We pride ourselves on having both day-to-day alignment with the latest CMS guidance and the long-term strategic vision to keep it all in perspective. Our mission as the industry’s most active professional services consultancy and provider of technology-based solutions is to empower health plans and providers to deliver higher quality care to beneficiaries at lower costs, while serving as valued, trusted partners to government health agencies. The COVID-19 pandemic put a strain on the entire healthcare industry and, for risk adjustment in particular, the disruption caused by the pandemic resulted in both positive and negative effects. Here… On September 14th, CMS published the 2022 Advance Notice Part I, with particular emphasis on Risk Adjustment. One key takeaway from this announcement is that CMS will push forward with their plan to… AIS Health recently spoke with GHG's Vice President, John Selby, about his analysis of the 2021 Medicare Annual Election Period.
The COVID-19 pandemic put a strain on the entire healthcare industry and, for risk adjustment in particular, the disruption caused by the pandemic resulted in both positive and negative effects. Here… CMS recently released the 2021 Program Audit Memo announcing that it will start sending engagement letters in March 2021, but health plans should remain diligent about audit preparation and their PBM… CMS recently surprised plans with the early release of Part II of the CY2022 Advance Notice, with several updates impacting Star Ratings. GHG's Jessica Assefa summarizes the noteworthy changes here.
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2021 Risk Adjustment Strategy and Program Readiness
Industry Alerts
2022 Advance Notice Part I Released, Heavy Focus on Risk Adjustment
Insights
With Switching Down, MAOs Seek ‘Untapped’ Market Segments
2021 Risk Adjustment Strategy and Program Readiness
CMS Program Audit Universes and Protocol Changes Tabled Until 2022
Part II of the CY 2022 Advanced Notice: Continued Evolution of the Medicare Advantage Star Ratings
Jean LeMasurier is Senior Vice President of Public Policy at GHG. Bringing GHG clients 30+ years of experience with the Centers for Medicare & Medicaid Services (CMS), Jean’s focus includes health policy and health care reform. Her strategic planning and consulting services have been critical inputs for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDPs), Medicaid managed care plans, pharmaceutical companies, and employers on legislation and regulatory impacts of changes in Medicare and Medicaid.
Jean has analyzed policies affecting creation of the ACA Health Insurance Marketplace, Qualified Health Plans, and dual eligible initiatives. She also was integral in advising plans and employers on retiree options. Jean’s engagements include analysis of Medicare market opportunities, strategic advice on CMS legislative/regulatory requirements, audits, and gap analysis to assure implementation of regulatory-compliant programs.
As a senior CMS official, Jean managed the $40 billion Medicare Managed Care programs for many years. This included serving as the Director of Policy and Acting Director/Deputy Director of Operations and Regulatory Oversight. Further, Jean served as Senior Advisor in the Employer Operations and Policy Group, implementing employer provisions of the Medicare Modernization Act. Jean was also a professional staff member on the U.S. Senate Finance Subcommittee on Health.
