Could Medicare Advantage Be Facing More Legislative Reform This Year?

The House Ways & Means Committee held a hearing Tuesday on the Medicare Advantage (MA) program. Lawmakers eagerly pointed out the success and bipartisan support for the program and were generally very receptive of the feedback received from the panel of experts. The panel included two plans – Clover Health and Independence Blue Cross of Philadelphia – and two policy researchers.

Star Ratings

Panelists were generally in agreement with Karoline Mortensen, Ph.D., who recommended the move to greater outcomes measures with the removal of some process measures to avoid cacophony. Mortensen also recommended the use of geographic assessment of Star Ratings and potentially utilizing MedPAC’s proposed peer-based grouping. The panel also noted the need to incorporate the newly established supplemental benefits into the Star Ratings system.

There was some discussion of the categorical adjustment index, which had lackluster effects on adjusting for socioeconomic status. Experts suggested changes to risk of fall measures and nutrition measures as well as looking at the readmission rate and “healthy days” measures.


Supplemental Benefits

Insurers were in strong support of the expansion of supplemental benefits, arguing the flexibility allows them to better focus on patients with unique and chronic conditions. While the two other policy experts cautioned on possible beneficiary confusion and cherry-picking of healthier enrollees, the plans noted the expansion allows them to focus on social determinants of health (SDOH) as well as increasing the quality of care beneficiaries receive. Klausner of Independence Blue Cross called the move one of the best things that’s happened to the MA system since she has been in the business, allowing for further investment into SDOH services such as nutrition, transportation, and loneliness.

One area called out that is likely to see some legislative movement is the incorporation of ancillary benefits such as dental, vision, and hearing.

Finally, Mortensen raised concern that traditional Medicare could be left in the dust if these benefits are only added to MA.


Medicare Plan Finder

All panelists agreed Medicare Plan Finder (MPF) is in need of significant reform. Lawmakers called on modernization of the tool in order to incorporate the best e-commerce practices on the MPF. Some ideas noted were to create a more user-friendly layout, include an internal provider directory and web chat features, and include layman’s terms. There was also a suggestion to include supplemental benefits and explain the effect leaving MA to pursue a traditional Medicare plan with a Medigap policy would have on a beneficiary.


Network Adequacy and Provider Consolidation

Clover Health, a new entrant into the MA market with a focus on big data and analytics to drive improvement in beneficiary health, noted huge barriers to entrance were provider consolidation and network adequacy, pricing the insurer out of several markets. The insurer suggested a standardized contract for systems that don’t contract with the plan due to unreasonable financial demands. Clover’s suggestions that MA should be treated by hospitals and providers with the same fairness as Medicare Fee for Service was well received by lawmakers, suggesting some possible proposed changes around network adequacy down the line.




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