Better Medicare Alliance Shares Policy Solutions to Strengthen Medicare Advantage for More than 31 Million Beneficiaries
With Medicare Advantage now serving more than half of the total Medicare population, BMA’s policy solutions offer program improvements to build on recent changes, stabilize the program and further empower beneficiaries in choosing high-quality health care
WASHINGTON — Better Medicare Alliance (BMA), the nation’s leading research and advocacy organization supporting Medicare Advantage, today released detailed policy recommendations for the Centers for Medicare & Medicaid Services (CMS), Congress, health plans, and other stakeholders, to strengthen and improve Medicare Advantage as a reliable, equitable, and high-quality health care coverage option for millions of seniors and people living with disabilities.
These policy recommendations come as seniors evaluate their health care coverage choices during the annual enrollment period and as Medicare Advantage is projected to grow to 33.8 million beneficiaries next year, according to recent CMS projections.
“Millions of American seniors and people with disabilities rely on Medicare Advantage for quality, affordable health care, and we are committed to keeping the program strong for present and future beneficiaries,” said Mary Beth Donahue, President and CEO of the Better Medicare Alliance. “As Medicare Advantage continues to grow, these proactive policy recommendations provide a road map for maintaining and modernizing the program for seniors. We value our partnership with CMS and applaud their recent progress in many of these areas. With sensible next steps, we can further strengthen Medicare Advantage for the future.”
These policy recommendations will strengthen Medicare Advantage, and:
- Advance health equity through better data collection and a diverse and culturally-competent workforce: The recent CMS changes aimed at reducing health disparities among MA beneficiaries are a strong start. Policymakers and stakeholders can help build on this foundation by advancing more complete data collection for evaluation, care delivery, and benefit design; aligning government programs to reduce gaps in care; and expanding retention efforts that support a diverse and culturally-competent health care workforce.
- Enhance supplemental benefit data collection and evaluation: More publicly available information on access and utilization of supplemental benefits is needed to help inform future policymaking and maintain the goal of transparency. Enhancing how CMS collects data from health plans and evaluates supplemental benefits in Medicare Advantage will help strengthen supplemental benefits for beneficiaries and guide future innovation.
- Strengthen the value of in-home health risk assessments: As health care delivery increasingly shifts into the home, models of care must adapt while maintaining the high-quality care Medicare Advantage beneficiaries receive in a provider’s office. In-home HRAs are used for preventative care and to assess the overall health of beneficiaries, document diagnoses, and identify gaps in care and unmet needs based on the information collected. BMA is committed to establishing robust, comprehensive best practices that will enable accountability, identify care gaps, and improve care coordination, particularly for those with complex health and social needs.
- Increase access to mental and behavioral health care: Ongoing challenges around the inadequate supply of mental and behavioral health providers remain a major hurdle to improving access to behavioral care. As policymakers and stakeholders work to ensure access to reliable, high-quality, and comprehensive behavioral health care, they must first take steps to help build and support a diverse workforce to meet the growing demand of patients.
- Improve provider directory accuracy: Creating accurate and beneficiary-focused provider directories is essential to supporting access to care, assisting beneficiary decision-making, and further coordinating and managing care. BMA is committed to working with policymakers and convening stakeholders to align on data elements and processes for a comprehensive and inclusive provider directory to enable accurate and actionable information to support beneficiary decision-making.
- Modernize and streamline utilization management and prior authorization: The passage of the Improving Seniors’ Timely Access to Care Act, supported by BMA, would modernize prior authorization as a clinical tool to coordinate beneficiaries’ care. To further support beneficiaries in receiving high-quality and timely care, policymakers and stakeholders should continue to modernize and align utilization management and prior authorization requirements by establishing more efficient processes, electronic standards, and expedited decisions for requests.
- Establish marketing guidance that supports beneficiaries in making informed choices: Accurate health plan information empowers beneficiaries to make informed decisions about their coverage options. Establishing clear marketing guidance and best practices for stakeholders, including health plans, brokers and agents, and third-party marketing organizations, will support oversight and ensure beneficiaries receive complete and accurate information.
“Hispanic enrollment in Medicare Advantage continues to grow each year, and the program plays an integral role in providing access to quality care for Hispanic seniors across the country,” said Dr. Elena Rios, President and CEO of the National Hispanic Medical Association. “As an organization that represents more than 50,000 licensed Hispanic physicians, we deeply appreciate BMA’s efforts to improve health equity by building a more diverse and culturally-competent workforce. BMA’s policy solutions represent clear and achievable steps forward that will strengthen Medicare Advantage to deliver for all of its beneficiaries.”
“The approximately 170,000 physicians affiliated with America’s Physician Groups (APG) serve nearly one-third of all Medicare Advantage (MA) beneficiaries,” said Susan Dentzer, President and Chief Executive Officer of APG. “The solutions advanced by the Better Medicare Alliance would result in further improvements to the increasingly popular MA program. All stakeholders have a role in making these improvements, from CMS to the clinicians who partner with MA plans to provide care. APG is especially grateful to BMA for identifying imperatives for improving not just MA, but all of U.S. health care – most notably the need to build a more diverse and culturally competent health care workforce; address a paucity of behavioral health providers; and create a centralized national provider directory as a vital resource for all providers, payers, and patients seeking care.”
“As a leading provider of affordable, value-based primary care for millions of patients, many of whom rely on Medicare Advantage, VillageMD supports plans to improve the program’s ability to deliver the high-quality care its beneficiaries deserve,” said Stuart Levine, MD, Chief Medical Officer of VillageMD. “Increasing access to the care patients need where they need it, modernizing the processes for evaluating supplemental benefits that address social determinants of health, and arming beneficiaries with accurate information that empowers them to make the best decisions for their care will lead to improved health outcomes for millions of Americans.”
“Behavioral health care services continue to be an essential component of whole-person health, but the current shortage of behavioral health providers remains a major hurdle that must be addressed. The development of a diverse workforce capable of closing the gap in access for patients requiring specialized care is critical, and we stand with BMA’s commitment to strengthening Medicare Advantage’s ability to meet the behavioral health needs of its beneficiaries.” said Pamela Greenberg, President and CEO of the Association for Behavioral Health and Wellness.
“On behalf of the thousands of senior nutrition programs that we are privileged to serve, Meals on Wheels America supports BMA’s policy efforts aimed at promoting and shaping a robust Medicare Advantage program for our nation’s seniors. Meals on Wheels programs ensure that seniors receive the tailored nutrition, social connection, and other services, e.g. safety checks and more that they need to remain healthy and independent in their homes. And to that end, supplemental benefit partnerships with Medicare Advantage plans allow more seniors to receive these vital services,” said Ellie Hollander, CEO of Meals on Wheels America.
“As a nonprofit community organization working with and advocating for Nevada seniors who choose Medicare Advantage for the high-quality, affordable healthcare it provides, we recognize that there are opportunities to continuously strengthen the program to best serve its beneficiaries,” said Diego Trujillo, CEO of Las Vegas HEALS. “The policy recommendations put forth by BMA identify many of those opportunities and offer direct, informed solutions that will enhance Medicare Advantage’s ability to deliver for Nevadans.”
More than 31 million Americans choose Medicare Advantage plans for innovative value-based care, with beneficiaries overwhelmingly reporting that they are satisfied with their health coverage. BMA is committed to working alongside community-based organizations, providers, health plans, minority health groups, patient advocates, beneficiaries, and policymakers to advance solutions that will promote coordinated and affordable care for all beneficiaries.
Read the full proposal HERE and see an overview of the solutions on our website HERE.
Better Medicare Alliance is a community of more than one million grassroots beneficiaries and 200+ Ally organizations working to improve health care through a strong Medicare Advantage. Learn more at www.bettermedicarealliance.org.
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