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Medicare Advantage's role in transition to value, potential as MACRA APM will be themes at AHIP conference

Medicare discussions will also include need for collaboration between plans, providers and the government.

Susan Morse, Managing Editor

The emergence of Medicare Advantage as key to the movement towards value is one of the main themes of an upcoming America's Health Insurance Plans conference on Medicare, Medicaid and dual eligibles.

Approaches used in the value-based Medicare Advantage model have a spillover effect. In areas where providers are seeing a lot of MA enrollees, the same providers are using the same model of care to treat enrollees in fee-for-service plans, to good effect, according to David Merritt, executive vice president, Public Affairs & Strategic Initiatives for AHIP.

"They've seen some good positive results," he said.

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Moreover, AHIP and insurers would like to see the Centers for Medicare and Medicaid Services consider MA for qualification as an advanced alternative payment model under the payment reform implementation of the Medicare Access and CHIP Reauthorization Act, he said.

In a June letter to CMS Acting Administrator Andy Slavitt, AHIP urged CMS to reconsider its approach and allow MA plans to be designated as Advanced APMs.    

[Also: AHIP to address Medicaid final rule, launch Modern Medicaid Alliance at conference]

"In addition, we have significant concerns with CMS' proposal that does not recognize Medicare Advantage plans as Advanced APMs in the initial years of the program," the letter states. "MA plans have already incorporated APM concepts that promote better health outcomes for beneficiaries by rewarding high-performing providers who provide clinically appropriate, cost-effective care."

Another theme during the Medicare portion of the AHIP conference is the collaboration needed between plans, providers and the government.

"That's been a very big priority for plans," Merritt said. "No one is going to solve improving quality and reducing costs by themselves."

Before insurers can talk about the future of Medicare and Medicare Advantage plans, they need to understand the next wave of enrollees.

[Also: Out-of-network providers charge on average 300 percent more than Medicare rate, AHIP says]

This is the younger boomer generation, ages 55 to 64, who are more tech savvy and less likely to leave their homes as they age, said Claire Boozer Cruse, Health Policy manager for the Deloitte Center for Health Solutions.

Cruse and Leslie Read, principal U.S. Health Plans Consumer & Digital Transformation Leader for Deloitte Consulting, will talk about the future of Medicare at a briefing Monday, Oct. 24, at the start of AHIP's conference on Medicare, Medicaid and dual eligibles in Washington, D.C.

Baby boomers are Americans born between 1946 and 1964. With almost 20 years between the oldest and youngest boomers, Deloitte has found from its annual consumer survey that the younger end of the generation is very different from the boomers who are already being served by Medicare and Medicare Advantage plans.

Deloitte looked at satisfaction, as baby boomers with employer-based insurance plans are less satisfied than those on Medicare and Medicare Advantage, as well as differences in personality factors.

More than half, 52 percent, of younger boomers say having access to online services is important to them, compared to 42 percent of older boomers, Cruse said.

While Medicare already has a lot of online processes, this generation is more likely to use them, she said.

Also, only 68 percent of the younger boomers made use of preventative services in the past year, compared to 76 percent of those already on Medicare.

"To me one of the interesting things around that, one of the more interesting theories I have, is that the younger baby boomer generation is a sandwiched generation," said Cruse, who has a degree in gerontology and who formerly worked in the aging services community.

What this means for insurers is paying more attention to self-service technology, to allow the upcoming generation of senior citizens to  make decisions online.

"They've shopped on Amazon and expect the same thing in enrolling," Cruse said.

[Also: AHIP urges more flexibility in new value-based Medicare Advantage model]

Also, this population is much more concerned about privacy protection because they may have already been impacted by cyber attacks.

One difference that is perhaps surprising is that younger boomers, when they retire, plan to age in their homes.

"They're not going to be moving into retirement homes as the previous generation," she said. "There's a large, changing force around aging."

During the conference on Medicare, Sean Cavanaugh, Patrick Conway and Andy Slavitt of the Centers for Medicare and Medicaid Services will also speak.

Cavanaugh, deputy administrator and director for CMS will address the future direction of Medicare Advantage and Part D plans; Conway, CMS acting principal deputy administrator will talk about delivery system reform; and Slavitt, acting administrator, will give the view of the Medicare program in 2017 and beyond.

Twitter: @SusanJMorse