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Atlantic Information Services’s Medicare Advantage News Reports on Plan Drop-Outs from Massachusetts Dual-Eligibles Demo

Washington, DC (PRWEB) July 31, 2013

Three of the six health plans selected to participate in Massachusetts’ CMS-funded demonstration program for Medicare-Medicaid dual eligibles recently dropped out, Atlantic Information Services’s Medicare Advantage News (MAN) has learned, largely because of dissatisfaction with the Medicare capitated payment rates on which they had just received data. As reported in the July 25 issue, three other plans are staying in what apparently will be the first of the capitated duals demos to launch, and it looks as though the program will commence on the scheduled Oct. 1 start date. A CMS official confirmed to MAN the information about who is in and out in Massachusetts, but would not elaborate on the specific plan decisions.

The plans choosing to exit the Bay State’s dual-eligibles program include two of the biggest ones selected, albeit not the ones with the most experience in caring for duals. They are a Blue Cross Blue Shield of Massachusetts-led joint venture and Boston Medical Center HealthNet Plan (BMCHP), which is the largest Medicaid managed care organization in the state. The third dropout is Neighborhood Health Plan. Remaining in are Commonwealth Care Alliance, Fallon Total Care and Network Health, which is a Tufts Health Plan unit.

According to MAN, the three defections raise questions about what will happen in the other four states approved for capitated demos so far by CMS and slated to start enrollments in 2014. Many of the issues seemingly arising in Massachusetts — among them uncertainties surrounding large performance “withholds” and costly supplemental benefits that the feds and states expect, as well as concerns about base payment rates — appear to apply as well in those states.

To read the article in its entirety, which also includes analysis from the CEO of one of the plans remaining in the dual-eligibles demo, as well as comment from the exiting plans and other outside observers, visit

About Medicare Advantage News
Medicare Advantage News is the health care industry’s #1 source of timely news and business strategies about Medicare Advantage plans, product design, marketing, enrollment, market expansions, CMS audits, and countless federal initiatives in this hotly contested area of health insurance. Published biweekly since 1994 (when it was Medicare+Choice), the newsletter exists to help plans boost revenues, increase enrollees, cut costs and improve outcomes in Medicare Advantage and Medicaid managed care.

About AIS
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at

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