Medicare

The Medicare program is a health insurance program funded by the federal government for older adults, aged 65 and above, as well as younger individuals who have disabilities or end-stage renal disease. There are both strategic opportunities and challenges for health and human service provider organizations serving Medicare beneficiaries, who often have complex health and social support needs. As a result, Medicare plans are looking for innovative services and initiatives that demonstrate a return-on-investment in spending and consumer outcomes.

Latest Resources

• The Three Largest Medicare Advantage Organizations Denied Requests For Long-Term Acute Care & Inpatient Rehabilitation At Some Of The Highest Rates
• Older Adults In 41 States & D.C. Projected To Outlive Retirement Savings
• Medicare Spending Projected To Continue Rising Through 2034; Medicaid & Private Insurance Growth To Slow
• Nursing Home Closure Rates Averaged 0.9% Before COVID & 1.1% During Public Health Emergency
• CMS Strengthens Oversight Of Accrediting Organizations, Prohibits Mock Surveys Before Accreditation Reviews
• Connie Health Acquires Clearlink Insurance Agency & Announces Series B Funding To Accelerate Growth In Medicare
• 95% Of Appealed Medicare Advantage Skilled Nursing Facility Denials Were Reversed
• GoHealth Medicare & Health Insurance Broker Files Chapter 11 Bankruptcy
• New York Governor Hochul Announces Completion Of $54 Million Supportive Housing Development On Manhattan’s Lower East Side
• Percentage Of Florida Older Adults Hospitalized For Mental Disorders Increased By 16% Between 2022 & 2024
• Five-Star Hospitals Increased 32% While One-Star Hospitals Declined 12% In Medicare’s 2026 Quality Ratings
• Health Care Professionals At PeaceHealth To Participate In Medicare Value-Based Care Programs Supported By Honest Health
• PacificSource To Exit ACA Market & Pull Out Of Montana Entirely
• Federal Home Health Value-Based Purchasing Program Linked To Reduced Dementia Care Disparities
• Providence Health Plan In The Pacific Northwest To Wind Down Insurance Business

See All

Higher Telemedicine Use By Medicare Mental Health Specialists Linked To Slight Increase In Rural Access

Medicare mental health specialists with high uptake of telemedicine mental health services between 2018 and 2023 had a 0.88 percentage point higher share of services provided to fee-for-service (FFS) beneficiaries in rural areas, compared to mental health specialists in the lowest telemedicine uptake quartile, according to a recent study. Much of the increase in rural service use was due to existing patients moving farther away from their specialists, rather than new rural beneficiaries seeking out… Read

• CMS Accelerates Efforts To Support Health System-Wide Electronic Prior Authorization
• Payments For At Least 16% Of Medicare Virtual Check-Ins Potentially Improper; E-Visit Error Rate Was At Least 2.6%
• Humana Introduces New Value-Based Cardiology Care Partnerships For Medicare Advantage Members
• CMS To Exclude Unsupported Diagnoses From Medicare Advantage Risk Scores Starting In 2027
• Hospital-At-Home Associated With Similar Or Better Short-Term Clinical Outcomes Compared With Traditional Inpatient Care

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