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Performance Scores for Dual-Eligibles Can Drag Down Medicare Advantage Ratings, Study Says
Low-income and disabled people who are dually eligible for Medicare and Medicaid and belong to Medicare Advantage plans consistently score worse than other Medicare Advantage enrollees on the performance measures that determine plan eligibility for bonus payments from the CMS.
Low-income and disabled people who are dually eligible for Medicare and Medicaid and belong to Medicare Advantage plans consistently score worse than other Medicare Advantage enrollees on the performance measures that determine plan eligibility for bonus payments from the CMS, according to a new study (PDF).
The results suggest a significant association between Medicare Advantage plan performance and the socio-economic status, demographics and severity of illness of subscribers. Experts say dual-eligible beneficiaries are a uniquely challenging population to serve, given the high percentage with multiple chronic conditions including physical and mental disabilities and substance abuse issues; also, a significant percentage are homeless. Some argue that it's difficult or impossible for even conscientious health plans serving large numbers of dual-eligibles to achieve Medicare's benchmarks of quality.
Read the full story here: http://bit.ly/1esoW8R
Source: Modern Healthcare
Hospital Participation in Medicare ACOs: No Change in Admission Practices and Spending
August 19th 2025Hospital accountable care organization (ACO) participation did not impact emergency department admission rates, length of stay, or costs, suggesting limited effectiveness in reducing spending for unplanned admissions and challenging hospital-led ACO cost-saving strategies.
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Laundromats as a New Frontier in Community Health, Medicaid Outreach
May 29th 2025Lindsey Leininger, PhD, and Allister Chang, MPA, highlight the potential of laundromats as accessible, community-based settings to support Medicaid outreach, foster trust, and connect families with essential health and social services.
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Care Quality Metrics in Medicare During COVID-19 Pandemic
August 12th 2025Medicare Advantage outperformed traditional Medicare on clinical quality measures before and during the COVID-19 pandemic; mid-pandemic, however, traditional Medicare narrowed the gap on some in-person screenings.
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