COVID-19 has had a financially debilitating effect on many medical practices. Some practices are not expected to survive. The impact has been felt by physicians as well as other healthcare entities and led to severe declines in fee-for-service revenue. The pandemic also caused the Center for Medicare and Medicaid Innovation to make adjustments to its Direct Contracting (DC) program. DC adjustments include adding a second cohort that begins January 2022, providing a capitation payment glide path, and increasing physician capitation choices.
These changes create an opportunity for organizations considering becoming Direct Contracting Entities (DCEs) to attract physicians who may not have been interested in the program previously. The application window for the second cohort of DCEs opens in March 2021. In this brief, Milliman’s Coleen Young, Hugh Larson, and Annie Man discuss DC and the impact of COVID-19 on physicians.
In the United States, the COVID-19 pandemic has put millions of people out of work. A portion of the newly unemployed and their families are expected to seek health insurance coverage. Some have been furloughed, which allows them to keep their employer-sponsored health insurance while applying for unemployment benefits. Others may be able to find employer-sponsored health insurance coverage with parents or spouses.
Before the Patient Protection and Affordable Care Act (ACA), newly uninsured adults and families could purchase COBRA coverage, individual market plans, or short-term plans, enroll in Medicaid, or participate more fully in federal health options for which they were eligible. Today, newly unemployed adults and their families have the following additional options not available prior to the ACA:
- Individual market plans through the state or federally run marketplaces with federal premium assistance for qualifying households
- Expanded Medicaid coverage in 36 states
- Young adults (under age 26) can enroll in their parents’ employer-sponsored insurance
In this brief, Milliman’s Annie Man and Barbara Dewey discuss the health insurance options available to the newly unemployed and how this may affect the ACA individual market.
Medicare Advantage (MA) plans
must cover all benefits offered by original Medicare. MA plans may offer extra
benefits such as dental and vision, called “supplemental benefits,” that are
tailored to improve the health of existing members, appeal to prospective
members, or provide the benefit of group purchasing power.
With the widespread nature of
COVID-19, social distancing measures have become a daily practice that affects
most Americans right now and have the potential to affect seniors for a longer
duration. Some supplemental benefits like a fitness benefit, which are intended
to keep seniors active, may not achieve their intended goals when gyms are
closed or discouraged for high-risk individuals.
In this brief, Milliman’s John Rogers, Annie Man, and Kyle Hutmaker examine how MA plans might think about offering supplemental benefits for 2021. While no one knows what will happen with COVID-19 in 2021, in the absence of a vaccine or other curative treatment, MA plans should consider the possible effects of the disease well into the future.
In September 2016, the Center for Medicare and Medicaid Innovation (CMMI) selected NORC at the University of Chicago to conduct an independent evaluation of the Next Generation Accountable Care Organization (NGACO) Model program. On August 27, 2018, CMMI released NORC’s first report on the findings of its evaluation, which included NORC’s estimate of the impact of the NGACO program on Medicare Part A and Part B spending (gross impact) in 2016. NORC defined the net impact of the program by combining this gross impact with the results of the NGACO program’s shared savings and losses. These results were published by CMMI in October 2017 (i.e., shared savings and losses).
In this paper, Milliman consultants combine the aggregate gross impact of each of the NGACOs shown in the NORC report with the shared savings/(loss) results of each NGACO to calculate the net impact of each individual NGACO.
Under the Medicare Access and CHIP Reauthorization Act of 2015, healthcare providers that participate in a Medicare Shared Savings Program (MSSP) as Track 3 accountable care organizations may qualify for the advanced Alternative Payment Model 5% bonus. Track 3 was first offered in 2016. This paper by Milliman consultants discusses first-year MSSP Track 3 performance and possible drivers of success.
Next Generation Accountable Care Organizations (NGACOs) now need to choose between whether they want to have their annual financial reconciliations based upon capped claims or uncapped claims. Previously, they didn’t have a choice and reconciliations were based upon capped claims. For some NGACOs, the choice between an annual financial reconciliation based upon capped claims or uncapped claims could have significant impact. Milliman consultants provide more perspective in this paper.