Developing population health management programs under risk-based contracts

Risk-based contracts are driving the development of population health management programs (PHMPs) that are designed to achieve the Institute for Healthcare Improvement’s Triple Aim goals. Health systems may need to redesign how they deliver healthcare to meet these goals. Risk-based contracts often give providers both the financial flexibility and incentive to redesign care.

In the article “Population health management program development: The path to the Triple Aim,” Milliman’s Nick Creten and Blaine Miller discuss the following five steps healthcare organizations must address when developing a PHMP in a risk-based contracting environment.

Step 1: Assess population costs, utilization, and risk
Step 2: Identify opportunities
Step 3: Segmentation
Step 4: Intervention development
Step 5: Monitor, assess, and improve

Regulatory roundup

More healthcare-related regulatory news for plan sponsors, including links to detailed information.

IRS extends due dates for furnishing to individuals with 2016 Form 1095-B and Form 1095-C
The Internal Revenue Service (IRS) released Notice 2016-70, which extends the due dates for certain information reporting requirements for 2016 imposed by the Patient Protection and Affordable Care Act (ACA) under section 6055 and 6056 of the Internal Revenue Code.

Specifically, this notice extends the due date for furnishing to individuals the 2016 Form 1095-B, Health Coverage, and the 2016 Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, from January 31, 2017, to March 2, 2017. This notice also provides for transitional good-faith relief from the penalties imposed by sections 6721 and 6722 of the Internal Revenue Code relating to the 2016 information reporting requirements under sections 6055 and 6056.

To read the entire notice, click here.

The ACA transitional reinsurance program
The Congressional Research Service (CRS) released “The Patient Protection and Affordable Care Act’s Transitional Reinsurance Program.” The first section of the report provides background information on reinsurance and the ACA risk-mitigation programs. The second section describes the components of the transitional reinsurance program as well as the amounts currently collected and remitted through the program. The third section discusses questions, including those raised by a recent Government Accountability Office (GAO) report, regarding the scope of the authority of the Department of Health and Human Services to administer the transitional reinsurance program. The last section briefly summarizes relevant legislation regarding the transitional reinsurance program.

To read the entire report, click here.

Registration now open for 2017 advance monthly payments of the Health Coverage Tax Credit
The IRS opened the new registration and enrollment process for qualified taxpayers to receive the benefit of the Health Coverage Tax Credit (HCTC) on an advance monthly basis during 2017.

Eligible taxpayers can have 72.5% of their qualified health insurance premiums paid in advance directly to their health plan administrators each month. Each payment made on their behalf to the health plan administrators lowers their out-of-pocket premium costs.

To learn more, click here.

2017 COLAs for Medicare benefits

The Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) has announced cost-of-living adjustment (COLA) figures for Medicare Part A and Part B for 2017. In April this year, CMS announced the updated amounts for the Medicare Part D standard prescription drug benefit for 2017. This Client Action Bulletin provides perspective.

MedPAC’s proposed changes to Medicare Part D: Considerations for Part D plan sponsors

The Medicare Payment Advisory Commission’s proposed modifications to the Part D federal reinsurance program could change the financial dynamics for Plan D plan sponsors, particularly if appropriate updates are not made to the risk score model. This paper by  Milliman consultants David Liner and Nicholas Johnson outlines key considerations for plan sponsors as they prepare for proposed changes to the Part D program.

This article is part two of a two paper series. Read paper one about considerations for Part D stakeholders.

MedPAC’s proposed changes to Medicare Part D: Impacts on various Part D stakeholders

The Medicare Payment Advisory Commission (MedPAC) proposed several changes to the Medicare Part D program in a June 2016 report. MedPAC advises Congress on policies related to Medicare and its recommendations could potentially be enacted by Congress. This paper by Milliman’s Katie Holcomb and Julia Friedman discusses the impact that MedPAC’s proposed changes could have on plan sponsors, Part D members, and pharmaceutical manufacturers.