Urges Agency to Make Good on Star Ratings Quality Payments
Washington (March 1, 2019) –The Alliance of Community Health Plans (ACHP) commends CMS for providing critical flexibility for health plans to address social determinants of health and combat the opioid epidemic as part of its 2020 Advance Notice and Call Letter. ACHP also urges CMS to ensure seniors receive the highest quality health care by addressing a glitch in the Medicare Advantage quality bonus program.
“We’re grateful CMS is supporting health plans in addressing the social risk factors that fuel so many health conditions. Resources that allow plans to tackle challenges such as housing, transportation and food insecurity will lead to healthier communities and help contain escalating health costs,” said ACHP President and CEO Ceci Connolly. “We do however urge CMS to restore full quality payments in the Medicare Advantage program. Millions of America’s seniors are missing out on lower premiums and enhanced benefits under the current implementation.”
Expanding the definition of supplemental benefits in Medicare Advantage provides patients with much-needed access to services beyond medical care. It also allows health plans to more effectively tailor care to the individual, including by addressing external factors that impact health. Under the rule, health plans will be able to offer services such as transportation to and from appointments and food prescriptions to support better access to fresh fruits and vegetables for patients with chronic conditions.
ACHP is also encouraged by CMS’ proposals to address the opioid epidemic. Expansion of coverage for opioid-use disorder treatment services, support for non-opioid pain management and increased access to naloxone are welcome steps. ACHP plans have been at the forefront of the nation’s response to the opioid epidemic, often serving regions that have been hardest hit and developing and implementing innovative approaches to curb prescribing and inappropriate use of opioids.
ACHP appreciates CMS’ continued commitment to quality in the health care system but also makes recommendations for improvement. Once again, ACHP is urging the Administration to make the full incentive payments promised to the highest-quality health plans. Due to a glitch in the benchmark calculation, millions of seniors in Medicare Advantage plans are losing out on about $821 million in additional benefits and premium reductions every year. A bipartisan coalition of lawmakers supports restoring the full quality payments.
ACHP member plans are some of the highest quality health plans in the nation, topping the CMS Star Ratings year after year. ACHP plans provide coverage to 74 percent of beneficiaries enrolled in 5-star plans. Overall, 34 Medicare Advantage contracts offered by ACHP members received 4 stars or above in 2018. ACHP plans provide care and coverage to more than 21 million Americans, including 2.6 million Medicare Advantage beneficiaries.
To access the full text of the ACHP comment letter, click here.
The Alliance of Community Health Plans (ACHP) is a national leadership organization bringing together innovative health plans and provider groups that are among America’s best at delivering affordable, high-quality coverage and care. ACHP’s member health plans provide coverage and care for more than 21 million Americans across 34 states and the District of Columbia. These organizations focus on improving the health of the communities they serve and are on the leading edge of innovations in affordability and quality of care, including primary care redesign, payment reform, accountable health care delivery and use of information technology. To learn more, go to www.achp.org and follow ACHP on Twitter @_ACHP.