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.
Key Facts: Over 3.5 million retirees nationwide, 20% of Medicare Advantage beneficiaries, are in EGWPs. Retiree enrollment continues to grow, nearly doubling since 2010. • Medicare Advantage employer plans provide the following benefits to retirees:…
Better Medicare Alliance presents the paper, “Understanding Risk Adjustment in Medicare Advantage.” Medicare Advantage relies on accurate and stable risk adjustment that ensures plans and practitioners are able to provide high value care to all beneficiaries, including…
In this report, Better Medicare Alliance and researchers from NORC at the University of Chicago examine the current limitations of measuring patient experiences in the Medicare Advantage and Prescription Drug (MA-PD) Consumer Assessment of Healthcare…
