AHIP president and CEO calls for strengthening Medicare Advantage, Medicaid managed care

Photo: Cecilie Arcurs/Getty Images

Delivering opening remarks during the AHIP 2021 National Conference this week, AHIP President and CEO Matt Eyles called for strengthening and protecting Medicare Advantage as well as Medicaid Managed Care, calling the programs "efficient, effective and popular."

Eyles touted the benefits of protecting such programs, particularly in the midst of the COVID-19 pandemic.

Speaking specifically about Medicare Advantage – which offers Medicare beneficiaries access to private healthcare plans with their own programs and benefits – Eyles said MA was a "prime example" of the public and private sectors working together to provide coverage for beneficiaries.

Eyles said insurance providers have continuously worked to improve their MA benefits and have innovated new ways to deliver care.

"They have used data and analytics to more deeply understand the health and well-being of Medicare enrollees, going beyond illnesses and chronic conditions to examine the importance of safe housing, food security and strong communities," he said, adding that insurers have also adopted care models that focus on whole-person health.

Those are among the reasons, said Eyles, that 27 million Americans have chosen Medicare Advantage over original Medicare for their coverage, adding that most of them are highly satisfied with their coverage and benefits, including coverage for preventive care.

WHY THIS MATTERS

Eyles' comments come as Congress is mulling a reconciliation package that could affect the landscape of American healthcare. The package proposes expanding Medicare to cover vision, hearing and dental, which some believe would cause the program to run dry by 2024 – and cost $358 billion over a decade, creating undue burden on taxpayers, according to Forbes.

In a letter to Congress earlier this month from Better Medicare Alliance and cosigned by 46 other organizations, the groups said additional benefits should be structured in a way that reflects the costs of adding dental, vision and hearing to Medicare in the benchmark calculation. If the cost of providing these benefits is not reflected in the benchmark, Medicare Advantage beneficiaries may see a loss of supplemental benefits, they said.

MANAGED MEDICAID

MA wasn't the only program praised by Eyles. He also placed focus on Medicaid managed care, which he said has been just as essential. 

As Medicaid and CHIP programs provide coverage and a pathway to care for one out of every five Americans, Medicaid managed care plans serve two-thirds of them, according to Eyles – low-income families, women and children, older adults, people with disabilities and military veterans.

Such plans, he said, deliver savings through patient-centered care coordination programs, increased use of generic drugs, accessible provider networks and programs focused on routine and preventive care. Managed care plans also encourage vaccinations, help those with substance use disorders overcome their addiction and help with challenges in care access, such as housing, transportation and healthy food.

"States have selected Medicaid managed care plans as a strategic partner because managed care works," said Eyles. "With more than 77 million Americans – nearly half of which are children – states and plans work together to ensure that they meet very high metrics for quality, value and satisfaction. And as a result, 84% of enrollees say they have regular access to the care they need.

"Adults and children alike are many times more likely to have a doctor they see regularly, and to get preventive services to stay healthy. And Medicaid managed care offers Americans access to home and community-based services, giving them the freedom to receive care in their home."

THE LARGER TREND

AHIP sees the COVID-19 crisis as highlighting the importance of health insurance provider partnerships through Medicare and Medicaid, with Eyles putting specific focus on the Vaccine Community Connectors program, spearheaded by AHIP, ACAP and the Blue Cross Blue Shield Association. The program, which launched earlier this year, helped vaccinate more than two million seniors in underrepresented communities in fewer than 100 days, said Eyles.

A January Morning Consult poll of more than 1,200 seniors on Medicare commissioned by Better Medicare Alliance showed near-universal satisfaction with Medicare Advantage's coverage (98%), provider networks (97%) and handling of the current health crisis (98%).

Ninety-five percent of respondents agreed it is important for seniors to have coverage options aside from traditional Medicare, and 93% reported that a candidate's support for Medicare Advantage is important to their vote. Three quarters (77%) of seniors on Medicare Advantage strongly oppose the federal government reducing the amount of money paid to Medicare Advantage, even if such cuts are billed as necessary to lower costs to taxpayers or reduce the national debt.

That's not to say there aren't problems with Medicare Advantage. Also in January, North Shore Insurance Brokers managing partner Ina Goldberg said that while premiums in MA plans are lower, and sometimes free, people pay more as they age and become sicker.

Yet Eyles pointed to data showing that premiums have decreased 34% from 2017 to 2021 due to MA, and the program outperforms original Medicare on a number of clinical quality measures.

A December 2020 Medicare Advantage study found that for 2021, consumers chose MA for the telehealth benefits as well as COVID-19 supplemental benefits offered by the private plans.

Of those who decided on an MA plan because of supplemental benefits, 35% cited COVID-19 supplemental benefits specifically, while 27% cited telehealth benefits, the report said. Thirty-five percent are enrolled in an MA plan for 2021 because they've had it before and prefer it; 29% like the prescription drug coverage; 16% like the affordability; and 9% like the supplemental benefits.

In addition, 45% are switching from an original Medicare plan in 2020 to a Medicare Advantage plan in 2021. Of those enrolled in a MA plan for 2021, 65% compared all of their Medicare options before enrolling, while 26% did a "brief amount of research."

ON THE RECORD

"MA has also been a tremendous benefit for dual-eligible Americans, who are often the most vulnerable seniors," Eyles said. "Dual eligibles enrolled in Medicare Advantage were less likely to experience any COVID-19-related disruptions to their healthcare compared to duals enrolled in original Medicare. They were also less likely to report that they were unable to get diagnostic or medical screening tests, treatment for ongoing conditions, and urgent care for accidents or illnesses during the pandemic."
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com