Medicare & Medicaid Program Design

ATI founder Anne Tumlinson shares her insights on the future of value-based care.

Fred Bentley talks with Skilled Nursing News about ACOs and nursing operators' opportunities.

Part II: ATI's Fred Bentle sits down with Dr. Charles T. Pu to ask him about his experience operating a unique SNF at Home Model. Dr. Pu shares learnings from his SNF at Home trial, recently published in the Journal of Applied Gerontology.

Policymakers are calling attention to nursing home regulations clearly identifying owners and operators. We reviewed capital market dynamics, the role of private capital in the industry, and included policy implications for future reform.

Part I: ATI's Fred Bentle sits down with Dr. Charles T. Pu to ask him about his experience operating a unique SNF at Home Model. Dr. Pu shares learnings from his SNF at Home trial, recently published in the Journal of Applied Gerontology.

Healthcare providers are adapting in response to technologies enabling remote work, staffing shortages, patient preferences, and the competitive landscape of inpatient care.

ATI Founder, Anne Tumlinson, collaborated with long-term care industry leaders, Bob Kramer and David Grabowski, in this Opinion piece in The Hill on America’s failing long-term care infrastructure

The long-term care insurance market has been on a downward spiral due to several factors. Some carriers have exited the industry, and remaining carriers' policies are at much higher premium levels. This presents challenges to downstream policy.

Activity in both public and private sectors has revealed concerted movement toward establishing a long-term care model that is accessible to consumers and sustainable for state Medicaid funds.

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.

An ATI Advisory analysis commissioned by Better Medicare Alliance found that Medicare Advantage beneficiaries report saving more than $2,400 annually on out-of-pocket costs and premiums compared to Fee-for-Service (FFS) Medicare beneficiaries.

Analysis of national Medicare Advantage enrollment data between 2022 and 2023 shows that Medicare Advantage gained more than two million enrollees, reaching more than 47% of the Medicare eligible population. Medicare Fee-For-Service enrollment data showed 800,000 fewer enrollees over the same period.

Anna Kaltenboeck recently penned a Health Affairs article that explains how the Inflation Reduction Act will affect Medicare Part D and prescription drug pricing.

Fred Bentley quoted in Modern Healthcare about considerations for providers with increased Medicare Advantage audits coming.

Fred Bentley talks to Skilled Nursing News transitions in care regarding skilled nursing and Medicare Advantage.

Four years into implementation, nearly 40% of Medicare Advantage plans are offering nonmedical supplemental benefits in 2023. This latest report examines why benefits that help members stay in their homes – specifically in-home support services (IHSS), caregiver supports, and social needs benefits – have experienced significant growth and adoption despite the challenges in providing a human-powered service.

Since 2019, ATI Advisory and the Long-Term Quality Alliance, with support from The SCAN Foundation, have led national efforts to advance person-centered, non-medical supplemental benefits in Medicare Advantage.

Bill Winfrey and Tyler Cromer talk with Home Health Care News about home-based care services in Medicare Advantage.

Allison Rizer and Laura Benzing share their perspective on Medicare Advantage supplemental benefits in Health Affairs.

MA plans were allowed to make midyear supplemental benefits changes to address beneficiaries’ needs during the pandemic. Early lessons plan experiences suggest supplemental benefits can help meet member needs and enable home-based care.

On February 1, 2023, CMS released the Advance Notice of Methodological Changes for Calendar Year (CY) 2024 for Medicare Advantage (MA) that proposed several changes to the Hierarchical Condition Category (HCC) model.

In response to Congress’ Request for Information to improve experiences for dual eligible individuals, ATI Advisory suggests key elements that would advance programmatic Medicare-Medicaid integration.

Allison Rizer outlines in Health Affairs how states using Medicaid FFS to serve dual-eligible individuals can create a more integrated, financially sustainable program design.

As CMS sunsets the MMP model, it will be important to preserve lessons that benefited stakeholders. CMS has authority to maintain MMP model attributes, and should preserve those that are in statute through a refined, innovative financial model.

ATI Advisory and Arnold Ventures share thoughts on opportunities for CMS to use Medicaid authority to advance integration for dual eligible individuals.

The shortage of worforce capacity to deliver services to beneficiaries limits the ability of state Medicaid agencies to provide services. States have three core options to encourage managed care entities to support HCBS capacity building efforts.

Medi-Cal allows managed care plans to provide flexible person-centered services and address social drivers of health. Other states across the country can look to California’s experience to explore opportunities to leverage ILOS more broadly.

CA's Medicare Innovation Office is the first dedicated office within a state Medicaid agency focused on program design for dual eligibles. Understanding the growing Medicare population is important for CA to identify opportunities to support them.

This report outlines strategic recommendations for the California Department of Aging to explore in its effort to improve quality, equity, and cultural competence. Other states and their SHIPs might also consider these recommendations.