INSIGHTS

FEATURED INSIGHT
LTC Provider-Led I-SNPs Increase by 28% in Plan Year 2021
While traditional insurance companies sponsor most Medicare Advantage (MA) plans, a growing number of long-term care (LTC) providers—nursing and assisted living facilities—are forming health plans, using special needs plan (SNP) authority under the MA program to focus...
LTC Provider-Led I-SNPs Increase by 28% in Plan Year 2021
While traditional insurance companies sponsor most Medicare Advantage (MA) plans, a growing number of long-term care (LTC) providers—nursing and assisted living facilities—are forming health plans, using special needs plan (SNP) authority under the MA program to focus...
Emerging Policies and Trends Addressing Social Need Among Medicare Beneficiaries
Social need is (rightfully) a growing focus among healthcare policy makers – with recognition that social determinants have considerable impact on one’s health and well-being. There’s a high prevalence of social need among Medicare beneficiaries, with nearly a fifth...
COVID-19: If Ever There Was a Time to Care about Medicare-Medicaid Integration, It’s Now
The 2019 Novel Coronavirus (COVID-19) is disproportionately impacting Medicare beneficiaries also eligible for Medicaid (“dual eligible”). This is partially due to a combination of socioeconomic, racial, workplace, and clinical characteristics that align with other...
Medicare Advantage Plans Gearing Up To Coordinate Palliative Care and Hospice for Members
Beginning in January 2021, the Centers for Medicare & Medicaid Services (CMS) is adding a hospice component to the Medicare Advantage Value Based Insurance Design (VBID) Model. Despite calls to delay the start of the hospice component in VBID, CMS is moving ahead,...
Transportation Access, Dual Eligibility, and COVID-19
ATI Contributor: Allison Rizer The COVID-19 public health emergency continues to accentuate racially- and income-based healthcare disparities in our country. And individuals dually eligible for Medicare and Medicaid (“dual eligibles”) are at the center of it all....
Left Behind in the Era of Internet: Yet Another Challenge Facing Dual Eligible Beneficiaries
ATI Contributor: Allison Rizer Telehealth has been essential during COVID-19 to preserve access to care, mitigate social isolation risks, and meet the needs of individuals temporarily holed up in their homes. The provision of telehealth advanced about 10 years over...
Making Sense of Medicare-Medicaid Integration Models
ATI Contributor: Allison Rizer Most of us agree: there is value in Medicare-Medicaid integration. But how well do you understand the programs that aim to accomplish integration? I presented on this topic to a group of providers recently and someone bravely mentioned...
Medicaid-Capitated D-SNPs: An Innovative Path to Medicare-Medicaid Integration
ATI Contributor: Allison Rizer In eight short months, Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) will be operating under new Bipartisan Budget Act (BBA 2018) rules that require D-SNPs to assume a more active role in integrating Medicare and...
How Does a Federal Agency Give Away $100 Billion?
ATI Contributor: Tyler Overstreet Cromer In distributing $100 billion, the Centers for Medicare & Medicaid Services (CMS) must accurately aim funding at providers with the highest COVID-19-related costs while getting cash onto the front lines of healthcare as...
State Approaches Will Shape the Successes (and Failures) of New Supplemental Benefits in D-SNPs
ATI Contributor: Allison Rizer Last year marked one of the most significant policy changes in the Medicare program in a very long time. In 2019, Medicare suddenly became more than the acute/post-acute, medical program it has been for more than five decades, by...
Post-Acute Care Providers and COVID-19
The COVID-19 pandemic will impose unprecedented stresses on our Nation’s hospitals, whose capacity falls well short of the projected demand for beds. As one option to expand capacity, public health officials should consider the possible contribution of post-acute...
Telehealth and COVID-19
ATI Contributor: Allison Rizer Expanding access to telehealth is a top strategy to prevent avoidable hospitalizations and increase the capacity of our health system during the current crisis we are experiencing. This is particularly important for the frail elderly...
Newly Expanded Non-Medical Supplemental Benefits in Medicare Advantage: A Primer
ATI Contributors: Tyler Cromer and Elexa Rallos Medicare Advantage plans can now offer a wide range of diverse benefits to address the needs of the aging population, through newly expanded supplemental benefits. This expansion gives plans more flexibility to meet...
Enrollment, Environment, and Efficiency: How the New Perennial Consortium Checks the Boxes for I-SNP Readiness
Few would expect nursing homes and assisted living operators to be able or willing to manage health care risk for some of the highest-cost Medicare beneficiaries. Yet, earlier this month, Senior Housing News announced the formation of the Perennial Consortium, a group...
The Big Problem With Post-Acute Care: Three Things Hospitals and Managed Care Plans Can Do To Help
For frail older adults, an inpatient hospital stay can be destabilizing, often marking the beginning of a decline in functioning. For these folks and their families, the post-hospital period is a risky, confusing, and stressful time. Our Medicare system offers...
CHRONIC Care Act Advances the Business Case for Innovation
In February 2018, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act (CCA) was passed by Congress and signed by President Trump, making significant policy changes to advance the goals of integrated, person-centered care for...
The Need for Financing Solutions
Our chances are 50/50 that in our old age, we’ll need someone else’s help with basic activities of daily life—like bathing, dressing, eating, getting out of bed. Many families are caught off guard when it happens. Medicare doesn’t cover the long-term,...
Under-Financing of Long Term Care Creates Economic Insecurity For Families
ATI founder, Anne Tumlinson, testifies to on the Federal Commission on Long Term Care's recommended changes to U.S. long-term care financing and delivery system. http://www.c-span.org/video/standalone/?c4506129/anne-tumlinson