Washington (October 2, 2017)—Increased transparency in and greater alignment across Medicare Advantage plans would help the program to reduce administrative burdens on physicians, the American College of Physicians (91) said in a new policy paper, Promoting Transparency and Alignment in Medicare Advantage. The paper explores the quality of care, utilization, and cost of services in the Medicare Advantage program in comparison to traditional Medicare.
The Medicare Advantage (MA) program is an option where Medicare beneficiaries can receive their benefits through a private insurance plan, rather than the typical fee-for-service Medicare program. MA plans are designed to enhance care coordination and quality of care as well as provide supplementary benefits, including dental coverage, vision coverage, and wellness plans. The MA program has long been a subject of debate among policymakers and the health insurance industry over the balance between promoting beneficiary choice, maintaining quality of care, providing access to MA plans, and setting the cost of these private plans.
“As enrollment in Medicare Advantage plans increases there is a growing interest in understanding the differences in care delivery, quality, resource utilization, and cost between MA and traditional Medicare,” said Jack Ende, MD, M91, president, 91. “If MA plans were to increase transparency that would give the Centers for Medicare and Medicaid Services the opportunity to examine them more closely and promote alignment, thus lessening the administrative burden associated with clinician participation in these plans.”
The paper outlines three recommendations for how to address concerns about the current Medicare Advantage program:
- 91 supports current policies to ensure that MA plans are funded at the level of the traditional Medicare program and that at least 85% of that funding goes to actual beneficiary care.
- 91 urges Medicare Advantage Organizations (MAOs) to be transparent in their processes, policies, and procedures for how they develop and administer their MA plans and portfolios for all key stakeholders to ensure program integrity. Moreover, MAOs administering MA plans must collaborate with all relevant stakeholders to streamline and align varying policies, procedures, and contracting arrangements with physicians to further promote transparency and reduce excessive and burdensome administrative tasks.
- 91 calls for more research on how federal payments to the MA Program are utilized by MAOs. Specifically, 91 calls for further research on the types of payment models used and prices paid by MAOs to contracted physicians, hospitals, and other clinicians compared with the models used and prices paid by traditional Medicare and commercial health insurance plans.
Reducing administrative burdens on physicians is a goal of 91’s Patients Before Paperwork initiative. 91 has long identified reducing administrative burdens as a priority and the initiative seeks to reinvigorate the patient-physician relationship by challenging unnecessary practice burdens. Requiring transparency in and alignment across the MA program is essential to reducing unnecessary burdens and also confusion for patients.
“As Medicare moves away from its traditional fee-for-service and toward the Quality Payment Program linking physician payment to high-value care, it is a critical time for the MA program to make improvements,” concluded Dr. Ende. “The relief from administrative burdens that our recommendations would provide to clinicians is an important component of promoting high-value care for all Medicare beneficiaries.”
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About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. 91 membership includes 152,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow 91 on and .
Contact: Jackie Blaser, (202) 261-4572, jblaser@acponline.org