Strengthen Value-Based Payment Arrangements in Medicare Advantage

With the growth of Medicare Advantage, Congress should seek greater alignment between alternative payment models (APMs) and Medicare Advantage to ensure that both models provide attractive, sustainable options for innovative care delivery.

MULTI-PAYER CONTRACTING GROWTH CONTINUES

  • 34 million Medicare beneficiaries (55 percent) are enrolled in a MA plan
  • A majority of ACOs today (roughly 75 percent) —hold contracts with more than one type of payer.
  • Engagement with MA plans in value-based and risk-sharing arrangements has surged, with a growing share of lives under such models.
  • Patients in VBC arrangements are less likely to be admitted to the hospital for chronic conditions and less likely to go to the emergency room or be readmitted to the hospital.
  • VBC arrangements are shown to have a significant spillover effect on patients in traditional Medicare.

Reduce Burden and Maintain Access

  • Improve and streamline burdensome prior authorization process by supporting the Improving Seniors’ Timely Access to Care Act (S. 1816/ H.R. 3514).
  • Improve risk-adjustment approaches in MA and align approaches between APMs and MA.
  • Risk adjustment should not introduce burden for clinicians and should be derived from clinical data.
  • Efforts to improve risk adjustment should not introduce unintended consequences that would limit or disrupt home health providers’ ability to provide appropriate care in the home by excluding in-home primary care services from the statutory definition of health risk assessments in the No UPCODE Act.

Increase Parity Between MA and APMs

  • Congress and CMS should ensure comparable benchmarks and flexibilities across programs—where appropriate— to create a level playing field and support provider participation in value-based care, regardless of the model or population served.
  • Congress should direct CMS to ensure that shared savings or incentive payments that are included in MA benchmarks promote the adoption of value-based payment arrangements.