Unbiased Analysis of Today's Healthcare Issues
CMS recently authorized Medicare Advantage (MA) plans the ability to apply step therapy protocols to Part B drugs. Although it is not clear the degree to which the MA plans will implement step therapy, a good guide is to see what is happening in the commercial insurance market. A Health Affairs blog by Chambers, Panzer and Neumann attempts…
While most patients in Medicare use the traditional fee-for-service route, a growing percentage of Medicare beneficiaries are relying on managed care plans through Medicare Advantage. Medicare Advantage provides beneficiaries with additional choice and also serves as a competitive alternative to traditional Medicare. In theory, Medicare should just allocate a beneficiary’s funding to a managed care…
CMS has focused in recent years on payment reform–especially alternative payment models–in Medicare’s fee-for-service (FFS) reimbursement system, but much less has been paid to beneficiaries enrolled in Medicare’s managed care program (i.e., Medicare Advantage). Currently, however, more than 1 in 3 beneficiaries are enrolled in an Medicare Advantage plan, and by 2028 that number could…
Medicare provides health insurance for 58.4 million Americans. To provide health care to largely elderly Americans, it spent $710 billion in 2017. One key question is, does the federal government have the funds to continue to support this program as the baby boomers retire? According to the 2018 Medicare Trustees report, the answer is increasingly…
Austin Frakt of the Incidental Economist argues convincingly–and I agree with him–that the answer is no. Medicare Advantage plans have been found to be of higher quality than traditional Medicare. They also reduce wasteful use of health care by managing care, something the traditional program doesn’t do at all. Finally, they fill in gaps in coverage and…
Much of the news has claimed that the Affordable Care Act is a failure because individuals in many counties have few or even no health insurance options. However, how many counties truly will have zero Obamacare exchange insurance options in 2018 ? The Kaiser Family Foundation reports that there are only 17 counties covering 9,595…
Medicare’s cost are growing due to an aging population, technological advances, and other factors. One of those factors may be upcoding that is occurring among Medicare Advantage plans. Rick Kronick writes in Health Affairs that: Over the past decade, the average risk score for Medicare Advantage (MA) enrollees has risen steadily relative to that for fee-for-service…
CMS announced last week that they are extending their value-based insurance design (VBID) program to more states and more patients. I describe VBID and the proposed changes below. What is VBID? Value-Based Insurance Design (VBID) generally refers to health insurers’ efforts to structure enrollee cost sharing and other health plan design elements to encourage enrollees…
Do patients who enroll in Medicare Advantage go to the hospital less frequently? The answer is yes. However, this fact may not be causal. Patients who enroll in Medicare Advantage are generally younger and healthier than patients who enroll in Medicare’s fee-for-service (FFS) program. A paper by Duggan, Gruber and Vabson (2016) uses a novel…
In the 1990s, managed care began to take over the health care marketplace. However, backlash against managed care lead to a retrenchment in managed care in the late 1990s. A paper by Sinaiko and Zeckhauser (2015) notes that: After the MA-plan payment cuts imposed through the Balanced Budget Act of 1997, HMO availability dropped by nearly…