Medicare Advantage (MA) now serves more than half of all Medicare beneficiaries. But as the program has grown, so have the questions surrounding it.
What is MA designed to do within the broader Medicare program? How should it be compared with traditional Medicare? What does value look like for beneficiaries? And as policymakers consider changes to the program, how can they strengthen and modernize it for the future?
These inquiries were at the center of a recent congressional briefing hosted by HLC. The discussion featured John Brooks, Director of the Center for Medicare, Deputy Administrator for the Centers for Medicare & Medicaid Services (CMS), and Senior Counselor to the HHS Secretary; Michael Chernew, PhD, former Chair of the Medicare Payment Advisory Commission (MedPAC); and Barry Arbuckle, PhD, Executive Chairman of MemorialCare. Robert King, CMS reporter for POLITICO, moderated the conversation.
What is Medicare Advantage designed to do?
Before getting into costs, the panel started with the role MA plays within the broader Medicare program.
A major theme was how MA supports coordinated, value-based care. Arbuckle spoke from the provider perspective about the importance of integrated care, prevention, patient education, and chronic disease management, particularly for seniors with complex healthcare needs.
Brooks discussed how MA is intended to give plans incentives to manage care more efficiently and compete for beneficiaries through lower costs and additional benefits. His comments also raised a question that would carry through the rest of the conversation: how should the value generated by the program ultimately benefit patients, providers, taxpayers, and the Medicare program?
How should Medicare Advantage be evaluated?
This question drove some of the liveliest discourse of the briefing.
Chernew and Brooks walked through the different approaches MedPAC and CMS have taken to assess MA spending. Brooks discussed how CMS reached a estimate for the impact of coding intensity, noting that CMS focused its analysis on coding because the agency is required to make a coding intensity adjustment. He also flagged that CMS has not assessed MedPAC’s estimate of favorable selection but expressed openness to studying it in the future.
The exchange highlighted some of the challenges involved in estimating what Medicare would have spent if MA beneficiaries were instead enrolled in traditional Medicare. But the conversation quickly moved beyond methodology to MA’s value proposition. If the program provides coordinated care, a prescription drug benefit, and supplemental benefits, all at a lower beneficiary cost compared to traditional Medicare, how should those differences factor into the way policymakers assess its value?
There were different perspectives across the panel, but the exchange illustrated why seemingly technical questions about methodology can have significant implications. How the value of MA is measured can shape how the program is understood and, ultimately, the policies that follow.
What does value look like for beneficiaries?
The conversation then turned to the people who rely on the program for care.
Panelists discussed affordability, particularly for seniors living on fixed incomes and those managing chronic conditions. They also examined supplemental benefits and the role services such as dental and behavioral healthcare can play in a beneficiary’s overall health.
Chernew discussed the tradeoffs policymakers face in determining how much Medicare should spend to support additional benefits and how to assess whether those benefits are delivering enough value. Arbuckle brought the conversation back to the experience of patients and providers, emphasizing the real-world effects that changes to MA can have on access to care.
Quality also factored into the discussion. Brooks highlighted CMS’ efforts to focus on measures that matter, put greater emphasis on outcomes, and reduce the reporting burden on providers.
Taken together, the discussion underscored why beneficiary value can be difficult to capture through a single spending comparison. Government spending matters, but so does beneficiary affordability, access, quality, coordinated care, and the services seniors and those with disabilities receive.
How should Medicare Advantage be modernized?
Looking ahead, the panel identified several areas where MA can continue to improve.
Better data was one. Chernew discussed progress in MA encounter data while pointing to remaining gaps, particularly around supplemental benefits. He also cautioned against adding reporting requirements without a clear purpose, recognizing the administrative burden that additional data collection can create.
Prior authorization was another focus. Brooks discussed efforts to move toward electronic prior authorization and reduce variation in the information providers must submit across plans. The panel also touched on quality measurement, beneficiary choice, and telehealth, with Arbuckle calling for permanent telehealth flexibilities, particularly for seniors.
Running through these issues was another priority: stability. With tens of millions of Americans relying on MA, Brooks emphasized the importance of pursuing reform while maintaining stability, as changes to the program can have consequences for beneficiaries and the providers who care for them.
The conversation continues
The panel did not agree on every point, and that was part of what made the discussion valuable.
MA has become a central part of Medicare, but its growth brings difficult questions about cost, quality, measurement, and how the program should evolve. Answering those questions will require looking closely at the numbers while also understanding what policy changes mean for seniors and the healthcare providers who serve them.
As Congress and CMS consider MA’s future, HLC will continue to convene healthcare leaders to share insights, develop solutions, and advance policies that improve care and affordability for beneficiaries.
