

Just for Fun

Math Joke:

Why is there no use in arguing with pi?

Prior Week

Q: Why should you never mention the number 288?
A: Because it’s “two” gross!

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