Medicare

September 19, 2018

4 essentials for the continued success of Medicare Advantage

One in three Medicare beneficiaries is now enrolled in Medicare Advantage, a private health plan that focuses on coordinated, patient-centered care and provides benefits that aren’t available in traditional Medicare. Medicare Advantage now serves more than 21 million Americans – with Blue Cross and Blue Shield companies collectively covering more than three million people in Medicare Advantage plans.

4 essentials for the continued success of Medicare Advantage

Justine Handelman
Senior Vice President
Office of Policy and Representation Blue Cross Blue Shield Association

Here are four key points that are essential to the continued strength of Medicare Advantage:

Flexibility is Critical to Address Chronic Conditions and Social Determinants of Health

Congress and the administration recently implemented policies to allow more – and welcome – flexibility in effectively targeting care so that benefits can be tailored to meet patients’ needs. These new flexibilities strengthen plans’ ability to design benefits and cost-sharing around a patient’s specific chronic conditions and partner with community groups to address social needs that can sometimes leave seniors without adequate access to the services they need. 

For example, my colleague Daphne Klausner, Senior Vice President of Senior Markets for Independence Blue Cross, says that Independence plans to: lower out-of-pocket costs for diabetic supplies to improve adherence; waive copays to see a certain specialist crucial to the patient’s chronic condition; and explore providing transportation for doctor visits.  

Technological Advances Can Help Bridge Care Gaps and Increase Access to Care

Leveraging technology can help address a range of issues, from access to care in underserved rural areas to management of chronic disease. Congress took a significant and welcome action recently to give Medicare Advantage plans more flexibility to incorporate telemedicine into their benefits. This will help millions with a range of health conditions and challenges. 

For example, BlueCross BlueShield of Tennessee (BCBST) is piloting a technology-enabled behavioral therapy approach that aims to help beneficiaries with concerns, such as reducing pain and opioid use post-surgery, as well as coping with depression and bereavement. Preliminary clinical findings show significant decreases in depression, anxiety and stress, in addition to a reduction in hospital days and emergency room visits.

Quality Incentives Must Be Rooted in Clinical Outcomes

The Medicare Advantage Star Quality System (Star System) incentivizes health plans to improve quality, such as ensuring beneficiaries have flu shots and diabetic foot exams. We agree with experts that improvements to the Star System could be achieved by incorporating more measures tied to improvement in patient outcomes, with less reliance on measurements that assess process.

Consumers Need Useful Tools to Support Decisions

The promise of Medicare Advantage has always been to provide seniors with more choices—and it’s gratifying that nearly all seniors now have access to a Medicare Advantage plan. However, increased choice must be paired with improved, customized tools to support decision-making for beneficiaries who have unique needs and challenges. 

Seniors must have easy access to accurate information on the Medicare Plan Finder (on Medicare.gov) and other sources. They must understand the tradeoffs of different choices and get help choosing the best option for their needs.  

The evidence is clear. Seniors are increasingly choosing Medicare Advantage because it provides the coverage and benefits they need at an affordable cost. By 2028, as many as half of all Medicare beneficiaries could be in Medicare Advantage, for good reason.   

Medicare Advantage has a track record of reducing costs and improving care as an effective public-private partnership between health insurers and the government. Lawmakers should continue to strengthen the popular program so it can provide the affordability, care coordination, and additional benefits enrollees rely on.

Read more insights on my LinkedIn page.

Categories: Medicare
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