Buried deep in a proposal from the federal Centers for Medicare & Medicaid Services (CMS) last week was a proposal to consider new payment and delivery models designed to lower costs and improve quality.
Most of the news about the proposal issued Feb. 21 involved the CMS plan to cut payments to health plans serving Medicare Advantage members by 19 percent. But in the same proposal, CMS said it was seeking to partner with health plans to develop value-based insurance design (VBID) strategies and to improve member engagement.
Medicare advantage is popular but relatively expensive. Some private insurers may leave the program if funding is cut, forcing some seniors to change providers. Cuts may also hit extras like hearing aids and health club memberships.
Preventative services such as mammograms and diabetes classes will be better covered under most proposals.
Some plans may punish hospitals with high readmission rates and encourage all hospitals to work to keep patients from coming back.
Any move to electronic medical records and better coordination of care would benefit Medicare patients and providers, as Medicare suffers from many of the same inefficiencies as the system at large.
As for the notorious prescription drug coverage “doughtnut hole,” the house democrats have proposed a plan that would fill it in by 2023.
Cranberg urges the press to pay close attention to the impending showdown between the president and a coalition of insurance companies and Medicare Advantage clients grown accustomed to heavy government subsidies. The administration estimates cutting the Advantage program will save $176 billion over the next decade, money the president hopes to use to expand coverage.