Providers’ experiences with Medicare Advantage plans’ capitated payment models, supplemental benefits, and overall influence gave them recommendations for CMS.
There has been a lot of valuable conversation around the benefits that Medicare Advantage health plans can offer to consumers, but now providers have offered their perspectives on this form of health insurance in Better Medicare Alliance’s (BMA’s) white paper, conducted by Health Management Associates (HMA).
“Through extensive research and thoughtful interviews with leading health plans and providers, HMA offers unique insight into the actions that Medicare Advantage took during this unprecedented health crisis to keep beneficiaries safe from harm – all while playing an important role in keeping doctors offices’ doors open,” Mary Beth Donahue, president and chief executive officer of the Better Medicare Alliance, shared in the press release.
“From firsthand stories of health plans purchasing toilet paper for beneficiaries and offering virtual companionship to ease the pain of isolation that COVID-19 wrought for so many, to providers’ testimonials of Medicare Advantage’s faster transition to virtual care and quicker claims payment, this report shows how Medicare Advantage met the moment and showed up for beneficiaries and providers alike.”
BMA and HMA analyzed 70 publications, public information, conducted a thorough Google Scholar search, and interviewed 18 Medicare Advantage plan professionals including a broad variety of providers.
First, providers enjoyed capitated payment arrangements with Medicare Advantage plans.
All of the providers that BMA interviewed reported that value-based contracts with capitated payment arrangements allowed them to have more financial stability. Having a scheduled, expected payment enabled providers to reach out to patients more regularly.
Even providers who did not engage in capitated payment models during the pandemic told BMA that the model was well-suited for the volatility of the pandemic.
Second, providers found that Medicare Advantage plans were more communicative than fee-for-service Medicare.
Several providers noted that Medicare Advantage health plans channeled coronavirus-related information to both them and their patients, such as public health guidelines. By contacting beneficiaries with this information, Medicare Advantage plans diminished the burden on providers to connect with all of their patients about this information.
Medicare Advantage plans also updated providers on any coverage flexibilities more frequently and more clearly than fee-for-service Medicare.
“A few providers even characterized the communications coming from CMS as inconsistent and confusing relative to Medicare Advantage communications, which were often easier to understand and digest,” the paper stated.
Finally, providers found that Medicare Advantage plans’ efforts to address the coronavirus pandemic had a positive ripple effect, touching beneficiaries and individuals who did not have Medicare Advantage plans.
By quickly updating beneficiaries about changing guidelines and benefits, Medicare Advantage plans allowed providers to focus their outreach efforts on the fee-for-service Medicare population.
In addition to these three points, providers noted that Medicare Advantage helped rapidly advance virtual care services, employed supplemental benefits that improved patients’ ability to isolate and observe providers’ directions, offered care management services, and improved claim payment speed.
The providers recommended that CMS should transition fee-for-service Medicare to population-based payment models or capitated payment. Additionally, they suggested a national patient dataset to support vaccine coordination, population health management efforts, and case management.
Providers also stressed that CMS should improve its methods of communication—both with patients and providers. They requested changes to reimbursement billing instructions and coding. The agency should also change risk adjustment in Medicare Advantage to account for certain common practices that are currently unbillable.
During future public health emergencies, providers recommended that the government close coverage gaps and expand coverage for the uninsured.
These providers’ perspectives are important as policymakers decide how to phase out, maintain, or adjust coronavirus-related Medicare policies.
Separate studies have affirmed that Medicare Advantage coronavirus-related hospitalizations were lower than fee-for-service Medicare hospitalizations. Additionally, racial care disparities tend to be lower in Medicare Advantage plans than in fee-for-service Medicare.