Health Care Matters | October 4, 2024
Congress Still Has a Long To-Do List in 2024
On Monday, Modern Healthcare published an article listing the many unfinished items that Congress left until after the election when Congress returns. In addition to normal appropriations for FY25, Congress still has priority legislation up for negotiation that would provide $8 billion in Medicaid Disproportionate Share Hospital payment cuts, respond to the 2.9% reduction in Medicare physician reimbursement, provide funding for Community Health Centers, and extend telehealth flexibilities. These are only a few of the many health care bills that have been introduced in committee.
Why It Matters
Depending on the outcome of the election, many of these bills may be pushed to the next Congress. Additional legislative priorities on deck include prior authorization reform, site neutral payments, mental health parity, and health care cybersecurity standards. While many of these measures have some bipartisan support, whether they advance and in what form will have a lot to do with what the next Congress looks like.
Medicare Advantage Plans Preparing For Open Enrollment Fear Lower Star Ratings
In advance of CMS' release of official star ratings for 2025. which is expected next week, analysis of preliminary data indicate that some plans may see significant declines. Based on analysis by JP Morgan, only 25% of Humana members, the second-largest MA insurer in the country, will be in plans that are four stars or above next year compared to 94% this year. A number of other major insurers expect to maintain their star ratings. According to health care analysts, the 2025 cut points used to determine star ratings, which are based on 2023 data, have increased, meaning that even if a plan maintained measure performance rates from the prior year, their star rating may decrease. The increase is due to an overall market improvement in many measures that caused CMS to raise the bar.
Why It Matters
Lower star ratings for some plans may mean disruption to consumers ahead of annual enrollment as plans exit the market or modify their benefit design. Four or five star ratings mean increased revenue for plans from a 5% quality bonus payment that can fund additional supplemental benefits. CMS plans to pay out 11.8 billion in bonus payments to MA plans this year. The 2025 star ratings determine bonus payments for 2026. Star ratings also drive enrollment in a highly competitive market. Because of Humana’s anticipated drop in stars, their stock dipped 15% on Wednesday. Despite turmoil in financial markets for some plans, CMS reported that average monthly plan premiums for all MA plans are projected to decrease from $18.23 to $17.00 with benefit options remaining stable. As seniors begin to select plan options beginning October 15, it will be important to take a close look at how these plans compare due to significant variation across payers.
For Medicare Advantage enrollment resources, check out:
What We Are reading
Expanding Permanent Pathways In Medicare For Accountable Care
Leaders at CMS published a Health Affairs Forefront article detailing their approach for scaling Innovation Center models into the permanent Medicare program.
Recently Released
NOFO to Establish National Coordinating Center for AHRQ
State-Based Health Care Cooperatives
The Agency for Healthcare Research and Quality (AHRQ) has released a Notice of Funding Opportunity (NOFO) to establish a National Coordinating Center (NCC) to provide support and guidance to AHRQ’s state-based healthcare extension cooperatives.
Notice of Funding Opportunity (NOFO) applications are due by November 25, 2024.
New VBC Resources Available
Advancing Affordability in Value-Based Care Models
The Health Care Transformation Task Force presents 15 strategies that health care organizations can implement under VBC arrangements to drive affordable care for patients, increase access to care, and advance health equity.
The National Association of ACOs (NAACOS) shares lessons learned from the early days of ACO adoption through today based on in-depth interviews with leadership teams of high performing ACOs.
Medicare ACO Beneficiary Board Orientation
NAACOS, in collaboration with the Patient Advocate Foundation, has created a recorded orientation webinar to educate Medicare beneficiary representatives on ACO boards about value-based care and how to be an engaged patient voice.