CMS and Seema

CMS and Seema



Hey everyone and welcome back!

I want to talk to you about something that is going on now that is so impressive: we have a government-pending shutdown.

Is it going to shut down? Is it not?

Is it going to stay open? We don’t know.

But that’s why it’s so impressive when you have a bipartisan backing on something going to The White House.

Everybody agrees to this. Yes, everybody is agreeing to the concepts that were put forth by CMS in December of this past year by Seema Verma.

The suggestion was to expand Medicare Advantage plans and push forward for value-based insurance design as much as possible.

Value-based insurance design, as we’ve discussed in the past, is something that’ll keep the cost down for the membership and the insurer by making sure that the value is at the highest level possible for the care that is provided.

So, I just want to point out to you all, that we will see a big expansion from the insurance companies on Medicare Advantage and of course, more membership on Medicare Advantage plans.

You probably already knew this because you saw our preview 2019 video where we discussed this would be coming down the pipe.

So, yes, this is something that was suggested by Seema Verma and, by the way, Seema, what does a guy have to do to get connected with somebody on LinkedIn?

I put the request out there, I keep trying to get connected. Seema, do you see me?

Another thing that I want to point out, back to business, is Any Willing Provider.

This is something that is in certain areas of the marketplace where, if you’re a willing provider and you want to participate with a certain health plan you are able to.

They are also suggesting that this gets scaled back because it is putting the insurers a little bit in a corner.

By making them have to bring providers in network, that takes away their leverage. Therefore, in order to keep their cost down, they end up charging the membership more money, which nobody likes.

So, they did put in a suggestion regarding the Any Willing Provider to try to scale that back down. But, remember, for the Medicare Advantage plans, yes, you probably will see a big expansion of that.

So, while the government is deciding if they should shut down or not, you just make sure that your business doesn’t shut down. That’s what you’ve got to do and they’ll handle that part.

If you have any questions, comments, or suggestions, please let us know so that we can make this better for you.