Will Medicare Advantage be the future of Alternative Payment Models

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…

VBID comes to Medicare Advantage

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…

Why Medicare Advantage is thriving

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…

2015 Medicare Advantage Enrollment

About two-thirds of Medicare beneficiaires are enrolled in tradiational Medicare FFS, but the remaining thrid is now enrollingin Medicare Advantage plans.  Which plans are dominant? The following figure from Avalere provides a breakdown. Note that this figure obscures significant regional variation in plan market share. For instance, Kaiser Permanente has almost half (48%) of the…

Medicare Advantage Plans: Thumbs Up or Down?

Austin Frakt says although Medicare Advantage plans used to be considered high cost, low-quality options, in recent years, these Medicare Advantage plans have vastly increased quality of care and have become less focused on cream-skimming healthier patients.   Medicare Advantage plans — private plans that serve as alternatives to the traditional, public program for those…