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Healthcare Reform Lessons from Medicare Advantage

June 10, 2021 by chris dsouaz

Currently, more than 18 million Americans are enrolled in Medicare Advantage plans, with roughly one-third of all Medicare beneficiaries opting for one. Americans are not only enrolling in these affordable Medicare solutions in greater numbers, but they are also satisfied with them.

So, what’s the catch? Medicare Advantage has created a plan that provides subscribers with affordable, high-quality, patient-centered care with a wide range of options while also motivating providers to keep people healthy.

While the affordable Medicare solution is not without flaws, it has proven to be a success that the healthcare profession can learn from. From the pages of Medicare Advantage’s playbook, we can learn a few things.

Keep care affordable with accurate compensation for insurers

For starters, Medicare Advantage has devised an incentive scheme that rewards insurers equitably for providing value-based care. However, this wasn’t always the case. In the beginning, Medicare Advantage insurers were paid the same amount for everyone registered in their health plan, regardless of whether they were affordable or had complicated chronic diseases.

As a result, the government seemed to compensate healthy enrollees while underpaying sicker ones. As a result, insurers were compelled to enroll healthy patients while avoiding sicker ones, creating a barrier to providing high-quality, affordable Medicare solutions to those who needed them.

The Centers for Medicare & Medicaid Services (CMS) adopted risk adjustment for Medicare Advantage plans in 2004 to address this issue. Risk adjustment, in general, describes a single individual’s health and well-being, aggregates the health of all individuals throughout a plan, and then determines how much a single insurance company or healthcare provider will be paid per patient.

These payments are determined by how sick or healthy a member is, ensuring that sick patients receive the affordable Medicare solutions they require and that physicians get compensated for providing that care. Because Medicare Advantage plans are reimbursed for the average cost of caring for an individual, it incentivizes organizations to provide cost-effective care to a population.

With such results, it’s simple to understand why Medicare Advantage’s use of risk adjustment is a valuable lesson for the government as it seeks to bend the expense curve of Medicare and healthcare in general while preserving access and quality.

Incentivize comprehensive care coordination for better care outcomes

An affordable Medicare plan’s success isn’t determined solely by its ability to control costs; it must also produce high-quality outcomes. Chronic disease management and care coordination are directly impacted and improved by Medicare Advantage.

Provider networks operating under Medicare Advantage models, on the other hand, have a global budget related to their capacity to track and report on care coordination, clinical results, and beneficiary satisfaction.

This encourages practitioners to accurately document clinical diagnoses in order to guarantee that beneficiaries receive the care management and related services that are suitable for their condition. Effective recording and diagnosis have been shown to lead to earlier treatment interventions, higher treatment rates, affordable Medicare solutions, and improved health outcomes.

A path forward

Certainly, Medicare Advantage has its share of difficult difficulties. However, it is apparent that it is a successful aspect of the healthcare system that has provided improved value for each healthcare dollar spent for both enrollees and the government.

Take a look at Medicare Advantage and its value-based approach to managing it as government officials and the industry navigate the healthcare changes and learn from what works.

Meanwhile, if you’re looking for affordable Medicare solutions for senior health, choose National Senior Services. We are here to help you locate the correct coverage by guiding you through the process step by step. With so many alternatives and variables to consider, we can assist you to understand which plan or plans will work best for you


chris dsouaz

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National Senior Services is not connected with or endorsed by the US government or the federal Medicare program; Medicare has neither reviewed nor endorsed this information. We are a licensed and approved Medicare Service Provider.

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