Differential coding by Medicare Advantage plans appeared to have pushed their risk scores higher than traditional Medicare's scores. Those greater risk scores led to $33 billion in extra revenue for ...

Differential coding in MA plans results in higher risk scores and increased payments compared to TM, with significant insurer variation. UnitedHealth Group's risk scores were significantly higher than ...

Numerous studies show that employer plans pay providers significantly more than Medicare, but less is known about prices in nongroup plans sold both on and off the Marketplaces established by the ...

Over 35 million prior authorization requests were submitted to Medicare Advantage insurers in 2021, according to a new report from the Kaiser Family Foundation (KFF). Two million of these requests, or ...

The Direct Contracting Model saved Medicare $70 million in 2021 as the Biden administration plans a major overhaul to the value-based care program next year. Recently released data from the Centers ...

Implementing the Medicare $2 drug list model would have reduced out-of-pocket spending by 63% for Part D beneficiaries in 2021. The model caps cost-sharing at $2 for a 30-day supply of 101 generic ...

Despite the fact that the 10 top-selling Medicare Part D drugs only accounted for 0.3% of total covered drugs in 2021, they represented 22% of total gross Medicare drug spending, a new KFF analysis ...