Medicare Advantage: The Choice of America’s Seniors

Congress created Medicare Advantage (MA) in 2003 to provide America’s seniors a convenient, coordinated option for their health coverage and to drive greater value and accountability in the Medicare program. Today, the evidence is clear: MA is working, providing exceptional coverage and care for nearly 23 million seniors. The program provides all the benefits of traditional Medicare, plus enhanced benefits, high value coverage, better health outcomes, greater transparency and superior customer experience – all at a lower price.

ACHP member organizations are also amongst the highest quality MA health plans in the nation. As integrated, provider-aligned health organizations, ACHP members lead the industry in high-value care delivery and outcomes-based payment models that coordinate and streamline care for beneficiaries. This focus on quality in coverage and care is clear in MA, where nearly 40 percent of all 4.5 and 5 Star plans available in 2018 were offered by ACHP members. 

Strengthening MA

Continued investments in MA can enhance quality of care for America’s seniors while fostering a more efficient, smarter approach to health care.

That’s why ACHP advocates for policies that enhance and improve the MA experience:

  • Innovative care coordination and delivery models improve health outcomes—and help drive the larger health system toward a model based on how well care is delivered, not how much care is delivered.
  • Flexibility for MA plans to offer supplemental benefits, such as telehealth, and to address underlying social risk factors can expand access and improve quality of care.
  • Properly rewarding high-quality health plans will improve health outcomes and spur additional care innovations.

Improving Care Coordination and Delivery Models

The MA program has encouraged investment in value-based care models, leading to more effective care management and better health outcomes. Congress and the Administration can continue promoting this approach by increasing investments in care coordination and offering additional flexibility in plan design. These changes would allow MA plans to further refine patient-centered, value-based programs dedicated to delivering the best care and coverage possible.

Statement for the Record: Ways & Means Committee MA Hearing on Promoting Integrated and Coordinated Care for Medicare Beneficiaries

Encouraging Access and Addressing Social Determinants of Health

ACHP advocates for policies that improve access to care and that allow MA plans to address underlying factors critical to health outcomes.

Telehealth

ACHP members have shown that telehealth is an important and cost effective way to provide access to high quality care and coverage.  As such, ACHP advocated aggressively for allowing MA plans to include telehealth-based services as a basic benefit – which now allows seniors in MA plans to cost-effectively access the care they need. Additional policy changes that recognize the role of telehealth in network adequacy would expand access even further.

ACHP Recommendations to CMS for Implementing Telehealth Provisions

Social Determinants

The evidence is clear: health outcomes improve when care providers look beyond the exam room and commit to addressing a patient’s often unmet social needs. For years, ACHP member plans have been taking steps to address these needs, improving overall health outcomes, building healthier communities and acting as a role model for the entire industry. ACHP supported recent policy changes that now provide MA plans the flexibility to use supplemental benefits to address underlying risk factors, including access to healthy food and healthy living environments. 

Medicare Advantage Quality Payments

The MA program was designed to improve quality and value by rewarding health plans providing the highest quality coverage and care. Importantly, plans reinvest quality bonus dollars into member services, improving benefits and reducing premiums. However, due a cap on these payments, many of the best MA plans are receiving only a fraction or, in some cases, no bonus payments at all.

That’s why ACHP proudly supports the Medicare Advantage Quality Payment Relief Act, sponsored by Reps. Ron Kind (D-WI), Mike Kelly (R-PA), Mike Doyle (D-PA), Brett Guthrie (R-KY) and Sens. Steve Daines (R-MT) and Angus King (I-ME). The bipartisan bill would allow a more accurate calculation of payments and restore quality payments to the highest performing 4- and 5-star health plans.

RELEASE: ACHP Applauds House and Senate for Commitment to Quality & Value in Medicare Advantage
Quality Bonus Payment Fact Sheet
Letter to House Ways and Means Committee on addressing the benchmark cap
Letter to House Ways and Means Subcommittee on Health on addressing barriers to innovation

Other resources:

Response to RFI on Reducing Administrative Burden to Put Patients over Paperwork, August 2019
Comment Letter on 2019 Advance Notice and Call Letter, March 2019