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?
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.
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
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
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
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?
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
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.
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)
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)
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
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)
"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