Dr. Sachin Jain: 5 fixes for Medicare Advantage Note # 2

[Duaine]

Five key changes could improve Medicare Advantage, SCAN Group CEO Sachin Jain, MD, wrote in Forbes Jan. 30.

Though the program can provide more benefits at a lower cost to older adults, there are well-documented issues with Medicare Advantage, Dr. Jain wrote.

Here are five improvements that could cut down on overpayments and improve the quality of the program, according to Dr. Jain:

1. Standardizing benefits to make sure plans provide valuable supplemental benefits. MedPAC has pitched standard benefits as a way to simplify beneficiaries' choices.
   
   
2. Reforming the broker industry to focus on providing support for the entire time beneficiaries are enrolled in Medicare Advantage, not just when they choose their plan.
   
   
3. Reorienting star ratings around outcomes, rather than processes.
   
   
4. Updating risk adjustment audits to focus on current data, rather than years-old data.
   
   
5. Incentivizing capitated payments to providers.

So do I need to go and get my medical and counseling degrees? Hmmmm Doctor of Insurance....sounds good to me.

II. Reform the Broker Industry to Focus More on Clinical Support​

About a third of MA beneficiaries rely on brokers to help them choose a plan. At their best, brokers are knowledgeable about trends in the industry and can help match a beneficiary to a plan that meets their specific needs. But they could do so much more. As the leader of healthcare organizations, I’ve met hundreds of brokers who are not just random salespeople; they are trusted members of their communities and a regular fixture in the lives of the people they serve. As such, they could augment the healthcare workforce (in a time of growing workforce shortages) by performing many of the functions that community health workers typically perform—such as helping with care navigation, counseling people on health behaviors, ensuring medication adherence, and even providing direct care services such as blood pressure screenings. Brokers—who earn lifetime commissions for enrolling someone in a Medicare advantage plans—can be rewarded for the work they do to keep seniors healthy and independent as they age.

[EXTERNAL LINK] - 5 Ways To Improve Medicare Advantage