Plans must cover the same benefits as Traditional Fee-For-Service (FFS) Medicare, and these payments are risk adjusted to reflect the specific characteristics and anticipated cost of providing care to each beneficiary. Within this capitated payment, plans, providers, and community-based partners must work together to effectively care for the beneficiary. The goal of managing within a fixed payment is to encourage coordinated care that emphasizes prevention, customized care, and innovation to improve outcomes and prevent avoidable adverse events.
by Mary Beth Donahue Today the House Energy and Commerce Committee’s Subcommittee on Oversight and Investigations held a hearing on Medicare Advantage, entitled “Protecting America's Seniors: Oversight of Private Sector Medicare Advantage Plans." Lawmakers were…
On Tuesday, June 28th, 2022 the House Energy and Commerce Committee’s Subcommittee on Oversight and Investigations held a hearing entitled “Protecting America's Seniors: Oversight of Private Sector Medicare Advantage Plans." Better Medicare Alliance provided this statement…
It is important that beneficiaries’ complete diagnostic information is accurately captured so health plans can effectively manage their population’s clinical care. Stable payments and risk adjustment calculations are needed to ensure that adequate resources are…
