Boost Performance & Stay Ahead of Regulatory Changes

Medicaid enrollees who used long-term services and supports (LTSS) had disproportionately high spending in 2020, but just 24% who utilized the benefit did so in an institutionalized setting, according to a recent KFF report.  As the population continues to age, it is...

Special Needs Plans (SNPs) and Medicare-Medicaid Plans (MMPs) have long worked to match their dual members with much-needed in home services such as personal care or transportation.  As more plans offer these types of non-medical services, are they having the intended...

Health plans, healthcare providers, and community-based organizations (CBOs) are increasingly partnering to deliver home- and community services to older adults, many of whom have chronic health conditions or disabilities.  These partnerships can be game changers,...

SCAN Group, a mission-driven organization whose holdings include SCAN Health Plan, one of the nation’s largest not-for-profit Medicare Advantage plans, has made its latest strategic investment in Dina. Earlier this year, Dina and SCAN launched a program in California...

As more health plans prioritize the home as a primary site of care, they’ll also need to invest in the tools, services, and partners to build out that capability beyond traditional home care.  Personal care, meal delivery, home modification, and transportation are...

Seniors, people with disabilities, and those with chronic conditions rely on Medicaid home and community-based services (HCBS) to live independently outside of nursing homes and other institutions. Medicaid fills an important gap as the sole source of coverage for...

Millions of people – children, adults, and seniors – need to access long-term services and supports (LTSS) as a result of disabling conditions and chronic illnesses. In 2020, an estimated 5.8 million people used LTSS delivered in home and community settings, and 1.9...

Chronic care management (CCM)is an urgent need as chronic disease is a significant driver of healthcare costs.  Those living with chronic conditions interact with the healthcare system in unique ways and as the number of chronic conditions increases, so do the...

Most benefit coordination is bogged down by time-consuming tasks– phone calls, faxes, multiple emails–to identify and activate services for members. And as people continue to age in place, the demand for a full range of services to support them intensifies.  Jacqui...

As of April, Medicaid was serving almost one in four Americans. However, most Medicaid plans struggle to unlock benefits and coordinate personal services that could help seniors stay in their homes safely and longer. This was a central theme of the recent Home and...

Medicare Advantage (MA) enrollment has been on a steady climb for the past two decades following changes in policy designed to encourage a robust role for private plan options in Medicare.  In 2023, 30.8 million people are enrolled in a MA plan, accounting for 51%...

Supporting people who are aging in place often requires basic home modifications like removing trip hazards and installing grab bars, handrails and other assistive devices. These changes can help people reduce the risk of falls and stay home safely. “Aging in place...

The continued growth in the Dual Special Needs Plan (D-SNP) space is tempered only by the frustration associated with members who can (and do) switch throughout the course of the year. The 2023 Dual Eligible Retention Study from Deft Research found that dual eligible...

Medicare Advantage (MA) enrollment has been on a steady climb for the past two decades, following changes in policy designed to encourage a robust role for private plan options in Medicare. In 2023, 30.8 million people are enrolled in a MA plan, accounting for more...

Medicare Advantage (MA) plans have long been accountable for quality performance, and Stars, the CMS quality assessment program, is an important measure. CMS Star Ratings help MA plans attract members and earn financial incentives. Plans with higher Star Ratings are...

As Americans age, their desire to stay in their homes remains steadfast. According to the AARP, 77% of adults aged 50 and older want to remain in their homes for the long term — a number that has remained unchanged for more than 10 years now.  But unexpected medical...

The number of Medicare Advantage (MA) Special Needs Plans (SNPs) has surged in enrollment, growing its member base by more than twofold from 2020 to 2022. This influx of new members has generated an opportunity to achieve better health outcomes for targeted groups of...