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…
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…
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…
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…
Although the typical economist answer would be yes, in the case of one Medicare Advantage program, the answer is ‘no’. A paper by Layton and Ryan (2015) [earlier draft] examine the Medicare Advantage Quality Bonus Payment Demonstration (MA QBP) which began in 2012. In this program: …plans receive bonus payments based on an overall plan quality…
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…
A KFF article provides some highlights of changes to Medicare Advantage for 2015: Near universal access to an MA plan. 99% of Medicare beneficiaries will have access to a Medicare Advantage plan as an alternative to traditional Medicare in 2015. The only individuals without access to an MA plan are concentrated in a few rural areas. Lots of…