Healthcare Financing and Delivery Innovation

Insights

CY2025 Medicare Advantage Proposed Rule

On November 6, 2023, CMS released its Contract Year 2025 Medicare Advantage and Part D Proposed Rule [CMS-4205-P]. ATI Advisory prepared a summary of key provisions and insights across D-SNP and dual eligible impacts, supplemental benefits, Part D formularies, network adequacy, agent and broker commissions, and equity-related provisions. The Rule has a heavy focus on beneficiary protections and program transparency.
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Work

Guiding the GUIDE Model Toward Stronger Caregiver Supports

ATI Advisory in partnership with the Rosalynn Carter Institute for Caregivers (RCI) sought to explore the evidence and needs of dementia caregivers that might inform a Medicare model test related to dementia care. On July 31, 2023, the Center for Medicare and Medicaid Innovation (CMMI) released the Guiding an Improved Dementia Experience (GUIDE) Model that includes explicit support for caregivers and is set to launch in July 2024.
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News

The CAPABLE Program: An Effective Intervention For Dual Eligible Individuals In Integrated Programs

Sarah Rosenblum and Allison Rizer explain how CAPABLE is a data-tested tool for dual eligible integration and pathways for state Medicaid programs to implement the program.
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News

CMS Threads The Needle On A Tricky Question: What Is A Drug?

Anna Kaltenboeck writes for Health Affairs on the ways in which the Centers for Medicare and Medicaid Services can define and select drugs for the first round of prescription drug negotiations on September 1, 2023.
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Work

Medicare Beneficiaries with LTC Needs by Setting

ATI Advisory identifies what sets apart individuals with Long Term Care (LTC) needs from the rest of the Medicare population. This work examines the demographic profiles, care complexity, medications, and medical and pharmacy spending for Medicare beneficiaries receiving LTC in different settings, as well as for Medicare beneficiaries who do not receive LTC.
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Insights

What Everyone Is Missing About CMS’ Coverage Of Alzheimer’s Drugs

Few drugs have triggered as much controversy and debate as those for Alzheimer’s Disease. So, it should come as no surprise that last week’s update from Centers for Medicare and Medicaid Services (CMS) on its coverage for these treatments would trigger a wide range of responses. Some outlets reported that CMS was broadening its coverage, even as other groups stated that the agency was limiting access. Others argued that the update heralded no change at all.
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