Farzad Mostashari Profile picture
Sep 8, 2020 5 tweets 3 min read Read on X
1/ Some more peeks at age-specific COVID symptom trends from FB/CMU surveys at state level.

Here's Massachusetts and Maine

The rates are VERY LOW- the Northeast is the only oasis of green in the country on COVIDExitStrategy.org

but is there a worrisome trend developing? Image
2/ Look at the y axis for these states- GA/SC/TN/KY

Unlike MA/ME, they are persistently over 0.8% CLI rate , and heading thew wrong direction, including among the older age group.

Rising deaths will follow. Image
3/ The y axis jumps again-

MS and LA are very high, especially in youngest age group, but also 55+

They are also among the highest in test positivity.

We need to quench the outbreak in these states. If governments won't, then schools, businesses, families have to act Image
4/ I'm also worried about Florida

Like Texas, trends came down from the July peak. But unlike Texas, there was a second August wave among the young, and now an increase among the older population

Despite/Because official assertions, things will get worse usatoday.com/story/travel/n… Image

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More from @Farzad_MD

Apr 6
1/ The Final 2027 Rate Notice will be welcome news for those battered Medicare advantage stocks

The Final notice comes in at 239bps better than the Advance notice (when asked recently, I hazarded it would be 150-200bps better)

let's revisit this string to see what changed Image
2/ On the Effective Growth Rate (the actuarial folks that are fiercely indendent)-

2 changes that are basically aligned with what I thought would happen:

2025 (8% -> 7.3 w slower trend in H2 data
2026 (2% -> 3.1% on assumptions)

so net up about 40 bps
3/ On the risk adjustment policy front, there was a technical problem

The update (2023 data predicting 2024 costs) included skyrocketing skin substitute costs. Since policy took those costs away after 2025, model needed to be redone to lower the weight given to eg skin ulcer Dx
Read 7 tweets
Apr 4
1/ A new @CMSinnovates ACO model was released this week

In our interview with @AbeSutton on the #ACOshow I teased him about how every new CMMI director seems to believe the world needs yet another primary care model (instead of improving the #MSSP model)

Did he prove me wrong? Image
2/ He might have

Here's what the RFA says is the new model is testing- bear with me and we will walk through each one

1. Bringing in high cost providers
2. Benchmarking that avoids ratchets
3. High needs/duals patient
4. Specialist engagement fin model
5. Beneficiary incentives Image
3/ Growing ACO participation

MSSP winners have been more efficient physician-led practices (fewer specialist/procedures, less expensive hospital care)

The hypothesis is that if we can get high cost providers into ACOs, they can save more money.

I'm skeptical, but good to test Image
Read 15 tweets
Jan 29
1/ CMS released the "2027 Medicare Advantage and Part D Advance Notice" on Monday afternoon, and health plan stocks lost some $100B of market value?

What was so shocking?

Let's descend into policy weeds & make some predictions about Final Notice

(not investment advice obvsly) Image
2/ Here's the big components of this year's notice, compared to last year.

A 5 percentage point difference in payments is a BIG deal for a $500B industry currently nursing profit margins of 0-2%

(this does not include an expected 2.45% increase in payments from coding trend) Image
3/ The top part is actuarial math-

good or bad, most people ascribe political intent to it, but it's just what the independent green-eyed shade professionals estimate for trends in costs in Traditional Medicare

by law, that's what the MA plan rate increases are indexed to
Read 29 tweets
Aug 28, 2025
1/ The 2024 Medicare Shared Savings Program results are released from embargo!

topline results:
10,326,340 bene-years (12% @AledadeACO )
$6,452,075,989 in savings versus benchmark
$4,062,804,612 in payments to ACOs (19% Aledade)
Largest savings ever
Higher quality than FFS🎉
2/ fact sheet:
$643 (2024) vs $515 (2023) in gross per capita savings

Almost 2x savings rate for "low revenue ACOs" (physician-led/FQHC/RHCs) and for those composed predominantly of primary care clinicians vs high revenue ACOs (typically hospital-led)

cms.gov/files/document…
3/ How do they get savings?

"lower utilization compared to their benchmark across many categories of utilization including hospital discharges, Emergency Department visits and Skilled Nursing Facility stays"

Better chronic disease management
More prevention
Less suffering
Read 10 tweets
Apr 7, 2025
1/ The CMS final 2026 rate notice for Medicare Advantage just dropped, on the "no later than" date of April 7

The final rate is up- by a lot more than industry consensus of 75-100 bps!

I think a lot of plans are going to feel a little relief about their preliminary bids tonight Image
2/ One sell side analyst said "the most bullish expectation we heard [before] was a +125bps improvement"

ahem... my expectation was better than that, but even I didn't think it would be 310 bps better.

So why?

Because Dr Oz likes Medicare Advantage?

3/ If you missed, go back ands read my January tweetorial on the Advance Rate Notice (which was already "better than expected")

The short answer is that each year's "FFS growth rate" includes a true up of CMS actuaries' past and future cost estimates

Read 14 tweets
Mar 15, 2025
1/ I love reading the annual March MedPAC report to Congress on Medicare Payment Policy

such good, clear data and policy thinking.

kudos to @medicarepayment staff and chair @Michael_Chernew

I'll post some thoughts/highlights as I read through this morning
2/ My focus will be on the areas I know best
-Primary care
-Alternative payment models
-Medicare Advantage
-Competition and consolidation

The report is here for those following at home.

medpac.gov/document/march…
3/ Here's the first nugget from their core responsibility - recommending payment rates to congress that ensure beneficiary access to care

Clinicians are paid 140% of Medicare by commercial plans... but you wouldn't know that by working with independent practices (as I do) Image
Read 39 tweets

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