Washington (April 10, 2019) – The Alliance of Community Health Plans (ACHP) applauds both the House and Senate for prioritizing value-based care and taking steps to address a glitch in the Medicare Advantage quality payment program. H.R. 2131/S. 1114, the Medicare Advantage Quality Payment Relief Act, proposes a simple policy fix that would benefit seniors and reward health plans for delivering the highest quality care.
“In 2018, seniors missed out on approximately $821 million in increased services and reduced premiums due to the payment glitch,” said ACHP President and CEO Ceci Connolly. “We thank Sens. Steve Daines (R-MT), Angus King (I-ME), and Reps. Ron Kind (D-WI) and Mike Kelly (R-PA), Mike Doyle (D-PA) and Brett Guthrie (R-KY) for their leadership on this issue. Rewarding quality in the Medicare Advantage program means better care for millions of America’s seniors.”
Quality bonus payments in Medicare Advantage, which must be returned as benefits to enrollees, are subject to a payment cap. The glitch in how HHS has interpreted this artificially cuts off the full payments to the highest quality plans. In 2018, over 11 million people in Medicare Advantage missed out on more than $800 million in increased services and/or reduced premiums due to this payment flaw. If corrected, ACHP member plans would be able to offer additional or enhanced benefits such as dental, hearing and vision services. One ACHP member, Security Health Plan, part of the Marshfield Clinic in Wisconsin, could reduce its monthly Medicare Advantage premium by $25 per month.
The bill, which has broad bipartisan support, would allow a more accurate comparison of benchmarks and restore quality payments to the highest performing 4- and 5-star health plans. The bill is critical to ensuring value in the Medicare Advantage program.
“As a local, not-for-profit health care organization caring for a population that is rapidly aging in a mostly rural state, we thank Senator Daines and Senator King for introducing this important bill to address the Medicare Advantage Benchmark Cap,” said David Howes, MD, President and CEO of Martin’s Point Health Care in Maine. “If enacted, this effort will unlock quality payments while strengthening care and coverage for our members through enhanced benefits in our Medicare Advantage plans.”
“ACHP and our members are committed to making high-quality coverage and care accessible, and recognizing top quality in Medicare Advantage is central to this goal,” said Connolly. “We look forward to working with the Administration and Congress to provide seniors with the highest quality care.”
ACHP has long advocated for a remedy to the quality payment glitch in Medicare Advantage, supporting legislation in the 115th Congress to fix the problem and H.R.4952 directing HHS to study the effects of the payment cap.
ACHP member organizations account for half of the top-scoring, or 5-Star, MA plans nationwide. They are leaders at managing chronic conditions, enhancing communication with care teams and increasing preventive screenings. Nearly all ACHP MA enrollees—97 percent—are in a four star plan or higher. ACHP plans provide coverage and care to more than 21 million Americans across 34 states and the District of Columbia.
About ACHP 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.