August 22, 2016

Mike Adelberg Quoted in Medicare Advantage News About CMS "Secret Shopping" and Additions to VBID Model

FaegreBD Consulting Senior Director Mike Adelberg contributed several quotes to a recent edition of Medicare Advantage News where he discussed two different topics surrounding changes in the Medicare marketplace.

In one article, Adelberg shared his observations on the secret shopping different Medicare health plans by Centers for Medicare and Medicaid Services (CMS). Due to widespread concerns about industry marketing tactics a decade ago, CMS began secret shopping Medicare Advantage marketing events, as well as other places, where Medicare health and drug plans were sold. But last year, 85.5 percent of CMS secret shops found no deficient practices, leading Adelberg to wonder if CMS may be readying to shift its focus elsewhere.

“When you contrast the agency’s secret shop findings with those of six or seven years ago, the improvement is remarkable. CMS made agent-broker oversight a priority, and the industry responded,” said Adelberg.

The second article discussed the recent decision by CMS to expand the Medicare Advantage Value-Based Insurance Design (VBID) model before it even launches. CMS chose to add three new states and two new conditions to the demonstration, which will likely bring a wider variety of value-based benefits into the assessment.

“The modest expansions of the model suggest that CMS looked at the feedback it received after the first round of applications, and thought enough of it to tweak the model even in advance of VBID performance data,” said Adelberg.

The full articles are available for subscribers. 

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