New Report: CMS’ Changes To Medicare Advantage Undermine Care For Beneficiaries Managing Chronic Conditions

posted by Clare Krusing

on January 22, 2016

For Immediate Release

Washington, D.C. — With 17 million seniors and individuals with disabilities depending on the Medicare Advantage program, a report¬†from Avalere Health raises new concerns about CMS’ policies that undermine health plans’ efforts to care for beneficiaries managing multiple chronic conditions. After assessing the accuracy of CMS’ current risk adjustment model and the cost of care for chronic health conditions, the Avalere analysis found that the model under-predicts costs for individuals with multiple chronic conditions by $2.6 billion on an annual basis. These findings come just weeks before CMS releases its annual proposed payment notice and call letter for Medicare Advantage and Part D plans, which may include further changes to the program and seniors’ benefits.

Unlike traditional fee-for-service Medicare, Medicare Advantage provides tailored care coordination and disease management programs that allow beneficiaries to better manage their chronic conditions. Research shows that these programs consistently lead to improved health outcomes for seniors and serve as the foundation for care delivery innovations across the health system. As a result, Medicare Advantage beneficiaries consistently report high satisfaction with the program, and a growing number are enrolling in Medicare Advantage for the high-quality care these plans provide.

In the spring of 2015, CMS finalized changes to the risk adjustment system, which directly targeted chronic disease prevention programs. This latest Avalere analysis demonstrates that these changes significantly limit health plans’ early intervention efforts and seniors’ benefits. Under the current risk adjustment model, CMS substantially under-predicts expenditures for providing care to beneficiaries, including those with the following conditions:

  • Chronic kidney disease;
  • Osteoarthritis;
  • Rheumatoid arthritis; and
  • Alzheimer’s disease and related conditions.

“Further cuts to Medicare Advantage and seniors’ benefits are fundamentally at odds with the goal of delivering better care and better value for beneficiaries,” AHIP President and CEO Marilyn Tavenner said. “Rather than relying on an antiquated fee-for-service approach as the model for care delivery, CMS should focus on strengthening Medicare Advantage and the innovative programs that improve seniors’ health.”

Last year, more than 340 members of Congress, lead by Sen. Chuck Schumer (D-NY), Sen. Mike Crapo (R-ID), Rep. Patrick Murphy (FL-18), and Rep. Brett Guthrie (KY-02), urged CMS to protect seniors’ coverage and provide stability to the program. Ahead of the upcoming February rate notice, more than 2 million seniors from AHIP’s Coalition for Medicare Choices have mobilized, urging Washington to defend the Medicare Advantage program from further payment cuts.

To view the full report, click here. For more information on Medicare Advantage, click here.

Providing Health Benefits for Over 200 Million Americans.

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