A Medicare Advantage (MA) insider shares advice on how entrepreneurs can more effectively anticipate opportunities to help MA Organizations improve performance
Yep. Duncan is right. That Final Call Letter is critical to the bid. But there is an Advance Notice letter that CMS publishes in the months leading up to it that gives us a heads up about what they're thinking. That Final Call Letter, the Advance Notice and Managed Care Manual are great primers on the Medicare Advantage industry. And the benchmarks come from their county rate file too. But be aware that understanding it multi-layered.
One thing that is important is for any value-based group to know their benchmark environment. If their county benchmark is going up by 5%, that'll give them a favorable backdrop, but if it's dropping by 5%, it'll create a headwind even if they do a better job on documentation, controlling costs, etc. Another big impact is a county switching into and out of double bonus. Not only for the stars impact, but it'll greatly magnify or diminish the impact of any risk score changes.
They should also know if they're operating in an ACA capped rate county ... but that gets really nuanced. And I probably shouldn't even mention that because some people might get pretty ticked off when they understand the implications of it. :)
This is a really clear explanation, Duncan. Great work. One thing that wasn’t clear (and may emphasize my naïveté): when in the process does the benchmark become known? Do plans know if they are above or below benchmark when they submit?
Very nice explanation on how this process work. I finally think I understand it better. I remember you asking me to include it in our RA timeline and I had not clue had to do it.
Yep. Duncan is right. That Final Call Letter is critical to the bid. But there is an Advance Notice letter that CMS publishes in the months leading up to it that gives us a heads up about what they're thinking. That Final Call Letter, the Advance Notice and Managed Care Manual are great primers on the Medicare Advantage industry. And the benchmarks come from their county rate file too. But be aware that understanding it multi-layered.
One thing that is important is for any value-based group to know their benchmark environment. If their county benchmark is going up by 5%, that'll give them a favorable backdrop, but if it's dropping by 5%, it'll create a headwind even if they do a better job on documentation, controlling costs, etc. Another big impact is a county switching into and out of double bonus. Not only for the stars impact, but it'll greatly magnify or diminish the impact of any risk score changes.
They should also know if they're operating in an ACA capped rate county ... but that gets really nuanced. And I probably shouldn't even mention that because some people might get pretty ticked off when they understand the implications of it. :)
This is a really clear explanation, Duncan. Great work. One thing that wasn’t clear (and may emphasize my naïveté): when in the process does the benchmark become known? Do plans know if they are above or below benchmark when they submit?
Bring on Part 2! Good learning here!
Very nice explanation on how this process work. I finally think I understand it better. I remember you asking me to include it in our RA timeline and I had not clue had to do it.
Good stuff Duncan!
Another great article Duncan! I just joined SCAN and my head is spinning from the bid process right now :)