Report: Private Medicare Advantage Plans Make Progress in Combating Chronic Disease

Elements of the Medicare Advantage program, which offers seniors private health plan options with integrated care, could improve traditional Medicare.

• A new report from Emory University suggests incorporating into fee-for-service Medicare how MA prevents or treats chronic diseases.

• One-fifth of Medicare beneficiaries suffer from at least five chronic conditions.  These patients command half of all Medicare spending.

• The Medicare Advantage Experience:  Lessons for Reform to Original Medicare says the way MA and private insurance manage chronic care could improve beneficiaries’ health and save Medicare money.

• Adopting care coordination and similar lessons from MA and private coverage would beat cutting provider payments as a way to rein in Medicare spending.

Because chronic diseases like diabetes drive up Medicare spending, applying the best practices from consumer-centered health coverage could help prevent and manage chronic conditions in the fee-for-service program.

• Medicare Advantage and private health plans employ prevention strategies, care coordination and other “best practices” that have proven to promote better health and reduce health spending.

• The report recommends, “Identifying the best practice techniques and adopting them into traditional Medicare should be a key element of entitlement reform.”

• Team-based care, comprehensive medication therapy management, health coaching and transition care are all effective MA best practices.

• The Diabetes Prevention Program could become a covered Medicare benefit.  This approach coordinates diabetics’ care and helps them modify their habits to live healthier.

• Transitional care management payment in the 2013 doctor fee schedule could be built upon in traditional Medicare.  This only applies when a patient moves from hospital to community-based care.  But the report suggests coordinating patient care across the spectrum of patients’ providers.

Since its start in 2003, Medicare Advantage has gained popularity because of its high quality, coordinated benefits and patient-centeredness.  Its central role for private health plans makes MA extremely popular with seniors.  The best practices of these plans should be integrated into conventional Medicare.  That’s the only hope if Medicare is to contain its costs without sacrificing quality and care in the process.