CMS Outlines 5 Goals For Advancing Health Equity, Expanding Coverage

Modern Healthcare: CMS Focuses On Health Equity, Accountable Care In Its New Strategic Plan
For its second decade in operation, Centers for Medicare and Medicaid Services Innovation Center is implementing strategies to drive healthcare transformation, using demographic data, industry feedback and more accessible payment models. In a Wednesday webinar, CMS leaders outlined the agency's five new objectives and how they will advance health equity, expand coverage and improve health outcomes going forward. Driving accountable care: The first goal guiding the agency's work is to increase the number of people in relationships with providers that are accountable for patients' costs and improving their care history, said Dr. Liz Fowler, CMS Innovation Center director, during the virtual conference. (Devereaux, 10/20)

In other Medicare and Medicaid news —

Modern Healthcare: CMMI Official Pushes For More Participation In Value-Based Care Models
The Biden administration hopes to increase participation in alternative payment models as a way to save the government money and improve care for beneficiaries, a senior official said Wednesday. Purva Rawal, chief strategy officer for the Center for Medicare and Medicaid Innovation, speaking at the Better Medicare Alliance conference, said the administration wants to "accelerate" the movement to value-based care through Accountable Care Organizations and other models. "We need to recognize we need to increase the number of ACOs and the beneficiaries assigned to them, increase opportunities for providers who want to participate and deliver whole-person, integrated care," Rawal said. (Hellmann, 10/20)

Modern Healthcare: Feds: UnitedHealthcare Scored $3.7B In Questionable Medicare Advantage Pay
UnitedHealth Group generated $3.7 billion in Medicare Advantage payments in 2016 by listing patient conditions unverified through outside medical claims, according to a Wednesday report by federal investigators. The announcement stems from a September report by the Office of Inspector General, which now indicates the Minnetonka, Minnesota-based health giant captured a significant number of member diagnoses through chart reviews and health risk assessment services, tactics that "may be particularly vulnerable to misuse by Medicare Advantage companies," since they are often performed by the health plan or conducted by vendors hired by the health plan, OIG said. The Star Tribune first reported the finding. (Tepper, 10/20)

AP: Auditor: Iowa's Privatized Medicaid Illegally Denies Care
Iowa’s privatized Medicaid system has illegally denied services or care to program recipients, and both private insurance companies managing the system have violated terms of their contracts with the state, according to a state audit released Wednesday. Auditor Rob Sand released a report from his investigation that examined cases from 2013 through 2019. He said his investigators found a massive increase in illegal denials of care by managed care organizations, or MCOs, under privatized Medicaid. (Pitt, 10/21)

CNBC: Switching To Medicare From Public Exchange: How To Avoid Mistakes
For anyone nearing age 65 who gets health insurance through the public marketplace, it’s almost time to make the move to Medicare. Generally speaking, you must sign up when you reach that age unless you have qualifying coverage elsewhere. And health plans through the exchanges, whether federal or state, do not count. “You need to be prepared to make that change,” said Karen Pollitz, a senior fellow with the Kaiser Family Foundation. “Otherwise you can face [costs] for being late to enroll in Medicare and for being late getting out of the marketplace.” (O'Brien, 10/20)