Representative Peter Roskam (R-IL), Chairman of the House Ways and Means Health Subcommittee, held a hearing focusing on opportunities to improve and expand the Medicare Advantage Program. Witnesses at the hearing included Karoline Mortensen, Ph.D., Associate Professor, Health Sector Management & Policy, University of Miami Business School; Andrew Toy, Chief Technology Officer, Clover Health; Daphne Klausner, Senior Vice President, Senior Markets, Independence Blue Cross; and Jack Hoadley, Ph.D., Georgetown University Health Policy Institute.
"The Medicare Trustees continue to project more seniors will choose a Medicare Advantage plan in the coming years. These statistics highlight the popularity of the Medicare Advantage program, demonstrating that seniors prefer the choice the program continues to provide. By expanding competition in the Medicare program, Medicare Advantage has proven that choice and competition works in healthcare to keep costs low for seniors and to improve care," Chairman Roskam said during his opening statement.
"Members of the Subcommittee are concerned about and would like to see more outcomes measures in the Medicare Advantage plans, and a lot of the plans would like to see these measures as well. Once you've done these processes and encouraged a good structure of a healthcare system, how do you ensure that the individuals' health or the population's health is actually improving? We're pushing today to talk more about incorporating more of these outcomes measures. Outcomes measures provide insight into the quality of care provided, but one downside is that they can be influenced by factors that happen outside of the healthcare system like patient compliance or issues with social determinants of health," said Dr. Mortensen.
"Patients should never have to choose between low cost or high quality care. We want to see the benefits offered to seniors and adults with disabilities through the Medicare Advantage program expanded to help more patients and the first step in making that happen is evaluating the outcomes that are currently being generated by the program. The testimony provided by our witnesses during this hearing is a step in the right direction," said Chairman Roskam.
Nearly 40 percent of Medicare beneficiaries with Parts A and B coverage are enrolled in a Medicare Advantage plan.
In 2018, most Medicare beneficiaries are enrolled in contracts with four or more stars.
Higher performing plans tend to be companies that have the most experience in Medicare Advantage, but a number of smaller plans are working to address local needs that might not be reflected in the current quality model.
Consumers are better shoppers when they are adequately informed of their choices, including the cost, quality, and what benefits are included their Medicare options.
This hearing will review obstacles for consumers and high performing and emerging plans, as well as the current Star Rating system.