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Report: Protect Medicare Advantage’s Ability To Care For Patients With Complex Health Needs

posted by Alicia Caramenico

on January 26, 2016

Changes to the Medicare Advantage risk adjustment model undermine health plans’ efforts to care for beneficiaries managing multiple chronic conditions, concludes a new report from Avalere Health. This will have real consequences for the millions of seniors and individuals with disabilities who rely on the Medicare Advantage program.

The Avalere report found that the model under-predicts costs for individuals with osteoarthritis, rheumatoid arthritis, Alzheimer’s disease, and chronic kidney disease,  and the under-prediction can significantly limit health plans’ early intervention efforts – which are critical to managing these conditions and mitigating complicated health issues that may arise in the future.

A previous Oliver Wyman analysis demonstrated the serious trade-offs that come with changes to the Medicare Advantage program. That analysis showed that under CMS’ proposal the majority of beneficiaries with chronic kidney disease would not be identified as having the disease and would risk losing access to the disease management services that help them get the right care at the right time before their health conditions worsen or become more serious.

Medicare Advantage beneficiary Paula Ercolini depends on her Medicare Advantage coverage for innovative care coordination benefits and disease management services to keep on top of her chronic kidney disease. When CMS releases proposed changes to Medicare Advantage payments for next year, it should protect the stability of the program and help seniors like Paula take control of their health and their lives.