Medicare Advantage in 2007
CMS (Centers for Medicare and Medicaid Services)
In 2007, the Medicare Advantage program is providing an affordable, high value choice for all Medicare beneficiaries.
The value and availability of plans is a direct result of Congressional policies establishing minimum rates for MA plans in some regions where the MA option was not yet available. These policies were established to ensure wide availability of MA plans and to do so, in part, by providing extra benefits to enrollees.
Plans, even those without networks of providers, can work directly with providers and beneficiaries, as many disease management companies do to ensure they receive appropriate follow-up and preventive services.
It is difficult to build these programs into the FFS program. Providers are not expected to coordinate care across settings or over time with patients after they leave their specific setting of care. It would require the program to pay either a care management organization separate from the delivery system to manage the patient or to pay physicians or others for these services.
http://www.cms.hhs.gov/HillNotifications/downloads/MedicareAdvantagein2007.pdf
And…
Low-Income and Minority Beneficiaries in Medicare Advantage Plans, 2004
AHIP (America’s Health Insurance Plans)
February 2007
The two main reasons that beneficiaries cited for choosing Medicare Advantage plans in 2004 were: (1) Lower costs (cited by 34 percent), and (2) Better benefits and coverage (cited by 21 percent) than fee-for-service Medicare.
http://www.ahip.org/content/fileviewer.aspx?docid=19240&linkid=165238
And…
The Facts: Medicare Advantage
Galen Institute
March 22, 2007
This fact sheet was jointly prepared by health policy experts from the American Enterprise Institute, the Center for Medicine in the Public Interest, the Galen Institute, The Heritage Foundation, the Institute for Policy Innovation, the Institute for Research on the Economics of Taxation, the National Center for Policy Analysis, the Pacific Research Institute, and Project Hope.
Wouldn’t it be better to simply add to traditional Medicare the extra benefits that Medicare Advantage plans offer?
Traditional Medicare pays for acute care after patients are ill and for some preventive services. Medicare Advantage plans offer added services for prevention and early detection of disease, and they are better able to provide coordinated medical care. This is the 21st century approach to medical care that the commercial market is finding offers better care at lower long-term costs.
One of the most critical issues in the future is how the Medicare program will address the growing numbers of beneficiaries with chronic conditions. In the traditional Medicare program, this responsibility either has to be taken on by one of the beneficiaries’ many providers, or by a separate entity that would need to coordinate with the variety of providers and with the beneficiary. Medicare cannot duplicate this role of MA plans by simply adding more services such as preventive care, more comprehensive drug coverage, and dental and vision care to the Medicare payment schedule. A strong MA program provides the best opportunity for creating a program to meet the growing need for coordinated care.
http://www.galen.org/medicare.asp?DocID=997
Comment:
By Don McCanne, MD
To advance the conservatives’ agenda of privatizing Medicare, private health plans had to be enticed to submit bids by being offered an average of an additional twelve percent over the costs of providing care within the traditional FFS (fee-for-service) Medicare program. In turn, the private plans could use a modest portion of this higher payment to offer greater benefits to entice patients to join the plans. It worked. Nineteen percent of Medicare beneficiaries are now enrolled in these private Medicare Advantage plans, and they are enjoying greater benefits as a result.
This higher payment has been characterized as an overpayment to the plans, and it is, when considering that most of it is used by the insurers for their own intrinsic purposes and not for patient care. But that portion which expands benefits is appropriate, except that it is very unfair. The other four-fifths of Medicare beneficiaries should be receiving the same enriched benefit package.
The administration, the insurance lobby, and the conservative think tanks are all pleading to stop the efforts to reduce these higher payments, correctly demonstrating that individuals enrolled in these Medicare Advantage programs will lose benefits. The solution is obvious. Payments required to maintain these benefits should be preserved, but the extra payments wasted by the insurers should be eliminated. And for fairness, the same extra benefits should be granted to everyone remaining in the traditional FFS Medicare program. The funds wasted by the Medicare Advantage plans would go a long way toward payment for the enrichment of benefits for everyone.
Understanding that this position might be taken by some of us who are more concerned about patients than insurers, the proponents of private plans have also countered with the claim that only they can provide coordinated care through care management services. CMS states that coordinated care services could be provided through the traditional FFS Medicare program only by requiring the program “to pay either a care management organization separate from the delivery system to manage the patient or to pay physicians or others for these services.”
To be sure we understand what they are saying, maybe we should expand on that last statement. If we want our traditional Medicare program to provide coordinated services then either we are going to have to hire managed care organizations and their administrators to manage the medical care of the patients, or we are going to have to pay primary care physicians appropriate compensation to manage medical care.
Everyone agrees that we need to reinforce our primary care infrastructure. Maybe this is the way to do it. Start paying primary care physicians and practitioners designated fees for the job that they were trained to do – coordinating the care of their patients. They could do it for a lot less than the wasteful, private Medicare Advantage plans. And they would do it while injecting a full dose of humanity – a product that private insurers can’t deliver.