The role of Medicare Advantage in propelling the value-based healthcare transformation

Abhinav Shashank
Fri 11 Oct 2019
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Statistics suggest that one out of three people eligible for Medicare are enrolled in Medicare Advantage Plans. This option is deemed to be more attractive than the traditional Medicare Part A and B because it offers more coverage (for instance, dental and optical insurance). Additionally, some plans offer no-cost premiums and feature out-of-pocket spending limits. MA Plans are overall more convenient for beneficiaries; they offer medical and hospital benefits (prescription drugs included) in just a single plan.

What lies in the future of Medicare Advantage Plans

Not very long ago, CMS released a fact sheet, from which a comprehensive list of MA Plans innovations will be tested on the Value-based Insurance Design (VBID) model in CY2020. The purpose of the model would be fixated on diminishing the expenses of the Medicare programs, boosting the quality of care and enhancing the efficiency of care delivery.

Contribution of Medicare Advantage to value-based initiatives

The very reason that more and more Medicare beneficiaries are opting for MA Plans is that they are able to derive more value through it. MA Plans offer much more than what traditional Medicare enrollees get.

New CMS regulations and beneficiaries’ inclination for MA Plans will make it inevitable for providers to adopt methods to drive smarter clinical interventions. What providers need to figure out in this changing landscape is how to deliver the best care and contain costs to get satisfactory incentives.

Delivering quality care to MA Plan enrollees

  • Access to data insights about the patient population

If healthcare organizations could get their hands on real-time information about their patients at the point of care, they can considerably improve healthcare outcomes. Not only would they be able to suggest the best course of care, but they will also be able to make timely interventions.

  • Factoring the social needs of the patients 

According to a CMS regulation, based on the socioeconomic or financial condition of the beneficiaries, healthcare organizations are allowed to test non-uniform benefits designs to provide rebates in cost-sharing and additional financial supplements. In this way, they would be able to target the right audience considering the non-clinical aspects instead of providing care based on clinical data alone.

  • Leveraging telehealth network to boost patient engagement

Healthcare providers can encourage MA Plans to propose the use of telehealth services more than in-person visits. It will reduce the utilization rates and costs as well as make it convenient for patients to readily access healthcare services.

  • Improving care management in the network

Value-based Insurance Design aims to improve wellness and healthcare planning. MA Plans participating in this model would want the providers in their network to follow an efficient care management approach. With this approach, providers can offer the best care services to not just the MA enrollees, but also other patients in the network.

The road ahead

US healthcare is progressing in its value-based initiatives, and the increased focus on delivering holistic patient-centered care is a clear sign of the transformation. Patients have become enlightened, and they are making choices that offer them more services. No wonder enrollments for MA Plans are increasing! The organizations that are able to offer more services and satisfaction are likely to succeed in the long run.

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Tags: Medicare Advantage
Abhinav Shashank
The role of Medicare Advantage in propelling the value-based healthcare transformation

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