In-home services have been shown to address social determinants of health and health equity. But finding capacity and arranging services for members remains a problem. “It is always difficult to find the right provider at the right time to meet the specific needs of...

Providing care and services to people following a hospital stay or during an extended illness is critical. But timely access to care remains a massive problem. For health plans and providers, the process often involves intricate workflows, multiple healthcare IT...

The rapid growth of our aging population is reshaping how we think about administering long-term care in the home. But accessing in-home services remains a massive problem. Persistent workforce shortages and rising care costs present hurdles. And new mandates from CMS...

Forward looking health plans are leveraging supplemental and home-based benefits as an integral part of their value-based care strategies and programs. Many are offering preventative interventions including ADL support through homemaker and home health aide services,...

Most Medicare Advantage (MA) plans use the extra benefits they offer to attract new members and differentiate themselves from Medicare. That's nothing new.  What is new is increasing pressure from CMS to deliver those benefits in a high-quality, low-cost manner.  But...

Demand for behavioral healthcare services has skyrocketed, reflecting a growing recognition of the importance of mental health. However, access to these essential services remains a challenge.  Behavioral health conditions affect people of all ages: About one in five...

Dina has named healthcare veteran Sherman Sanchez as its new president. In this role, Sanchez will collaborate with the executive team to steer the company's continued growth and innovation strategy. Sanchez brings a 20-year track record of high growth and...

The “Ensuring Access to Medicaid Services'' rule has been finalized and the “80-20” provision has gone through as proposed. This means providers will eventually need to direct 80% of reimbursement for home- and community-based services (HCBS) to caregiver wages. ...

Higher medical spending could be the new normal for the future of Medicare Advantage plans — and insurers will have to find a way to respond, according to a recent McKinsey report.  Some MA payers reported higher-than-expected inpatient and outpatient care utilization...

Non-medical supplemental benefits like personal care, meal delivery and home modifications have become important to health plans as a way to meet member’s needs and differentiate themselves from Medicare and their competitors. But they often struggle to operationalize...

CMS has signaled a renewed commitment to health equity with the introduction of the Health Equity Index (HEI), designed to motivate Medicare Advantage (MA) plans to identify and address disparities in care to members with social risk factors such as dual-eligibility,...

First Analysis Managing Director Andrew Walsh is a longtime healthcare executive and entrepreneur, who has worked with organizations like Optum, UnitedHealth Group and DaVita Health. He founded and scaled Educerus Health Solutions (acquired by PopHealthCare), an...

CMS released its much-anticipated 2024 Medicare Advantage final rule and Part D, which go into effect in 2025, codifying many of the provisions it proposed in the fall. We highlight six changes that will impact general enrollment MA plans, supplemental benefits...

Much like social determinants of health, addressing health related social needs (HRSN) is important for improving overall health outcomes and reducing health disparities. Several states are taking steps to address health related social needs and CMS is offering...

The shift to value-based care and the role of health plans to support that vision was a key theme at the recent RISE National Conference in Nashville. “We continue to hear from benefit and in-home service providers about the importance of creating value and moving the...

CMS recently published an update on its Medicare value-based care strategy that anchors on three pillars: alignment, growth and equity. Notably, CMS calls on MA plans to use supplemental benefits to create value, and lean into the shift to value-based care. This call...

The D-SNP market continues to grow to accommodate the rapid rise of the dual-eligible population and ongoing policy changes from CMS that will shape the market. Beneficiaries who are dually enrolled in both Medicare and Medicaid are cited as a target pocket of growth...

CMS has proposed regulatory requirements for supplemental benefits in 2025 that will demand a new approach from Medicare Advantage plans. And with recent legislative progress, some changes are increasingly close to a reality.  With an eye on the ever-evolving health...