Making Medicare Advantage Even More Advantageous

In an effort to get input on how to improve Medicare’s Part C, better known as Medicare Advantage (MA), the Centers for Medicare and Medicaid Services (CMS) has issued a Request for Information, (RFI) to get input from stake holders on improvements to this important part of Medicare. MA is the fastest growing option for those who are 65 and older, offering an option for a private insurance company to provide your healthcare.

The Healthcare Leadership Council (HLC) is the sponsor for Seniors Speak Out and is in a unique position to offer insightful and balanced suggestions on how to improve MA. This unique position comes from the fact that HLC is a coalition of chief executives from all disciplines within American healthcare. Members of HLC – hospitals, academic health centers, health plans, pharmaceutical companies, medical device manufacturers, laboratories, biotech firms, health product distributors, post-acute care providers, home care providers, and information technology companies – advocate for measures to increase the quality and efficiency of healthcare through a patient-centered approach. This broad membership ensures this balanced approach to the suggestions for improving MA.

While the suggestions offered by HLC covered many aspects of MA, I want to highlight a few that I feel are very important improvements to MA.

Telehealth – While it is difficult to think there was anything good that came out of the pandemic, there was at least one silver lining. The use of telehealth was slowly growing prior to the pandemic and then we were suddenly thrust into the directed isolation of this deadly virus, which was especially dangerous for older people. The very people who historically require more healthcare services were advised to limit their exposure to other people, especially doctor’s offices and hospitals. These healthcare providers were suddenly asked to find alternative ways to treat their patients. Another silver lining of COVID-19 was the crash course seniors went through to learn how to use Zoom and other virtual platforms, since it was often the only way they could see the faces of their loved ones. It shortened the learning curve on using this new technology and enabled doctors to both talk and see their patients, a definite plus in the evaluation of their patient’s condition. Using emergency powers, the administration enabled Medicare to pay for these remote services by waving certain payment restrictions. It is important now that those payment restrictions be extended and permanent payment options be studied and instituted. For example, studies have shown that Virtual care during the pandemic reduced patients’ risk of overdose and boosted the use of medication-assisted treatment for opioid use disorder, the CDC, CMS, and theNational Institute on Drug Abuse found in a new study out in JAMA Psychiatry. Researchers examined data from more than 175,000 Medicare beneficiaries between September 2018 and February 2021. They found that during the pandemic, receiving opioid-use treatment via telehealth was linked to better retention for medication-assisted treatment and a lower risk of medically treated overdose compared to people who didn’t receive opioid use services via telehealth. This specific example shows that telehealth can be very effective. The best practices gleaned from the COVID-19 experience should allow us to reap the savings and efficiencies of providing remote healthcare.

Broadband Access – The pandemic emphasized the need for broadband access and accelerated the upgrading of internet access. Access to a high-speed internet connection has reduced the barriers for those who live in rural areas, reduced the problem of transportation, and even increased the equitable application of healthcare. As states imposed stay-at-home orders, consumers required alternative sources to remain connected with healthcare professionals so they could continue to receive important care – this was particularly critical for people with chronic conditions, who required access to consistent, continuous care to manage their overall health. Additionally, many home digital health products offered today work most effectively with a sufficient and sustained connection. As the Infrastructure Investment and Jobs Act included provisions to advance digital connectivity, CMS should continue to partner with agencies such as the National Telecommunications and Information Administration and the Federal Communication Commission to better target communities in need and work to reduce existing health disparities. CMS needs to pursue options that increase Medicare beneficiaries’ connection to, and use of, digital tools, such as supporting cellular devices programs and incorporating digital literacy.

Data Interoperability – The ability for different computer systems to communicate with each other is extremely important when it comes to healthcare. There are many initiatives, like the Trusted Exchange Framework and Common Exchange, that support a common baseline for quickly sharing information among stakeholders while ensuring that healthcare information receives robust privacy and security protections. We all fill out many forms during our visit to different healthcare providers, many times entering the same information over and over. Some of this duplicity is due to the inability of different information systems to share a common standard which would ensure the quick and accurate sharing of information. I have personally advocated for years for the establishment of a standard and secure way to share information. It is imperative that we consider the needs of healthcare stakeholders to ensure a smooth and successful transition to an efficient secure standard.

The improvements detailed above are a few of the improvements mentioned in the HLC letter but I feel they are key in turning the silver linings that came from the COVID-19 pandemic into permanent improvements in the MA program. It’s an opportunity for improvement that we can’t let slip away.

Best, Thair